Hussein Kareem, Black Colin
Department of Anaesthesia, Children Health Ireland at Crumlin Hospital, Dublin, Ireland.
J Anaesthesiol Clin Pharmacol. 2023 Jan-Mar;39(1):56-60. doi: 10.4103/joacp.joacp_147_21. Epub 2022 Jan 6.
Pulmonary complications are the most common non-neurologic complications following surgical correction of scoliosis. These can affect postoperative recovery by increasing the length of stay and/or the need for ventilatory support. The aim of this retrospective study is to determine the incidence of radiographic abnormalities reported in chest radiography after posterior spinal fusion surgery for the treatment of scoliosis in children.
A retrospective chart review of all patients who underwent posterior spinal fusion surgery in our center between January 2016 and December 2019 was attempted. Radiographic data including chest and spine radiographs were reviewed on the national integrated medical imaging system using medical record numbers for all patients in the 7 postoperative days.
Seventy-six (45.5%) of the 167 patients developed radiographic abnormalities in the postoperative period. There was evidence of atelectasis in 50 (29.9%) patients, pleural effusion in 50 (29.9%) patients, pulmonary consolidation in 8 (4.8%) patients, pneumothorax in 6 (3.6%) patients, subcutaneous emphysema in 5 (3%) patients, and rib fracture in 1 (0.6%) patient. Four (2.4%) patients were noted to have an intercostal tube inserted postoperatively, three for treating pneumothorax, and one for pleural effusion.
A large number of radiographic pulmonary abnormalities were encountered in children following surgical treatment of pediatric scoliosis. Although not all radiographic findings may be clinically significant, early recognition may guide clinical management. The incidence of air leak (pneumothorax, subcutaneous emphysema) was significant and could influence local protocol formulation with regards to obtaining immediate postoperative chest radiograph and intervention if clinically necessary.
肺部并发症是脊柱侧弯手术矫正后最常见的非神经系统并发症。这些并发症可通过延长住院时间和/或增加通气支持需求来影响术后恢复。本回顾性研究的目的是确定儿童脊柱后路融合手术治疗脊柱侧弯后胸部X线检查报告的影像学异常发生率。
试图对2016年1月至2019年12月在本中心接受脊柱后路融合手术的所有患者进行回顾性病历审查。使用所有患者的病历号，在国家综合医学影像系统上审查术后7天内包括胸部和脊柱X线片在内的影像学数据。
167例患者中有76例（45.5%）在术后出现影像学异常。有证据显示50例（29.9%）患者发生肺不张，50例（29.9%）患者发生胸腔积液，8例（4.8%）患者发生肺部实变，6例（3.6%）患者发生气胸，5例（3%）患者发生皮下气肿，1例（0.6%）患者发生肋骨骨折。4例（2.4%）患者术后插了肋间引流管，3例用于治疗气胸，1例用于治疗胸腔积液。
小儿脊柱侧弯手术治疗后，儿童出现大量肺部影像学异常。虽然并非所有影像学发现都具有临床意义，但早期识别可能有助于临床管理。漏气（气胸、皮下气肿）的发生率较高，可能会影响术后立即进行胸部X线检查以及必要时进行干预的当地方案制定。
