PDF(Pubmed)
Abstract：
Background: Pedicle subtraction osteotomy (PSO) is a powerful tool for sagittal plane correction in patients with rigid adult spinal deformity (ASD); however, it is associated with high intraoperative blood loss and the increased risk of durotomy. The objective of the present study was to identify intraoperative techniques and baseline patient factors capable of predicting intraoperative durotomy. Methods: A tri-institutional database was retrospectively queried for all patients who underwent PSO for ASD. Data on baseline comorbidities, surgical history, surgeon characteristics and intraoperative maneuvers were gathered. PSO aggressiveness was defined as conventional (Schwab 3 PSO) or an extended PSO (Schwab type 4). The primary outcome of the study was the occurrence of durotomy intraoperatively. Univariable analyses were performed with Mann-Whitney U tests, Chi-squared analyses, and Fisher\'s exact tests. Statistical significance was defined by p < 0.05. Results: One hundred and sixteen patients were identified (mean age 61.9 ± 12.6 yr; 44.8% male), of whom 51 (44.0%) experienced intraoperative durotomy. There were no significant differences in baseline comorbidities between those who did and did not experience durotomy, with the exception that baseline weight and body mass index were higher in patients who did not suffer durotomy. Prior surgery (OR 2.73; 95% CI [1.13, 6.58]; p = 0.03) and, more specifically, prior decompression at the PSO level (OR 4.23; 95% CI [1.92, 9.34]; p < 0.001) was predictive of durotomy. A comparison of surgeon training showed no statistically significant difference in durotomy rate between fellowship and non-fellowship trained surgeons, or between orthopedic surgeons and neurosurgeons. The PSO level, PSO aggressiveness, the presence of stenosis at the PSO level, nor the surgical instrument used predicted the odds of durotomy occurrence. Those experiencing durotomy had similar hospitalization durations, rates of reoperation and rates of nonroutine discharge. Conclusions: In this large multisite series, a history of prior decompression at the PSO level was associated with a four-fold increase in intraoperative durotomy risk. Notably the use of extended (versus) standard PSO, surgical technique, nor baseline patient characteristics predicted durotomy. Durotomies occurred in 44% of patients and may prolong operative times. Additional prospective investigations are merited.
摘要：
背景：椎弓根减影截骨术（PSO）是一种有力的工具，可以矫正患有刚性成人脊柱畸形（ASD）的矢状面；然而，它与高的术中失血量和硬骨切开术的风险增加有关。本研究的目的是确定术中技术和能够预测术中截骨切开术的基线患者因素。方法：回顾性查询三机构数据库中所有接受PSO治疗ASD的患者。基线合并症数据，手术史,收集了外科医生的特征和术中操作。PSO侵袭性定义为常规PSO(Schwab3PSO)或扩展PSO(Schwab4型)。该研究的主要结果是术中发生了硬体切开术。单变量分析使用Mann-WhitneyU检验进行，卡方分析，和费希尔的精确测试。统计学显著性定义为p<0.05。结果：116例患者（平均年龄61.9±12.6岁；男性占44.8%），其中51人（44.0%）经历了术中截骨。在基线合并症中，有和没有经历截骨切开术的患者之间没有显着差异，除了基线体重和体重指数较高的患者没有接受硬骨切开术.先前的手术（OR2.73；95%CI[1.13，6.58]；p=0.03）和，更具体地说,PSO水平的术前减压(OR4.23;95%CI[1.92,9.34];p<0.001)可预测硬体切开术。外科医生培训的比较显示，研究金和非研究金培训的外科医生之间的截骨率没有统计学上的显着差异，或者在整形外科医生和神经外科医生之间。PSO级别,PSO侵略性，在PSO水平存在狭窄，使用的手术器械也不能预测硬骨切开术发生的几率。那些接受硬骨切开术的人住院时间相似，再次手术率和非常规出院率。结论：在这个大型多位点系列中，既往有PSO水平的减压史与术中胆总管切开术风险增加4倍相关.值得注意的是，使用扩展(与)标准PSO，外科技术,基线患者特征也不能预测硬体切开术。44％的患者发生十二指肠切除术，可能会延长手术时间。值得进行其他前瞻性调查。
