OBJECTIVE: To discuss the causes and treatments of wound infections after scoliosis surgery. METHODS: Nine hundred and twenty-four caes of scoliosis were reviewed, and the clinical data of 15 cases of postoperative in...OBJECTIVE: To discuss the causes and treatments of wound infections after scoliosis surgery. METHODS: Nine hundred and twenty-four caes of scoliosis were reviewed, and the clinical data of 15 cases of postoperative infection were analysed retrospectively. RESULTS: All 15 cases underwent spinal posterior fusion with autologous bone graft using instrumentations. Seven were diagnosed as early infection, and 8 were delayed infection. Radical debridement was performed in all 15 cases. The duration of antibiotics administration was 10 to 34 days with continuous closed irrigation for 2 to approximately 4 weeks and primary closure for the wounds. All patients were followed up for an average of 3.5 years (2 to 7.5 years) with good outcomes and no recurrence. CONCLUSION: Wound infection following surgical correction of scoliosis primarily results from intraoperative seeding, although host-related and operation-related factors may contribute to its development. Once the infections are diagnosed, good results can be achieved by prompt surgical debridement, irrigation and reasonably administered antibiotics. Removal of hardware may be necessary in deep infections.展开更多
BACKGROUND Adolescent idiopathic scoliosis remains a major problem due to its high incidence,high risk,and high cost.One of the aims of the management in scoliosis is to correct the deformity.Many techniques are avail...BACKGROUND Adolescent idiopathic scoliosis remains a major problem due to its high incidence,high risk,and high cost.One of the aims of the management in scoliosis is to correct the deformity.Many techniques are available to correct scoliosis deformity;however,they are all far from ideal to achieve three-dimensional correction in scoliosis.AIM To develop a set of tools named Scoliocorrector Fatma-UI(SCFUI)to aid threedimensional correction and to evaluate the efficacy,safety,and functional outcome.METHODS This study consists of two stages.In the first stage,we developed the SCFUI and tested it in finite element and biomechanical tests.The second stage was a single-blinded randomized clinical trial to evaluate the SCFUI compared to direct vertebral rotation(DVR).Forty-four subjects with adolescent idiopathic scoliosis were randomly allocated into the DVR group(n=23)and SCFUI group(n=21).Radiological,neurological,and functional outcome was compared between the groups.RESULTS Finite element revealed the maximum stress of the SCFUI components to be between 31.2-252 MPa.Biomechanical analysis revealed the modulus elasticity of SCFUI was 9561324±633277 MPa.Both groups showed improvement in Cobb angle and sagittal profile,however the rotation angle was lower in the SCFUI group(11.59±7.46 vs 18.23±6.39,P=0.001).Neurological and functional outcome were comparable in both groups.CONCLUSION We concluded that SCFUI developed in this study resulted in similar coronal and sagittal but better rotational correction compared to DVR.The safety and functional outcomes were also similar to DVR.展开更多
BACKGROUND The treatments for early-onset scoliosis(EOS),defined as curvature of the spine with onset before 10 years of age,continue to pose a great challenge for pediatric orthopedics.The treatment goals for EOS inc...BACKGROUND The treatments for early-onset scoliosis(EOS),defined as curvature of the spine with onset before 10 years of age,continue to pose a great challenge for pediatric orthopedics.The treatment goals for EOS include minimizing spinal deformity while maximizing thoracic volume and pulmonary function.Different surgical techniques have different advantages and drawbacks;however,the two major concerns in the management of EOS are repeated surgeries and complications.AIM To review the current literature to assess the safety of EOS surgical treatment in terms of the rate of complications and unplanned surgeries.METHODS In January 2021 two independent reviewers systematically searched three electronic medical databases(PubMed,the Cochrane Library,and Embase)for relevant articles.Every step of the