FOCOS Orthopaedic Hospital, No 8 Teshie Street Pantang, Accra, Ghana.
New York Presbyterian, The Allen Hospital, New York, USA.
Spine Deform. 2023 Jul;11(4):833-840. doi: 10.1007/s43390-023-00660-7. Epub 2023 Feb 24.
Retrospective review of prospectively collected data.
To determine the incidence of medical complications in the pediatric population aged 10-20 years with baseline deformities exceeding 100 degrees or who had 3CO at surgery. Severe pediatric spine deformity poses a great challenge to the treating physician and carries a high complication rate. Pulmonary complications are among the most life threatening. The onus is on the treating surgeon to identify patients who are high risk and institute measures to mitigate the risk for successful outcomes.
Data of 251/311pts from FOX pediatric database from 17 international sites was queried for incidence of major medical complications. Comparative analysis was done to determine the impact of such complications on HRQoL using paired t-test. Risk factors associated with medical complications were assessed using Firth logistic regression.
251/311pts had min 2 year f/u. 142F/109 M, average age 14.61years (10-20). Etiologies included 96 Cong,94 Idiopathic, 14-Post TB, 12-NM,12-NF,10-syndromic,8 others. Curve types included Scoliosis-121, Kyphoscoliosis 72, Kyphosis 58. Coronal and sag cobb avg 88° ± 41.47 and 91.92° ± 39.17, respectively. Deformity apices were in the thoracic region in 88% of patients. Pre-op co-morbidities included 54 (21.5%) cardiopulmonary; 7(2.79%) Genitounrinary;13 (5.18%) GI;13 (5.18%) Anxiety/depression; neurological 24 (9.56%). HGT was utilized in 103pts (41%) at an average duration of 68 days. Mean OR time was 459 min, blood loss averaged 1465 ml. VCR was performed in 120(47.81%), PSO in 16 pts (6.37%), SPO in 145pts (57.77%), Thoracoplasty in 132 pts (52.8%). 96% had blood and other blood products transfusion (FFP and platelets). There were 35 post-op medical complications occurring in 29pts (11.6%). Event-specific cumulative incidence was 24 (9.6%) pulmonary, 5(2.0%) gastrointestinal, 3(1.2%) cardiovascular, 1(0.4%) genitourinary and 1(0.4%) other complication. There was no mortality. Osteotomy grade was found to be an independent predictor of pulmonary complication. Despite significant improvement in baseline SRS total and Domain scores at 2 year FU irrespective of medical complication, the improvement in SRS scores were blunted in the complication group.
Medical complications are common among pediatric patients undergoing complex spine surgery for severe deformity. However, medical complications can be managed successfully. Although baseline HRQoL improved irrespective of medical complication status, clinical differences in the magnitude of the changes in HRQoL were observed in some domains.
前瞻性收集数据的回顾性研究。
确定基线畸形超过 100 度或手术时存在 3CO 的 10-20 岁儿科患者中出现医疗并发症的发生率。严重的儿科脊柱畸形对治疗医生来说是一个巨大的挑战，并且并发症发生率很高。肺部并发症是最具威胁生命的并发症之一。治疗医生有责任识别出高风险患者，并采取措施降低风险，以获得成功的治疗结果。
从 17 个国际站点的 FOX 儿科数据库中查询了 251/311 例患者的数据，以确定主要医疗并发症的发生率。使用配对 t 检验比较分析这些并发症对 HRQoL 的影响。使用 Firth 逻辑回归评估与医疗并发症相关的风险因素。
251/311 例患者至少有 2 年的随访。142 例女性/109 例男性，平均年龄 14.61 岁（10-20 岁）。病因包括 96 例先天性脊柱侧凸、94 例特发性脊柱侧凸、14 例脊柱结核后、12 例神经纤维瘤病、12 例非综合征性脊柱侧凸、10 例综合征性脊柱侧凸、8 例其他。脊柱弯曲类型包括脊柱侧凸 121 例、脊柱后凸侧凸 72 例、后凸 58 例。冠状和矢状 Cobb 角平均分别为 88°±41.47 和 91.92°±39.17，畸形顶点位于 88%的患者的胸段。术前合并症包括心肺 54 例（21.5%）、泌尿生殖系统 7 例（2.79%）、胃肠道 13 例（5.18%）、焦虑/抑郁 13 例（5.18%）、神经系统 24 例（9.56%）。103 例患者（41%）接受了高位胸椎融合术，平均持续时间为 68 天。平均手术时间为 459 分钟，平均出血量为 1465 毫升。120 例患者（47.81%）行椎体切除术、16 例患者（6.37%）行后凸成形术、145 例患者（57.77%）行脊柱侧凸矫形术、132 例患者（52.8%）行胸廓成形术。96%的患者接受了输血（FFP 和血小板）。29 例患者（11.6%）出现 35 例术后医疗并发症。特定事件的累积发生率为 24 例（9.6%）肺部并发症、5 例（2.0%）胃肠道并发症、3 例（1.2%）心血管并发症、1 例（0.4%）泌尿生殖系统并发症和 1 例（0.4%）其他并发症。无死亡病例。截骨分级是肺部并发症的独立预测因素。尽管基线 SRS 总评分和各领域评分在 2 年随访时均显著改善，但并发症组的 SRS 评分改善幅度较低。
严重脊柱畸形的儿科患者行复杂脊柱手术后，医疗并发症较为常见。然而，这些并发症是可以得到成功管理的。尽管基线 HRQoL 不论医疗并发症状况如何都得到了改善，但在某些领域观察到 HRQoL 变化幅度的临床差异。
