Linden Gabriel S, Hresko Michael T, Cook Danielle, Birch Craig M, Hedequist Daniel J, Hogue Grant D
Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA.
Harvard Medical School, Boston, MA.
Spine (Phila Pa 1976). 2022 Nov 1;47(21):1483-1488. doi: 10.1097/BRS.0000000000004443. Epub 2022 Jul 28.
Retrospective cohort study.
To investigate the relationship between body mass index (BMI), spine flexibility index (FI), and their combined effects on adolescent idiopathic scoliosis (AIS) surgical outcomes.
BMI and FI are two factors considered during presurgical planning for AIS correction, but there is sparse research about their relationship. We hypothesize that AIS patients with increased BMI may be associated with decreased FI-a combination which could lead to worsened surgical outcomes.
AIS patients ages 11 to 19 at surgery, who underwent posterior fusion at a single center from 2011 to 2017, were reviewed. Patients without proper radiographs to assess FI, or a previous spine surgical history, were excluded. FI was categorized as stiff (FI<50) or flexible (FI≥50), and patients were separated by major curve region. BMI was categorized as underweight (less than fifth percentile), healthy weight (fifth-85th percentile), overweight (85th-95th percentile), or obese (>95th percentile). Regression analysis was conducted to test BMI and FI's effects on intraoperative, immediate postoperative, and two-year postoperative outcomes.
A total of 543 patients (82% female), with an average age of 14.9 years, were included. In all, 346 patients had available two-year data. A 10% increase in BMI was associated with a 1.3% decrease in FI for patients with major thoracolumbar/lumbar curves ( P =0.01). Obese patients were most likely to have a postoperative complication ( P =0.003) or a two-year complication ( P =0.04). Revision surgery occurred after 58% of postoperative complications (15/26) and 80% of two-year complications (4/5). FI was negatively associated with initial curve magnitude ( P <0.001), operative time ( P =0.02), and blood loss ( P =0.02). Overweight patients with flexible curves were 10.0 times more likely to sustain a postoperative complication than healthy weight patients with stiff curves ( P =0.001).
Elevated BMI was associated with decreased FI in patients with major thoracolumbar/lumbar curves. Patients with a high BMI and high FI were associated with the greatest risk of postoperative complication.
回顾性队列研究。
探讨体重指数（BMI）、脊柱柔韧性指数（FI）及其联合作用对青少年特发性脊柱侧凸（AIS）手术疗效的影响。
BMI和FI是AIS矫正术前规划时考虑的两个因素，但关于它们之间关系的研究较少。我们假设BMI升高的AIS患者可能与FI降低有关——这种组合可能导致手术疗效变差。
回顾了2011年至2017年在单一中心接受后路融合手术的11至19岁AIS手术患者。排除没有合适的X线片来评估FI或有脊柱手术史的患者。FI分为僵硬型（FI<50）或柔韧型（FI≥50），患者按主要弯曲部位分组。BMI分为体重过轻（低于第五百分位数）、健康体重（第五至第85百分位数）、超重（第85至第95百分位数）或肥胖（>第95百分位数）。进行回归分析以检验BMI和FI对术中、术后即刻及术后两年疗效的影响。
共纳入543例患者（82%为女性），平均年龄14.9岁。共有346例患者有两年的数据。对于主要胸腰段/腰段弯曲的患者，BMI每增加10%与FI降低1.3%相关（P =0.01）。肥胖患者术后并发症（P =0.003）或两年后并发症（P =0.04）的发生率最高！58%的术后并发症（15/26）和80%的两年后并发症（4/5）后进行了翻修手术。FI与初始弯曲度数（P <0.001）、手术时间（P =0.02）和失血量（P =0.02）呈负相关。柔韧性弯曲的超重患者术后并发症的发生率比僵硬型弯曲的健康体重患者高10.0倍（P =0.001）。
主要胸腰段/腰段弯曲的患者中，BMI升高与FI降低有关。BMI高且FI高的患者术后并发症风险最高。