review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Due to the heterogeneity of articles and topics after data analysis,a descriptive(synthetic)analysis was performed.RESULTS A total of 2136 articles were found.Forty articles were included in this systematic review,after applying our inclusion and exclusion criteria.EOS surgery has a varying but high rate of complications.The most frequent complications were categorized as implant(54%),general(17%),wound(15%)and alignment(12%).The rate of complications might have been even higher than reported,as some authors do not report all types of complications.About 54%of patients required unplanned surgeries due to complications,which comprised 15%of all surgeries.CONCLUSION The literature concerning the definitions,collection,and interpretation of data regarding EOS surgery complications is often difficult to interpret.This creates problems in the comparison,analysis,and improvement of spine surgery practice.Additionally,this observation indicates that data on the incidence of complications can be underestimated,and should be interpreted with caution.Awareness of the high rate of complications of EOS surgery is crucial,and an optimal strategy for prevention should become a priority.展开更多
Neuromuscular disorders are a group of diseases affecting the neuro-musculo-skeletal system. Children with neuromuscular disorders frequently develop progressive spinal deformities with cardio-respiratory compromise i...Neuromuscular disorders are a group of diseases affecting the neuro-musculo-skeletal system. Children with neuromuscular disorders frequently develop progressive spinal deformities with cardio-respiratory compromise in the most severe cases. The incidence of neuromuscular scoliosis is variable, inversely correlated with ambulatory abilities and with a reported risk ranging from 80% to 100% in non-ambulatory patients. As surgical and peri-operative techniques have improved, more severely affected children with complex neuromuscular deformities and considerable co-morbidities are now believed to be candidates for extensive surgery for spinal deformity. This article aimed to provide a comprehensive review of how neuromuscular spinal deformities can affect normal spine balance and how these deformities can be treated with segmental instrumentation and sub-laminar devices. Older concepts have been integrated with newer scientific data to provide the reader with a basis for better understanding of how treatment of neuromuscular scoliosis has evolvedover the past few decades. Recent advances, as well as challenges that remain to be overcome, in the surgical treatment of neuromuscular curves with sub-laminar devices and in the management of post-operative infections are outlined.展开更多
AIM To present our results on the use of a single rod instrumentation correction technique in a small number of patients with major medical co-morbidities.METHODS This study was a prospective single surgeon series. Pa...AIM To present our results on the use of a single rod instrumentation correction technique in a small number of patients with major medical co-morbidities.METHODS This study was a prospective single surgeon series. Patients were treated with single rod hybrid constructs and had a minimum 2-year follow-up. Indications included complex underlying co-morbidities, conversion of growing rods to definitive fusion, and moderate adolescent idiopathic primarily thoracic scoliosis with severe eczema and low body mass index(BMI).RESULTS We included 99 consecutive patients. Mean age at surgery was 12.8 years(SD 3.5 years). Mean scoliosis correction was 62%(SD 15%) from 73°(SD 22°) to 28°(SD 15°). Mean surgical time was 153 min(SD 34 min), and blood loss was 530 mL(SD 327 mL); 20% BV(SD 13%). Mean clinical and radiological follow-up was 3.2 years(range: 2-12) post-operatively. Complications included rod failure, which occurred in three of our complex patients with severe syndromic or congenital kyphoscoliosis(3%). Only one of these three patientsrequired revision surgery to address a non-union. Our revision rate was 2%(including a distal junctional kyphosis in a Marfan's syndrome patient).CONCLUSION The single rod technique has achieved satisfactory deformity correction and a low rate of complications in patients with specific indications and severe underlying medical conditions. In these children with significant co-morbidities, where the risks of scoliosis surgery are significantly increased, this technique has achieved low operative time, blood loss, and associated surgical morbidity.展开更多
