青少年特发性脊柱侧弯后路脊柱融合术后的并发症：一项使用改良Clavien-Dindo-Sink系统的回顾性队列研究
Complications following posterior spinal fusion for adolescent idiopathic scoliosis: a retrospective cohort study using the modified Clavien-Dindo-Sink system.
作者信息
Keil Lukas G, Himmelberg Stephen M, Guissé Ndéye F, Nash Alysa B, Fletcher Nicholas D, Stone Joseph D
机构信息
Department of Orthopaedic Surgery, School of Medicine, University of North Carolina, 130 Mason Farm Road, CB# 7055, Chapel Hill, NC, 27599-7055, USA.
School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
出版信息
Spine Deform. 2022 May;10(3):607-614. doi: 10.1007/s43390-021-00468-3. Epub 2022 Feb 3.
PURPOSE
Published complication rates after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) range from 1 to 22%. Complications are often minor and may be underestimated in registries. This study describes complications of PSF for AIS, classifies them according to a Clavien-Dindo-Sink (CDS) system, and investigates risk factors for occurrence of a complication.
METHODS
This retrospective cohort study at two academic centers included all AIS patients aged 10-18 who underwent primary PSF 4/2014-12/2019. Data included demographics, comorbidities, curve magnitude, Lenke classification, levels osteotomized/fused, implant density, 90-day emergency department visits, readmissions, reoperations, and complications as defined by Harms Study Group.
RESULTS
Among 424 patients, mean age was 14.7, mean BMI 22, 77% were female, and 57% had no comorbidities. There were 270 complications (0.64 per patient); 198 patients (47%) had ≥ 1 complication; and 63 patients (15%) had CDS grade ≥ II complications (deviation from standard postoperative course). Complications not related to persistent pain occurred in 103 patients (24%). Ninety-three percent of complications did not require readmission or reoperation (CDS I-II). Within 90 days, 8% presented to an ED, 2% required readmission, and 2% required reoperation. Common complications were back pain > 6 weeks postoperatively (26%), surgical site complications (7%), and ileus/prolonged constipation (3%). Risk factors for experiencing any complication were BMI ≥ 34 (OR 3.44) and Lenke 6 curve (OR 1.95).
CONCLUSION
One in four AIS patients experiences a complication not related to persistent pain after primary PSF, higher than rates published from self-reported registries. Obesity and Lenke 6 curve may increase risk. While most do not require readmission or surgery, 15% of patients have their postoperative course altered by complications.
LEVEL OF EVIDENCE
III-retrospective cohort study.
目的
青少年特发性脊柱侧凸（AIS）后路脊柱融合术（PSF）后已公布的并发症发生率为1%至22%。并发症通常较轻，在登记处可能被低估。本研究描述了AIS患者PSF的并发症，根据Clavien-Dindo-Sink（CDS）系统对其进行分类，并调查并发症发生的危险因素。
方法
这项在两个学术中心进行的回顾性队列研究纳入了2014年4月至2019年12月期间接受初次PSF的所有10至18岁AIS患者。数据包括人口统计学、合并症、侧弯度数、Lenke分型、截骨/融合节段、植入物密度、90天内急诊就诊情况、再入院情况、再次手术情况以及由Harms研究组定义的并发症。
结果
424例患者中，平均年龄为14.7岁，平均体重指数为22，77%为女性，57%无合并症。共发生270例并发症（每位患者0.64例）；198例患者（47%）发生≥1例并发症；63例患者（15%）发生CDS分级≥II级并发症（偏离标准术后病程）。103例患者（24%）发生了与持续性疼痛无关的并发症。93%的并发症无需再次入院或再次手术（CDS I-II级）。90天内，8%的患者到急诊就诊，2%的患者需要再次入院，2%的患者需要再次手术。常见并发症为术后6周以上背痛（26%）、手术部位并发症（7%）和肠梗阻/长期便秘（3%）。发生任何并发症的危险因素为体重指数≥34（比值比3.44）和Lenke 6型侧弯（比值比1.95）。
结论
四分之一的AIS患者在初次PSF后发生与持续性疼痛无关的并发症，高于自我报告登记处公布的发生率。肥胖和Lenke 6型侧弯可能增加风险。虽然大多数患者无需再次入院或手术，但15%的患者术后病程因并发症而改变。
证据级别
III级——回顾性队列研究。
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