Viviani G R, Raducan V, Bednar D A, Grandwilewski W
Department of Surgery, McMaster University, Hamilton, Ont.
Can J Surg. 1993 Oct;36(5):468-73.
To compare postoperative morbidity and length of hospital stay after combined anterior and posterior spinal fusion for patients treated by a one-stage procedure and those treated in two stages, 1 to 2 weeks apart.
Retrospective review of all cases handled by the first author between July 1989 and November 1991. The patients had been referred for treatment of severe spinal deformity, scoliosis or kyphosis by combined anterior and posterior spinal fusion.
The operations were performed at McMaster University Medical Centre, Hamilton, Ont., by the first author, who was assisted by another specialist in spinal surgery and a fellow or resident.
Eleven operations of each type were performed. The mean age of the 22 patients was 16.6 and 14.6 years for those who underwent the one-stage and the two-stage procedures respectively. The diagnoses included neuromuscular disease, neurofibromatosis, spina bifida, congenital kyphoscoliosis and severe idiopathic spinal curvature. The one-stage procedure was used after the surgical team became able to provide the care associated with this type of major surgery; selection of patients also involved preoperative risk assessment and the feasibility of combining two surgical procedures that would take a maximum of 9 hours. The preoperative plan was to spend a maximum of 9 hours in performing the one-stage procedure.
Similar surgical procedures were performed in both groups. The average number of intervertebral levels fused during the anterior component of the operation was 4.6 in the one-stage procedure and 6.0 in the two-stage procedure. Thoracolaparotomy was performed in four patients who underwent the two-stage procedure. During the posterior component of the operation, instrumentation was inserted through an average of 11.6 and 12.6 intervertebral levels in the groups undergoing the one-stage and the two-stage procedures respectively. Total operating time averaged 7 hours and 15 minutes for the one-stage procedure and 11 hours for the two-stage procedure. Mean blood loss was 1830 mL for the one-stage procedure and 2270 mL for the two-stage procedure.
The number of days spent in the intensive care unit (ICU) and the total number of days spent in hospital, as well as morbidity after the operation, were determined.
Postoperative morbidity included five minor complications in patients who underwent a one-stage procedure; all of these complications resolved well. Among those who underwent the two-stage procedure there were 11 complications; in two patients further surgery was required. The patients' stay in the ICU averaged 2.6 and 7.7 days respectively for one-stage and two-stage procedures, and the total stay in hospital averaged 14 and 33 days respectively.
When possible, the one-stage procedure for anterior and posterior spinal fusion is preferred over the two-stage procedure because of a significant reduction in the length of stay in the ICU and in hospital, as well as reduced morbidity. However, this analysis should be interpreted cautiously because of the small number of cases and the variables encountered in treating this type of spinal deformity.
比较一期手术和分两期、间隔1至2周进行前后路联合脊柱融合术患者的术后发病率及住院时间。
对第一作者在1989年7月至1991年11月间处理的所有病例进行回顾性研究。这些患者因严重脊柱畸形、脊柱侧凸或后凸而转诊接受前后路联合脊柱融合术治疗。
手术在安大略省汉密尔顿市的麦克马斯特大学医学中心由第一作者进行，另有一位脊柱外科专家及一名住院医生协助。
每种手术类型均进行了11例。22例患者的平均年龄，一期手术患者为16.6岁，二期手术患者为14.6岁。诊断包括神经肌肉疾病、神经纤维瘤病、脊柱裂、先天性脊柱侧后凸和严重特发性脊柱侧弯。在手术团队能够提供此类大手术相关护理后采用一期手术；患者选择还涉及术前风险评估以及两种手术联合进行（最长耗时9小时）的可行性。一期手术的术前计划是最长耗时9小时。
两组均进行了类似的外科手术。一期手术中前路手术融合的平均椎体节段数为4.6个，二期手术为6.0个。二期手术中有4例患者进行了胸腹联合切开术。在手术的后路部分，一期手术组和二期手术组分别平均通过11.6个和12.6个椎体节段置入内固定器械。一期手术的总平均手术时间为7小时15分钟，二期手术为11小时。一期手术的平均失血量为1830毫升，二期手术为2270毫升。
确定在重症监护病房（ICU）的住院天数、总住院天数以及术后发病率。
一期手术患者术后有5例轻微并发症；所有这些并发症均恢复良好。二期手术患者中有11例并发症；2例患者需要进一步手术。一期手术和二期手术患者在ICU的平均住院时间分别为2.6天和7.7天，总住院时间分别平均为14天和33天。
在可能的情况下，前后路联合脊柱融合术的一期手术优于二期手术，因为其可显著缩短ICU住院时间和总住院时间，并降低发病率。然而，由于病例数量较少以及治疗此类脊柱畸形时存在多种变量，该分析结果应谨慎解读。