Background Context: Patient demographic and medical indicators influence the well-being of spine surgery patients. It may, however, be worthwhile to evaluate other lifestyle and attitudinal factors. We hypothesized th...Background Context: Patient demographic and medical indicators influence the well-being of spine surgery patients. It may, however, be worthwhile to evaluate other lifestyle and attitudinal factors. We hypothesized that such factors would explain at least as much variance in outcome as more commonly considered covariates. Purpose: To compare explained variance in outcome of lifestyle and attitudinal factors as compared to standard demographic and medical covariates. Study Design/Setting: Cross-sectional observational study of patients drawn from an active clinic and internet-based support group. Patient Sample: A heterogeneous sample of 376 patients was recruited, comprised of people with diagnoses of cervical (n = 80), lumbar (n = 228), and scoliosis (n = 68) spine disorders. Outcome Measures: Quality of Life (QOL) outcomes were measured using the Oswestry Disability Index, Neck Disability Index, Rand-36, PROMIS Pain Impact, NRS Back and Leg Pain, Scoliosis Research Society-22r, and Global Health. Methods: This study compared explained variance in QOL outcomes in demographic and medical versus lifestyle and attitudinal factors. Demographic and medical factors included age, gender, body mass index, and co-morbidities. Lifestyle factors included exercise and commuting practice. Attitudinal factors related to social connectedness: giving and receiving emotional support, feeling overwhelmed by others’ needs, helping orientation, and general helping behaviors. Regression analyses estimated explained variance. Patient groups differed in most factors evaluated, so the regression analyses were computed separately by group. R2 statistics were characterized as null, small (0.02), medium (0.15), and large (0.35) effect sizes (ES), and proportions were compared for the medical/demographic versus lifestyle/attitudinal factors by group. Results: Similar proportions of variance were explained by demographic/medical and lifestyle/attitudinal covariates across groups, with half of effect sizes being small in magnitude and 6% being medium. Lumbar patients tended to have more small effect sizes among lifestyle and attitudinal covariates than among medical/demographic covariates (z = – 1.29, p < 0.10). Similar patterns were found for both generic and disease-specific outcomes. Conclusions: Spine surgery outcome research should investigate lifestyle and attitudinal factors to enhance the personal and salutogenic relevance of the research. Time spent commuting, exercise practice, and social connectedness appear to be relevant factors. A pre-operative evaluation of overweight and smoking status, limited social connectedness, and long daily commutes could alert the surgeon to delay or avoid performing procedures on these patients to avoid poor outcomes.展开更多
目的探究流程化沟通模式结合加速康复外科(enhanced recovery after surgery,ERAS)理念在先天性脊柱畸形(congenital scoliosis,CS)患儿围术期应用效果,总结临床经验。方法本研究为前瞻性研究,选取2022年2月至2023年2月于我院接受手术...目的探究流程化沟通模式结合加速康复外科(enhanced recovery after surgery,ERAS)理念在先天性脊柱畸形(congenital scoliosis,CS)患儿围术期应用效果,总结临床经验。方法本研究为前瞻性研究,选取2022年2月至2023年2月于我院接受手术治疗的CS患儿共68例作为研究对象,根据管理模式分为研究组(n=34)和对照组(n=34)。对照组采取单纯ERAS围术期管理模式,研究组采取流程化沟通模式结合ERAS理念进行围术期干预。比较两组患者术后首次排气时间、伤口愈合时间、平均住院日、中文版儿童焦虑性情绪障碍筛查表(Screen for Child Anxiety Related Emotional Disorders,SCARED)得分、中文版儿童抑郁障碍量表(Depression Self-rating Scale for Children,DSRSC)得分、治疗依从性评分、ERAS措施完成项目数、并发症率以及疼痛评分的差异。结果68例中,男27例、女41例,平均年龄(8.31±3.79)岁,两组基线资料差异无统计学意义(P>0.05)。研究组术后首次排气时间、伤口愈合时间分别为(32.76±5.57)h和(8.41±1.65)d,均明显早于对照组的(62.94±7.81)h和(9.56±2.60)d,差异均有统计学意义(P<0.05);研究组平均住院日为(11.12±2.14)d,较对照组的(15.18±2.48)d明显更短(t=7.221,P<0.001);两组患者入院时SCARED评分[研究组(20.65±2.01)分比对照组(20.18±2.17)分,t=0.928,P=0.357]和DSRSC评分[研究组(12.59±2.12)分比对照组(12.68±2.07)分,t=0.174,P=0.863]差异无统计学意义(P>0.05),但研究组出院时SCARED和DSRSC评分为(12.35±2.10)分和(9.88±1.70)分,明显低于对照组的(18.59±1.79)分和(11.09±1.85)分,差异均有统计学意义(P<0.05);研究组治疗依从性评分[研究组(13.76±1.44)分比对照组(9.32±1.84)分,t=11.102,P<0.001]、ERAS措施完成项目数[研究组(15.91±1.49)项比对照组(13.35±1.54)项,t=6.987,P<0.001]、并发症发生率(研究组5.88%比对照组23.53,χ^(2)=4.221,P=0.040)和疼痛评分[研究组(2.91±0.87)分比对照组(3.76±1.39)分,t=3.031,P=0.003]均优于对照组。结论CS患儿围术期应用流程化沟通模式结合ERAS理念进行围术期管理效果更好,可有效提高患儿的术后康复水平和治疗依从性、减轻其心理应激程度、减少并发症发生率。展开更多
