传统双生长棒技术治疗先天性早发性脊柱侧凸的内固定相关并发症及其危险因素分析

Risk factors for implant-related complications in congenital early-onset scoliosis patients treated with traditional dual growing rods

目的:观察传统双生长棒技术(traditional dual growing rods,TDGR)治疗先天性早发性脊柱侧凸(congenital early onset scoliosis,CEOS)的内固定相关并发症,并对其相关危险因素进行分析。方法:回顾性研究接受TDGR治疗的CEOS患者。所有患者至少接受2次生长棒撑开治疗且随访2年以上。统计内固定相关并发症,根据是否出现内固定相关并发症,将患者分为并发症组和非并发症组,记录两组患者年龄、撑开次数、撑开间隔、随访时间;同时对影像学资料(包括侧弯数目、主弯Cobb角度、T2-5后凸、T5-12后凸、T10-L2后凸、L1-S1前凸、T1-12长度、T1-S1长度等)进行测量。使用Logistic回归分析对内固定相关并发症的危险因素进行分析。结果:本研究共纳入48例患者,其中23例(47.9%)患者出现了49例次内固定相关并发症,包括脱钩15例次,螺钉拔出12例次,内固定棒断裂8例次,尾帽松动2例次,近端交界性后凸12例次。单因素回归分析结果显示术前T2-12后凸≥40°、术前T10-L2后凸≥10°是内固定相关并发症的显著性危险因素(P<0.05)。多因素回归分析结果显示术前T10-L2后凸≥10°[OR 4.12,95%CI(1.20-14.14),P=0.025]是内固定相关并发症的独立危险因素。结论:对于接受TDGR治疗的CEOS患者,术前T10-L2后凸≥10°是内固定相关并发症的独立危险因素,治疗过程中应注意胸腰段后凸畸形的处理,以降低内固定相关并发症的发生率。

Objectives:To identify risk factors for implant-related complications(IRCs)in congenital early-onset scoliosis(CEOS)patients treated with traditional dual growing rods(TDGR).Methods:Data of CEOS patients treated with TDGR were retrospectively reviewed.All patients received more than 2 lengthening procedures with a minimum of 2-year follow-up.Patients were divided into complication group and non-complica-tion group.Clinical data of all patients,including age,number of lengthening procedures,lengthening inter-vals,duration of follow-up,implant-related complications,and radiographic measurements were collected.The univariate analysis and multivariate logistic regression analysis were performed to identify the risk factors as-sociated with IRCs.Results:Among the 48 patients enrolled,23(47.9%)patients suffered 49 IRCs,including15 cases of hook dislodgement,12 cases of screw dislodgement,8 cases of rod breakage,2 cases of cap loosing,12 cases of proximal junctional kyphosis.The univariate Logistic regression analysis revealed preoper-ative T5-12 kyphosis≥40°and T10-L2 kyphosis≥10°were significant risk factors(P<0.05).Multivariable Logistic regression analysis demonstrated that preoperative T10-L2 kyphosis≥10°[OR 4.12,95%CI(1.20-14.14),P=0.025]was independent risk factor of IRCs.Conclusions:Preoperative T10-L2 kyphosis≥10°is independent risk factor for IRCs.Identification and proper correction of relevant spinal deformity may reduce IRCs incidence.