青少年特发性脊柱侧凸的手术治疗并发症：一项 10 年的前瞻性随访研究。
Complications following surgical treatment of adolescent idiopathic scoliosis: a 10-year prospective follow-up study.
机构信息
Pediatric Orthopedics of Southwest Florida, Fort Myers, FL, USA.
Department of Orthopaedics, Nemours Children's Hospital, Delaware, 1600 Rockland Road, Wilmington, DE, 19803, USA.
出版信息
Spine Deform. 2022 Sep;10(5):1097-1105. doi: 10.1007/s43390-022-00508-6. Epub 2022 Apr 30.
BACKGROUND
Accurate reporting of long-term complications of surgical treatment of adolescent idiopathic scoliosis (AIS) is critical, but incomplete. This study aimed to report on the rate of complications following surgical treatment of AIS among patients with at least 10 years of follow-up.
METHODS
This was a retrospective review of prospectively collected data from a multicenter registry of patients who underwent surgical treatment for AIS with minimum 10-year follow-up. Previously published complications were defined as major if they resulted in reoperation, prolonged hospital stay/readmission, neurological deficits, or were considered life-threatening. Rates and causes of reoperations were also reviewed.
RESULTS
Two hundred and eighty-two patients were identified with mean age at surgery of 14.6 ± 2.1 years. Mean follow-up was 10.6 (range 9.5-14) years. Eighty-seven patients had anterior spinal fusion (ASF); 195 had posterior spinal fusion (PSF). The overall major complication rate was 9.9% (n = 28) in 27 patients. Among PSF patients, the complication rate was 9.7% (n = 19) in 18 patients. The complications were surgical site infection (37%), adding-on (26%), pulmonary (16%), neurologic (11%), instrumentation (5%), and gastrointestinal (5%). In ASF patients, the complication rate was 10.3% (n = 9) among nine patients. The complications were pulmonary (44%), pseudoarthrosis (22%), neurologic (11%), adding-on (11%), and gastrointestinal (11%). The reoperation rate was 6.0% (n = 17) among 17 patients. Although most of the complications presented within the first 2 years (60.7%), surgical site infection and adding-on were also seen late into the 10-year period.
CONCLUSION
This is the largest prospective study with at least a 10-year follow-up of complications following spinal fusion for AIS, the overall major complication rate was 9.9% with a reoperation rate of 6.0%. Complications presented throughout the 10-year period, making long-term follow-up very important for surveillance.
LEVEL OF EVIDENCE
Therapeutic II.
背景
准确报告青少年特发性脊柱侧凸（AIS）手术治疗的长期并发症至关重要，但目前的报告并不完整。本研究旨在报告至少随访 10 年的 AIS 患者接受手术治疗后的并发症发生率。
方法
这是一项对多中心登记处前瞻性收集数据的回顾性研究，这些患者接受了 AIS 的手术治疗，随访时间至少为 10 年。先前报道的并发症如果导致再次手术、延长住院时间/再次入院、神经功能缺损或被认为有生命危险，则定义为主要并发症。还回顾了再次手术的原因和发生率。
结果
共确定了 282 名患者，手术时的平均年龄为 14.6±2.1 岁。平均随访时间为 10.6 年（范围为 9.5-14 年）。87 名患者接受了前路脊柱融合术（ASF）；195 名患者接受了后路脊柱融合术（PSF）。27 名患者中有 28 名（9.9%）出现了主要并发症。PSF 患者中，18 名患者中有 19 名（9.7%）出现并发症。并发症包括手术部位感染（37%）、附加（26%）、肺部（16%）、神经（11%）、器械相关（5%）和胃肠道（5%）。ASF 患者中，9 名患者中有 9 名（10.3%）出现并发症。并发症包括肺部（44%）、假关节（22%）、神经（11%）、附加（11%）和胃肠道（11%）。17 名患者中有 17 名（6.0%）需要再次手术。尽管大多数并发症在最初 2 年内出现（60.7%），但手术部位感染和附加并发症也在 10 年期间后期出现。
结论
这是 AIS 脊柱融合术后至少 10 年随访并发症的最大前瞻性研究，总体主要并发症发生率为 9.9%，再次手术率为 6.0%。并发症在 10 年内持续出现，因此长期随访对于监测非常重要。
证据水平
治疗性 II 级。
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