Objective： Conventional open spinal surgery of adult scoliosis can be performed from anterior, posterior, or combined approach. Minimally invasive spine surgery （MISS） was developed for the purpose of reducing the ...Objective： Conventional open spinal surgery of adult scoliosis can be performed from anterior, posterior, or combined approach. Minimally invasive spine surgery （MISS） was developed for the purpose of reducing the undesirable effects and complications. This review aimed to make a brief summary of recent studies of the approach and clinical outcomes of MISS in adult scoliosis. Data Sources： We conducted a systematic search from PubMed, Medline, EMBASE, and other literature databases to collect reports of surgical methods and clinical outcomes of MISS in treatment of adult scoliosis. Those reports were published up to March 2017 with the following key terms： ＆quot;minimally invasive,＆quot; ＆quot;spine,＆quot; ＆quot;surgery,＆quot; and ＆quot;scoliosis.＆quot;Study Selection： The inclusion criteria of the articles were as followings： diagnosed with adult degenerative scoliosis （DS） or adult idiopathic scoliosis; underwent MISS or open surgery; with follow-up data. The articles involving patients with congenital scoliosis or unknown type were excluded and those without any follow-up data were also excluded from the study. The initial search yielded 233 articles. After title and abstract extraction, 29 English articles were selected for full-text review. Of those, 20 studies with 831 patients diagnosed with adult DS or adult idiopathic scoliosis were reviewed. Seventeen were retrospective studies, and three were prospective studies. Results： The surgical technique reported in these articles was direct or extreme lateral interbody fusion, axial lumbar interbody fusion, and transforaminal lumbar interbody fusion. Among the clinical outcomes of these studies, the operated levels was 3–7, operative time was 2.3–8.5 h. Both the Cobb angle of coronal major curve and evaluation of Oswestry Disability Index and Visual Analog Scale decreased after surgery. There were 323 complications reported in the 831 （38.9%） patients, including 150 （18.1%） motor or sensory deficits, and 111 （13.4%） implant-related complications. Conclusions： MISS can provide good radiological and self-evaluation improvement in treatment of adult scoliosis. More prospective studies will be needed before it is widely used.展开更多
文摘OBJECTIVE: To discuss the causes and treatments of wound infections after scoliosis surgery. METHODS: Nine hundred and twenty-four caes of scoliosis were reviewed, and the clinical data of 15 cases of postoperative infection were analysed retrospectively. RESULTS: All 15 cases underwent spinal posterior fusion with autologous bone graft using instrumentations. Seven were diagnosed as early infection, and 8 were delayed infection. Radical debridement was performed in all 15 cases. The duration of antibiotics administration was 10 to 34 days with continuous closed irrigation for 2 to approximately 4 weeks and primary closure for the wounds. All patients were followed up for an average of 3.5 years (2 to 7.5 years) with good outcomes and no recurrence. CONCLUSION: Wound infection following surgical correction of scoliosis primarily results from intraoperative seeding, although host-related and operation-related factors may contribute to its development. Once the infections are diagnosed, good results can be achieved by prompt surgical debridement, irrigation and reasonably administered antibiotics. Removal of hardware may be necessary in deep infections.
基金The study was reviewed and approved by the Ethical Committee Faculty of Medicine,University of Indonesia(Approval No.KET-615/UN2.F1/ETIK/PPM.00.02/2020)Ethical Committee of Fatmawati General Hospital(Approval No.DM 01.01/VIII.2/1294/2020).
