NYU Langone Health Department of Orthopaedics Division of Spine-New York, NY.
Melbourne Orthopaedic Group, Melbourne, Australia.
Spine (Phila Pa 1976). 2021 Sep 15;46(18):1279-1286. doi: 10.1097/BRS.0000000000003984.
Retrospective cohort analysis.
To compare outcomes of plastic versus spine surgeon wound closure in revision 1 to 4 level thoracolumbar fusions.
Plastic surgeons perform layered musculocutaneous flap closures in high-risk spine patients such as revision posterior spinal fusion and complex deformity correction surgeries. Few studies have assessed outcomes of revision fusion performed with plastic surgical closures, particularly in nondeformity thoracolumbar spinal surgery.
A retrospective review of 1 to 4 level revision thoracolumbar fusion performed by Orthopedic or Neurosurgical spine surgeons. Patient charts were reviewed for demographics and perioperative outcomes. Patients were divided into two cohorts: wound closures performed by spine surgeons and those closed by plastic surgeons. Outcomes were analyzed before and after propensity score match for prior levels fused, iliac fixation, and levels fused at index surgery. Significance was set at P < 0.05.
Three hundred fifty-seven (87.3%) spine surgeon (SS) and 52 (12.7%) plastic surgeon (PS) closures were identified. PS group had significantly higher number of levels fused at index (PS 2.7 ± 1.0 vs. SS 1.8 ± 0.9, P < 0.001) and at prior surgeries (PS 1.8 ± 1.2 vs. SS 1.0 ± 0.9, P < 0.001), and rate of iliac instrumentation (PS 17.3% vs. SS 2.8%, P < 0.001). Plastics closure was an independent risk factor for length of stay > 5 days (odds ratio 2.3) and postoperative seroma formation (odds ratio 7.8). After propensity score match, PS had higher rates of seromas (PS 36.5% vs. SS 3.8%, P < 0.001). There were no differences between PS and SS groups in surgical outcomes, perioperative complication, surgical site infection, seroma requiring aspiration, or return to operating room at all time points until follow-up (P > 0.05 for all).
Plastic spinal closure for 1 to 4 level revision posterior thoracolumbar fusions had no advantage in reducing wound complications over spine surgeon closure but increased postoperative seroma formation.Level of Evidence: 4.
回顾性队列分析。
比较在 1 至 4 级胸腰椎融合翻修手术中，整形外科医生和脊柱外科医生的伤口缝合效果。
在高风险的脊柱患者（如翻修后路脊柱融合术和复杂畸形矫正手术）中，整形外科医生会进行分层肌皮瓣闭合。很少有研究评估使用整形外科闭合进行翻修融合的结果，尤其是在非畸形胸腰椎脊柱手术中。
对接受骨科或神经外科脊柱外科医生进行的 1 至 4 级胸腰椎翻修融合的患者进行回顾性分析。对患者的病历进行了人口统计学和围手术期结果的回顾。患者分为两组：由脊柱外科医生进行的伤口闭合和由整形外科医生进行的伤口闭合。在进行倾向性评分匹配之前和之后，对既往融合的节段数、髂骨固定和索引手术融合的节段数进行了分析。设 P 值小于 0.05 为差异有统计学意义。
共发现 357 例（87.3%）脊柱外科医生（SS）和 52 例（12.7%）整形外科医生（PS）闭合。PS 组在索引手术和既往手术中融合的节段数明显更多（PS 2.7 ± 1.0 与 SS 1.8 ± 0.9，P < 0.001），以及髂骨器械使用率（PS 17.3%与 SS 2.8%，P < 0.001）。整形外科闭合是住院时间 > 5 天（优势比 2.3）和术后血清肿形成（优势比 7.8）的独立危险因素。在进行倾向性评分匹配后，PS 组的血清肿发生率更高（PS 36.5%与 SS 3.8%，P < 0.001）。在所有时间点，直到随访结束，PS 和 SS 组在手术结果、围手术期并发症、手术部位感染、需要抽吸的血清肿或返回手术室方面均无差异（所有 P > 0.05）。
对于 1 至 4 级胸腰椎后路翻修融合，与脊柱外科医生的伤口闭合相比，使用整形外科脊柱闭合并没有降低伤口并发症的优势，但会增加术后血清肿的形成。
4 级。
