Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
Department of Anesthesiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
Eur Spine J. 2024 Apr;33(4):1683-1690. doi: 10.1007/s00586-023-08124-2. Epub 2024 Jan 31.
Prolonged surgical duration in severe adolescent idiopathic scoliosis (AIS) patients is associated with increased blood loss and perioperative complications. The aim of this study was to compare the duration of each stage of posterior spinal fusion (PSF) in severe AIS (Cobb angle ≥ 90°) with non-severe AIS patients. This analysis will identify the most time-consuming stage of PSF and help surgeons formulate strategies to shorten operative time.
Retrospective study whereby 90 AIS patients (Lenke type 2, 3, 4, and 6) who underwent PSF from 2019 to 2023 were recruited. Twenty-five severe AIS patients were categorized in Gp1 and 65 non-severe AIS patients in Gp2. Propensity score matching (PSM) with one-to-one with nearest neighbor matching (match tolerance 0.05) was performed. Outcomes measured via operation duration of each stage of surgery, blood loss, number of screws, fusion levels and screw density.
Twenty-five patients from each group were matched. Total operative time was significantly higher in Gp1 (168.2 ± 30.8 vs. 133.3 ± 24.0 min, p < 0.001). The lengthiest stage was screw insertion which took 58.5 ± 13.4 min in Gp1 and 44.7 ± 13.7 min in Gp2 (p = 0.001). Screw insertion contributed 39.5% of the overall increased surgical duration in Gp1. Intraoperative blood loss (1022.2 ± 412.5 vs. 714.2 ± 206.7 mL, p = 0.002), number of screws (17.1 ± 1.5 vs. 15.5 ± 1.1, p < 0.001) and fusion level (13.1 ± 0.9 vs. 12.5 ± 1.0, p = 0.026) were significantly higher in Gp1.
Screw insertion was the most time-consuming stage of PSF and was significantly longer in severe AIS. Adjunct technologies such as CT-guided navigation and robotic-assisted navigation should be considered to reduce screw insertion time in severe AIS.
在重度青少年特发性脊柱侧凸（AIS）患者中，手术时间延长与出血量增加和围手术期并发症相关。本研究的目的是比较重度 AIS（Cobb 角≥90°）与非重度 AIS 患者后路脊柱融合术（PSF）各阶段的持续时间。本分析将确定 PSF 最耗时的阶段，并帮助外科医生制定缩短手术时间的策略。
回顾性研究，纳入 2019 年至 2023 年接受 PSF 的 90 例 AIS 患者（Lenke 类型 2、3、4 和 6）。25 例重度 AIS 患者归入 Gp1，65 例非重度 AIS 患者归入 Gp2。采用 1:1 最近邻匹配（匹配容差 0.05）进行倾向评分匹配（PSM）。通过手术各阶段的手术持续时间、出血量、螺钉数量、融合节段和螺钉密度来测量结果。
每组匹配 25 例患者。Gp1 的总手术时间明显更高（168.2±30.8 分钟 vs. 133.3±24.0 分钟，p<0.001）。最长的阶段是螺钉插入，Gp1 为 58.5±13.4 分钟，Gp2 为 44.7±13.7 分钟（p=0.001）。螺钉插入占 Gp1 手术总延长时间的 39.5%。术中出血量（1022.2±412.5 毫升 vs. 714.2±206.7 毫升，p=0.002）、螺钉数量（17.1±1.5 个 vs. 15.5±1.1 个，p<0.001）和融合节段（13.1±0.9 个 vs. 12.5±1.0 个，p=0.026）在 Gp1 中显著更高。
螺钉插入是 PSF 最耗时的阶段，在重度 AIS 中明显更长。应考虑使用 CT 引导导航和机器人辅助导航等辅助技术来减少重度 AIS 中的螺钉插入时间。