文摘BACKGROUND Adolescent idiopathic scoliosis remains a major problem due to its high incidence,high risk,and high cost.One of the aims of the management in scoliosis is to correct the deformity.Many techniques are available to correct scoliosis deformity;however,they are all far from ideal to achieve three-dimensional correction in scoliosis.AIM To develop a set of tools named Scoliocorrector Fatma-UI(SCFUI)to aid threedimensional correction and to evaluate the efficacy,safety,and functional outcome.METHODS This study consists of two stages.In the first stage,we developed the SCFUI and tested it in finite element and biomechanical tests.The second stage was a single-blinded randomized clinical trial to evaluate the SCFUI compared to direct vertebral rotation(DVR).Forty-four subjects with adolescent idiopathic scoliosis were randomly allocated into the DVR group(n=23)and SCFUI group(n=21).Radiological,neurological,and functional outcome was compared between the groups.RESULTS Finite element revealed the maximum stress of the SCFUI components to be between 31.2-252 MPa.Biomechanical analysis revealed the modulus elasticity of SCFUI was 9561324±633277 MPa.Both groups showed improvement in Cobb angle and sagittal profile,however the rotation angle was lower in the SCFUI group(11.59±7.46 vs 18.23±6.39,P=0.001).Neurological and functional outcome were comparable in both groups.CONCLUSION We concluded that SCFUI developed in this study resulted in similar coronal and sagittal but better rotational correction compared to DVR.The safety and functional outcomes were also similar to DVR.
文摘BACKGROUND The treatments for early-onset scoliosis(EOS),defined as curvature of the spine with onset before 10 years of age,continue to pose a great challenge for pediatric orthopedics.The treatment goals for EOS include minimizing spinal deformity while maximizing thoracic volume and pulmonary function.Different surgical techniques have different advantages and drawbacks;however,the two major concerns in the management of EOS are repeated surgeries and complications.AIM To review the current literature to assess the safety of EOS surgical treatment in terms of the rate of complications and unplanned surgeries.METHODS In January 2021 two independent reviewers systematically searched three electronic medical databases(PubMed,the Cochrane Library,and Embase)for relevant articles.Every step of the review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Due to the heterogeneity of articles and topics after data analysis,a descriptive(synthetic)analysis was performed.RESULTS A total of 2136 articles were found.Forty articles were included in this systematic review,after applying our inclusion and exclusion criteria.EOS surgery has a varying but high rate of complications.The most frequent complications were categorized as implant(54%),general(17%),wound(15%)and alignment(12%).The rate of complications might have been even higher than reported,as some authors do not report all types of complications.About 54%of patients required unplanned surgeries due to complications,which comprised 15%of all surgeries.CONCLUSION The literature concerning the definitions,collection,and interpretation of data regarding EOS surgery complications is often difficult to interpret.This creates problems in the comparison,analysis,and improvement of spine surgery practice.Additionally,this observation indicates that data on the incidence of complications can be underestimated,and should be interpreted with caution.Awareness of the high rate of complications of EOS surgery is crucial,and an optimal strategy for prevention should become a priority.
文摘Neuromuscular disorders are a group of diseases affecting the neuro-musculo-skeletal system. Children with neuromuscular disorders frequently develop progressive spinal deformities with cardio-respiratory compromise in the most severe cases. The incidence of neuromuscular scoliosis is variable, inversely correlated with ambulatory abilities and with a reported risk ranging from 80% to 100% in non-ambulatory patients. As surgical and peri-operative techniques have improved, more severely affected children with complex neuromuscular deformities and considerable co-morbidities are now believed to be candidates for extensive surgery for spinal deformity. This article aimed to provide a comprehensive review of how neuromuscular spinal deformities can affect normal spine balance and how these deformities can be treated with segmental instrumentation and sub-laminar devices. Older concepts have been integrated with newer scientific data to provide the reader with a basis for better understanding of how treatment of neuromuscular scoliosis has evolvedover the past few decades. Recent advances, as well as challenges that remain to be overcome, in the surgical treatment of neuromuscular curves with sub-laminar devices and in the management of post-operative infections are outlined.
