Chan Kai Chun Augustine, Cheung Chi Chun Garvin, Tse Kai Yeung Elvis, Cheung Jason Pui Yin, Cheung Prudence Wing Hang
Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China.
Bone Joint J. 2025 Jul 1;107-B(7):736-743. doi: 10.1302/0301-620X.107B7.BJJ-2025-0073.R1.
There is little information in the orthopaedic literature about the rate of perioperative complications of vertebral body tethering (VBT), in the surgical management of patients with adolescent idiopathic scoliosis. The aim of this study was to determine the rate of these complications and to investigate the corresponding predictive factors.
This was a prospective single-centre study involving all patients who underwent VBT between February 2019 and October 2024. A total of 60 patients (51 females and nine males) with 79 instrumented curves were included. The primary outcomes were the rates of various non-implant-related perioperative complications. General complications included: postoperative wound issues (discharge, infection, erythema); bowel dysfunction; thigh pain and paraesthesia; pain in the hip, back, and shoulder; and weakness of hip flexion. Pulmonary complications included pneumothorax, atelectasis, pleural effusion, chylothorax, and a raised hemidiaphragm. Other complications that were investigated included peritoneal perforation, surgical emphysema, superior mesenteric artery syndrome, and screw loosening. Secondary outcomes were the differences in complication rates between types of VBT, the surgical approaches, and the implants. The relationships between pre- and intraoperative factors and complications were assessed using correlation and logistic regression.
A total of 29 operations (36.7%) were associated with at least one pulmonary complication. The rates of pneumothorax, atelectasis, pleural effusion, chylothorax, and raised hemidiaphragm were 30.4%, 12.7%, 12.7%, 3.8%, and 3.8%, respectively. An increased number of instrumented levels significantly predicted postoperative pneumothorax (odds ratio (OR) 2.58 (95% CI 1.27 to 3.51); p = 0.004) and pleural effusion (OR 2.95 (95% CI 1.21 to 7.22); p = 0.019). Thoracic VBT (OR 11.01 (95% CI 1.67 to 72.7); p = 0.012) and the rate of correction (OR 1.06 (95% CI 1.01 to 1.12); p = 0.042) were significant predictors of postoperative atelectasis.
The rate of perioperative complications in this study was higher than has been previously reported, with pneumothorax being the most common pulmonary complication. Thoracic VBTs had significantly more pulmonary complications, but neither the surgical approach, nor the type of implant which was used, was significantly associated with an increased rate of complications. An increased number of instrumented levels, the rate of correction, and instrumentation which included the thoracic spine, were found to be significantly predictive of pulmonary complications.
在骨科文献中，关于青少年特发性脊柱侧凸患者手术治疗中椎体牵张术（VBT）围手术期并发症发生率的信息较少。本研究的目的是确定这些并发症的发生率，并调查相应的预测因素。
这是一项前瞻性单中心研究，纳入了2019年2月至2024年10月期间所有接受VBT的患者。共纳入60例患者（51例女性和9例男性），有79条植入器械的曲线。主要结局是各种与植入物无关的围手术期并发症的发生率。一般并发症包括：术后伤口问题（引流、感染、红斑）；肠道功能障碍；大腿疼痛和感觉异常；髋部、背部和肩部疼痛；以及髋部屈曲无力。肺部并发症包括气胸、肺不张、胸腔积液、乳糜胸和膈肌抬高。其他调查的并发症包括腹膜穿孔、手术性气肿、肠系膜上动脉综合征和螺钉松动。次要结局是不同类型的VBT、手术入路和植入物之间并发症发生率的差异。使用相关性和逻辑回归评估术前和术中因素与并发症之间的关系。
共有29例手术（36.7%）至少与一种肺部并发症相关。气胸、肺不张、胸腔积液、乳糜胸和膈肌抬高的发生率分别为30.4%、12.7%、12.7%、3.8%和3.8%。植入器械节段数量增加显著预测术后气胸（优势比（OR）2.58（95%置信区间1.27至3.51）；p = 0.004）和胸腔积液（OR 2.95（95%置信区间1.21至7.22）；p = 0.019）。胸椎VBT（OR 11.01（95%置信区间1.67至72.7）；p = 0.012）和矫正率（OR 1.06（95%置信区间1.01至1.12）；p = 0.042）是术后肺不张的显著预测因素。
本研究中围手术期并发症的发生率高于先前报道，气胸是最常见的肺部并发症。胸椎VBT的肺部并发症明显更多，但手术入路和所用植入物类型均与并发症发生率增加无显著相关性。发现植入器械节段数量增加、矫正率以及包括胸椎的器械植入显著预测肺部并发症。
