已经研究了世界不同地区青少年特发性脊柱侧凸(AIS)的患病率。获得护理的机会差异很大,疾病严重程度和手术治疗结果的差异尚不清楚。这项研究旨在从国际队列中确定AIS患者的疾病表现和手术并发症的变化。
这是一项在美国7个外科中心(曼哈顿和迈阿密)进行的回顾性研究,加纳,巴基斯坦,西班牙,埃及,和中国。对541例AIS患者进行了评估。术前主要曲线幅度,操作参数,使用事后检验的方差分析和Pearson相关系数对不同地点的并发症进行了比较。单变量和多变量前向逐步二元逻辑回归确定了最能预测并发症的变量。
获得护理机会最少的国家(加纳,埃及,和巴基斯坦)显示更大的曲线,更多的层次融合,较长的手术时间(OT),估计失血量(EBL)大于其他国家(p≤0.001)。增加的曲线幅度与更高的融合水平相关,较长的OT,和更大的EBL在所有组(p=0.01)。在单变量回归分析中,科布震级,融合的水平,EBL,OT与并发症的发生有关。调整Cobb大小后,仅OT与并发症发生显着相关,融合的水平,和网站(比值比[OR]=1.005,95%置信区间1.001-1.007,p=0.003)。并发症在巴基斯坦和加纳最大(21.7%和13.5%,分别)和迈阿密最低(6.5%)。
在接入最少的国家中,更大的曲线幅度与更多的融合水平相关,较长的OT,和更大的EBL,这表明手术时曲线幅度的增加可以解释低治疗和高治疗国家之间手术发病率的差异.以OT为并发症的主要预测因素,我们认为,增加的曲线大小会导致更长的OTs和更多的并发症.缺乏骨科护理可能是推迟治疗的最大原因。
二级。
The prevalence of adolescent idiopathic scoliosis (AIS) in diverse regions of the world has been studied. Access to care varies widely, and differences in disease severity and operative treatment outcomes are not well understood. This
study aimed to determine variation in disease presentation and operative complications for AIS patients from an international cohort.
This is a retrospective
study carried out at seven surgical centers in the United States (Manhattan and Miami), Ghana, Pakistan, Spain, Egypt, and China. A total of 541 consecutive patients with AIS were evaluated. Preoperative major curve magnitude, operative parameters, and complications were compared among sites using analysis of variance with post hoc tests and Pearson correlation coefficients. Univariate and multivariate forward stepwise binary logistic regressions determined the variables most predictive of complications.
Countries with lowest-access to care (Ghana, Egypt, and Pakistan) displayed larger curves, more levels fused, longer operative time (OT), and greater estimated blood loss (EBL) than the other countries (p ≤ .001). Increasing curve magnitude was correlated with greater levels fused, longer OT, and greater EBL in all groups (p = .01). In the univariate regression analysis, Cobb magnitude, levels fused, EBL, and OT were associated with complication occurrence. Only OT remained significantly associated with complication occurrence after adjusting for Cobb magnitude, levels fused, and site (odds ratio [OR] = 1.005, 95% confidence interval 1.001-1.007, p = .003). Complications were greatest in Pakistan and Ghana (21.7% and 13.5%, respectively) and lowest in Miami (6.5%).
Larger curve magnitudes in the least-access countries correlated with more levels fused, longer OT, and greater EBL, indicating that increased curve magnitude at surgery could explain the difference in operative morbidity between low- and high-access countries. With OT as the prevailing predictive factor of complications, we suggest that increased curve magnitude leads to longer OTs and more complications. A lack of access to orthopedic care may be the largest contributor to the postponement of treatment.
Level II.