文摘AIM To present our results on the use of a single rod instrumentation correction technique in a small number of patients with major medical co-morbidities.METHODS This study was a prospective single surgeon series. Patients were treated with single rod hybrid constructs and had a minimum 2-year follow-up. Indications included complex underlying co-morbidities, conversion of growing rods to definitive fusion, and moderate adolescent idiopathic primarily thoracic scoliosis with severe eczema and low body mass index(BMI).RESULTS We included 99 consecutive patients. Mean age at surgery was 12.8 years(SD 3.5 years). Mean scoliosis correction was 62%(SD 15%) from 73°(SD 22°) to 28°(SD 15°). Mean surgical time was 153 min(SD 34 min), and blood loss was 530 mL(SD 327 mL); 20% BV(SD 13%). Mean clinical and radiological follow-up was 3.2 years(range: 2-12) post-operatively. Complications included rod failure, which occurred in three of our complex patients with severe syndromic or congenital kyphoscoliosis(3%). Only one of these three patientsrequired revision surgery to address a non-union. Our revision rate was 2%(including a distal junctional kyphosis in a Marfan's syndrome patient).CONCLUSION The single rod technique has achieved satisfactory deformity correction and a low rate of complications in patients with specific indications and severe underlying medical conditions. In these children with significant co-morbidities, where the risks of scoliosis surgery are significantly increased, this technique has achieved low operative time, blood loss, and associated surgical morbidity.
文摘Background Context: Patient demographic and medical indicators influence the well-being of spine surgery patients. It may, however, be worthwhile to evaluate other lifestyle and attitudinal factors. We hypothesized that such factors would explain at least as much variance in outcome as more commonly considered covariates. Purpose: To compare explained variance in outcome of lifestyle and attitudinal factors as compared to standard demographic and medical covariates. Study Design/Setting: Cross-sectional observational study of patients drawn from an active clinic and internet-based support group. Patient Sample: A heterogeneous sample of 376 patients was recruited, comprised of people with diagnoses of cervical (n = 80), lumbar (n = 228), and scoliosis (n = 68) spine disorders. Outcome Measures: Quality of Life (QOL) outcomes were measured using the Oswestry Disability Index, Neck Disability Index, Rand-36, PROMIS Pain Impact, NRS Back and Leg Pain, Scoliosis Research Society-22r, and Global Health. Methods: This study compared explained variance in QOL outcomes in demographic and medical versus lifestyle and attitudinal factors. Demographic and medical factors included age, gender, body mass index, and co-morbidities. Lifestyle factors included exercise and commuting practice. Attitudinal factors related to social connectedness: giving and receiving emotional support, feeling overwhelmed by others’ needs, helping orientation, and general helping behaviors. Regression analyses estimated explained variance. Patient groups differed in most factors evaluated, so the regression analyses were computed separately by group. R2 statistics were characterized as null, small (0.02), medium (0.15), and large (0.35) effect sizes (ES), and proportions were compared for the medical/demographic versus lifestyle/attitudinal factors by group. Results: Similar proportions of variance were explained by demographic/medical and lifestyle/attitudinal covariates across groups, with half of effect sizes being small in magnitude and 6% being medium. Lumbar patients tended to have more small effect sizes among lifestyle and attitudinal covariates than among medical/demographic covariates (z = – 1.29, p < 0.10). Similar patterns were found for both generic and disease-specific outcomes. Conclusions: Spine surgery outcome research should investigate lifestyle and attitudinal factors to enhance the personal and salutogenic relevance of the research. Time spent commuting, exercise practice, and social connectedness appear to be relevant factors. A pre-operative evaluation of overweight and smoking status, limited social connectedness, and long daily commutes could alert the surgeon to delay or avoid performing procedures on these patients to avoid poor outcomes.
