Department of Orthopaedic Surgery, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Orthop Surg. 2023 Mar;15(3):704-712. doi: 10.1111/os.13644. Epub 2023 Jan 4.
Postoperative ileus (POI) is a relatively common complication after spinal fusion surgery, which can lead to delayed recovery, prolonged length of stay and increased medical costs. However, little is known about the incidence and risk factors of POI after corrective surgery for patients with adolescent idiopathic scoliosis (AIS). This study was performed to report the incidence of POI and identify the independent risk factors for POI after postoperative corrective surgery.
In this retrospective cohort study, A total of 318 patients with AIS who underwent corrective surgery from April 2015 to February 2021 were enrolled and divided into two groups: those with POI and those without POI. The Student's t test, Mann-Whitney U test, and Pearson's chi-square test were used to compare the two groups regarding patient demographics and preoperative characteristics (age, sex and the major curve type), intraoperative and postoperative parameters (lowest instrumented vertebra [LIV], number of screws, and length of stay), radiographic parameters (T5-12 thoracic kyphosis [TK], T10-L2 thoracolumbar kyphosis and height [TLK and T10-L2 height], L1-S1 lumbar lordosis [LL], and L1-5 height). Then, a multivariate logistic regression analysis was used to identify independent risk factors for POI, and a receiver operating characteristic (ROC) curve was performed to assess the predictive values of these risk factors.
Forty-two (13.2%) of 318 patients who developed POI following corrective surgery were identified. The group with POI had a significantly longer length of stay, more lumbar screws, higher proportions of a major lumbar curve and lumbar anterior screw breech, and a lower LIV. Among radiographic parameters, the mean lumbar Cobb angle at baseline, the changes in the lumbar Cobb angle, and T10-L2 and L1-5 height from before to after surgery were significantly larger in the group with POI than in the group without POI. Multivariate logistic regression analysis showed that large changes in T10-L2 (odds ratio [OR] =2.846, P = 0.007) and L1-5 height (OR = 31.294, p = 0.000) and lumbar anterior screw breech (OR = 5.561, P = 0.006) were independent risk factors for POI. The cutoff values for the changes in T10-L2 and L1-5 height were 1.885 cm and 1.195 cm, respectively.
In this study, we identified that large changes in T10-L2 and L1-5 height and lumbar anterior screw breech were independent risk factors for POI after corrective surgery. Improving the accuracy of pedicle screw placement might reduce the incidence of POI, and greater attention should be given to patients who are likely to have large changes in T10-L2 and L1-5 height after corrective surgery.
术后肠梗阻（POI）是脊柱融合术后较为常见的并发症，可导致恢复延迟、住院时间延长和医疗费用增加。然而，对于青少年特发性脊柱侧凸（AIS）患者矫正手术后 POI 的发生率和危险因素知之甚少。本研究旨在报告 POI 的发生率，并确定矫正手术后 POI 的独立危险因素。
在这项回顾性队列研究中，共纳入 2015 年 4 月至 2021 年 2 月期间接受矫正手术的 318 例 AIS 患者，并将其分为两组：POI 组和非 POI 组。使用学生 t 检验、Mann-Whitney U 检验和 Pearson 卡方检验比较两组患者的人口统计学和术前特征（年龄、性别和主要曲线类型）、术中及术后参数（最低置钉节段[LIV]、螺钉数量和住院时间）、影像学参数（T5-12 胸椎后凸角[TK]、T10-L2 胸腰椎后凸角和高度[TLK 和 T10-L2 高度]、L1-S1 腰椎前凸角[LL]和 L1-5 高度）。然后，采用多变量逻辑回归分析确定 POI 的独立危险因素，并绘制受试者工作特征（ROC）曲线评估这些危险因素的预测价值。
在接受矫正手术后，42 例（13.2%）患者出现 POI。POI 组的住院时间明显延长，腰椎螺钉数量较多，主要腰椎曲线和腰椎前螺钉突破的比例较高，LIV 较低。在影像学参数方面，POI 组的基线腰椎 Cobb 角平均值、腰椎 Cobb 角变化值以及 T10-L2 和 L1-5 高度从术前到术后的变化值均明显大于非 POI 组。多变量逻辑回归分析显示，T10-L2 变化值较大（比值比[OR] =2.846，P =0.007）和 L1-5 高度变化值（OR =31.294，p =0.000）以及腰椎前螺钉突破（OR =5.561，P =0.006）是 POI 的独立危险因素。T10-L2 和 L1-5 高度变化值的截断值分别为 1.885 cm 和 1.195 cm。
在本研究中，我们发现 T10-L2 和 L1-5 高度的较大变化以及腰椎前螺钉突破是矫正手术后 POI 的独立危险因素。提高椎弓根螺钉放置的准确性可能会降低 POI 的发生率，对于矫正手术后 T10-L2 和 L1-5 高度变化值较大的患者应给予更多关注。
