青少年特发性脊柱侧凸椎体拴系术中胸椎和腰椎暴露的围手术期结果：大型单机构回顾性研究。

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2024-10-12 DOI:10.1016/j.jpedsurg.2024.162003

Jack W. Sample , Brett F. Curran , Todd A. Milbrandt , A Noelle Larson , D Dean Potter

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引用次数: 0

摘要

背景：椎体拴系（VBT）是一种治疗脊柱侧弯的新型非融合技术。尽管越来越受欢迎，但有关并发症和胸外科手术相关结果的数据却很缺乏：方法：对2015年1月1日至2022年1月3日期间接受视频辅助胸腔手术暴露的VBT患者进行了单一机构回顾性审查。获得的数据包括人口统计学、合并症、住院过程和结果：共发现 106 名患者（81% 为女性），手术时的平均年龄为 12.7 ± 1.5（9-16 岁）。大多数患者接受了单曲拴系（n = 93，87.7%），平均拴系椎体数为 8.0（范围 5-13）。平均手术时间为 236 ± 96 分钟（范围 129-661），估计失血量为 165 ± 143 毫升（范围 20-750），没有患者需要异体输血。系带程度与手术时间、输液量和胸管输出量的增加有显著相关性。除去器械相关并发症，并发症发生率为 13.2%，大部分发生在术后 30 天内，胸腔积液是最常见的并发症。两名患者术后出现血胸，需要再次手术。没有患者在手术暴露过程中因肋间和/或腰部血管分裂而继发脊髓缺血后遗症，也没有死亡病例：结论：对于骨骼尚未发育成熟的青少年来说，VBT似乎是脊柱融合术的一种安全替代方法，但这种手术存在与胸廓暴露相关的显著并发症。我们的经验表明，具有临床意义的肺部并发症并不常见，椎体暴露/系留的程度与手术时间、输液和胸管输出量密切相关：这篇原创文章是一项治疗研究，证据等级为 IV 级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Perioperative Outcomes Related to Thoracic and Lumbar Spine Exposure During Vertebral Body Tethering for Adolescent Idiopathic Scoliosis: A Large, Single-institution Retrospective Review

Background

Vertebral body tethering (VBT) is a novel non-fusion technique for the management of scoliosis. Despite growing popularity, data concerning complications and thoracic surgery-related outcomes are lacking.

Methods

A single-institution retrospective review was conducted of patients who underwent VBT with video-assisted thoracic surgical exposure from 1/1/2015–3/1/2022. Data obtained included demographics, comorbidities, hospital course, and outcomes.

Results

106 patients (81 % female) were identified with a mean age at surgery of 12.7 ± 1.5 (range 9–16). Most patients underwent single curve tethering (n = 93, 87.7 %) with a mean number of vertebral bodies tethered of 8.0 (range 5–13). The mean operative time was 236 ± 96 min (range 129–661) minutes with an estimated blood loss of 165 ± 143 mL (range 20–750) and no patients required allogeneic blood transfusion. The extent of tethering was significantly associated with increased operative time, fluids received, and chest tube output. Excluding instrument-related complications, the complication rate was 13.2 %, mostly occurring within the first 30 days after surgery and pleural effusion being the most common event. Two patients experienced a postoperative hemothorax requiring reoperation. No patients experienced sequelae of spinal cord ischemia secondary to the division of intercostal and/or lumbar vessels during surgical exposure and no deaths occurred.

Conclusion

VBT is a seemingly safe alternative to spinal fusion in skeletally immature adolescents, however, there are notable complications of this procedure related to thoracic exposure. Our experience indicates clinically significant pulmonary complications are uncommon and the extent of vertebral body exposure/tethering was strongly associated with operative duration, fluids, and chest tube output.

Levels of Evidence

This original article represents a treatment study of Level IV evidence.

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.