文摘目的探究流程化沟通模式结合加速康复外科(enhanced recovery after surgery,ERAS)理念在先天性脊柱畸形(congenital scoliosis,CS)患儿围术期应用效果,总结临床经验。方法本研究为前瞻性研究,选取2022年2月至2023年2月于我院接受手术治疗的CS患儿共68例作为研究对象,根据管理模式分为研究组(n=34)和对照组(n=34)。对照组采取单纯ERAS围术期管理模式,研究组采取流程化沟通模式结合ERAS理念进行围术期干预。比较两组患者术后首次排气时间、伤口愈合时间、平均住院日、中文版儿童焦虑性情绪障碍筛查表(Screen for Child Anxiety Related Emotional Disorders,SCARED)得分、中文版儿童抑郁障碍量表(Depression Self-rating Scale for Children,DSRSC)得分、治疗依从性评分、ERAS措施完成项目数、并发症率以及疼痛评分的差异。结果68例中,男27例、女41例,平均年龄(8.31±3.79)岁,两组基线资料差异无统计学意义(P>0.05)。研究组术后首次排气时间、伤口愈合时间分别为(32.76±5.57)h和(8.41±1.65)d,均明显早于对照组的(62.94±7.81)h和(9.56±2.60)d,差异均有统计学意义(P<0.05);研究组平均住院日为(11.12±2.14)d,较对照组的(15.18±2.48)d明显更短(t=7.221,P<0.001);两组患者入院时SCARED评分[研究组(20.65±2.01)分比对照组(20.18±2.17)分,t=0.928,P=0.357]和DSRSC评分[研究组(12.59±2.12)分比对照组(12.68±2.07)分,t=0.174,P=0.863]差异无统计学意义(P>0.05),但研究组出院时SCARED和DSRSC评分为(12.35±2.10)分和(9.88±1.70)分,明显低于对照组的(18.59±1.79)分和(11.09±1.85)分,差异均有统计学意义(P<0.05);研究组治疗依从性评分[研究组(13.76±1.44)分比对照组(9.32±1.84)分,t=11.102,P<0.001]、ERAS措施完成项目数[研究组(15.91±1.49)项比对照组(13.35±1.54)项,t=6.987,P<0.001]、并发症发生率(研究组5.88%比对照组23.53,χ^(2)=4.221,P=0.040)和疼痛评分[研究组(2.91±0.87)分比对照组(3.76±1.39)分,t=3.031,P=0.003]均优于对照组。结论CS患儿围术期应用流程化沟通模式结合ERAS理念进行围术期管理效果更好,可有效提高患儿的术后康复水平和治疗依从性、减轻其心理应激程度、减少并发症发生率。
文摘Objective： Conventional open spinal surgery of adult scoliosis can be performed from anterior, posterior, or combined approach. Minimally invasive spine surgery （MISS） was developed for the purpose of reducing the undesirable effects and complications. This review aimed to make a brief summary of recent studies of the approach and clinical outcomes of MISS in adult scoliosis. Data Sources： We conducted a systematic search from PubMed, Medline, EMBASE, and other literature databases to collect reports of surgical methods and clinical outcomes of MISS in treatment of adult scoliosis. Those reports were published up to March 2017 with the following key terms： ＆quot;minimally invasive,＆quot; ＆quot;spine,＆quot; ＆quot;surgery,＆quot; and ＆quot;scoliosis.＆quot;Study Selection： The inclusion criteria of the articles were as followings： diagnosed with adult degenerative scoliosis （DS） or adult idiopathic scoliosis; underwent MISS or open surgery; with follow-up data. The articles involving patients with congenital scoliosis or unknown type were excluded and those without any follow-up data were also excluded from the study. The initial search yielded 233 articles. After title and abstract extraction, 29 English articles were selected for full-text review. Of those, 20 studies with 831 patients diagnosed with adult DS or adult idiopathic scoliosis were reviewed. Seventeen were retrospective studies, and three were prospective studies. Results： The surgical technique reported in these articles was direct or extreme lateral interbody fusion, axial lumbar interbody fusion, and transforaminal lumbar interbody fusion. Among the clinical outcomes of these studies, the operated levels was 3–7, operative time was 2.3–8.5 h. Both the Cobb angle of coronal major curve and evaluation of Oswestry Disability Index and Visual Analog Scale decreased after surgery. There were 323 complications reported in the 831 （38.9%） patients, including 150 （18.1%） motor or sensory deficits, and 111 （13.4%） implant-related complications. Conclusions： MISS can provide good radiological and self-evaluation improvement in treatment of adult scoliosis. More prospective studies will be needed before it is widely used.
