背景:虽然青少年特发性脊柱侧凸(AIS)和成人特发性脊柱侧凸(AdIS)的自然史在文献中有很好的记载,年龄对术后结局的影响仍是一个活跃的研究领域.我们进行了系统评价和荟萃分析,以比较接受AIS和AdIS手术的患者:(1)术后Cobb矫正,(2)围手术期变量,(3)术后并发症。
方法:根据系统评价和荟萃分析(PRISMA)指南的首选报告项目进行系统文献检索。
方法:2002年至2022年发表的研究,回顾性,并比较AIS与接受畸形手术的AdIS患者。主要结果是术后Cobb矫正。次要结果包括估计失血量(EBL),手术时间,总仪表水平,停留时间(LOS)术后并发症。根据DerSimonian和Laird的方法进行随机效应模型。
结果:在190篇确定的文章中,14符合纳入标准。共纳入1788名患者,1275(71.3%)与AIS,和513(28.7%)与AdIS。AIS和AdIS之间存在显着年龄差异(15.3vs.36.7年,平均差(MD)=21.3年,95CI=14.3-28.4,p<0.001)。5篇文献报道了术后平均Cobb百分比校正,AIS(68.4%)明显高于AdIS(61.4%)(MD=-7.2,95CI=-11.6,-2.7,p=0.001)。EBL在AIS和AdIS之间没有显着差异(695.6mL对817.7mL,p=0.204)。此外,手术时间无差异(MD=37.9分钟,95CI=-10.7;86.6,p=0.127),仪器总水平(MD=0.88,95CI=-0.7,2.4,p=0.273),和LOS(MD=0.5,95CI=-0.2;1.2,p=0.188)。四篇文章报道了AIS与AdIS的术后并发症,在神经功能缺损方面没有区别,器械相关并发症,和医疗并发症。
结论:与AdIS相比,AIS患者的影像学矫正效果更好。尽管在围手术期结局和并发症方面没有发现差异,这些发现强调了就手术矫正的最佳时机向患者提供咨询的重要性.
BACKGROUND: While the natural history of adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AdIS) is well documented in the literature, the impact of age on postoperative outcomes remains an active area of research. We performed a systematic review and meta-analysis to compare patients undergoing surgery for AIS and AdIS with respect to: (1) postoperative Cobb correction, (2) perioperative variables, and (3) postoperative complications.
METHODS: A systematic literature search was performed in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.
METHODS: studies published between 2002 and 2022, retrospective, and comparing AIS vs. AdIS patients undergoing deformity surgery. The primary outcome was postoperative Cobb correction. Secondary outcomes included estimated blood loss (EBL), operative time, total instrumented levels, length of stay (LOS), and postoperative complications. Random-effects models were performed according to the method of DerSimonian and Laird.
RESULTS: Of 190 identified articles, 14 fit the inclusion criteria. A total of 1788 patients were included, 1275(71.3%) with AIS, and 513(28.7%) with AdIS. There was a significant age difference between AIS and AdIS (15.3 vs. 36.7 years, mean difference (MD) = 21.3 years, 95%CI = 14.3-28.4,p < 0.001). Mean postoperative Cobb percentage correction was reported in 5 articles and was significantly higher in AIS (68.4%) vs. AdIS (61.4%) (MD = -7.2, 95%CI = -11.6,-2.7,p = 0.001). EBL was not significantly different between AIS and AdIS (695.6 mL vs 817.7 mL,p = 0.204). Furthermore, no difference was found in operative time (MD = 37.9 min,95%CI = -10.7;86.6,p = 0.127), total instrumented level (MD = 0.88,95%CI = -0.7,2.4,p = 0.273), and LOS (MD = 0.5, 95%CI = -0.2;1.2, p = 0.188). Four articles reported postoperative complications in AIS vs AdIS, with no difference in neurological deficit, instrumentation-related complications, and medical complications.
CONCLUSIONS: AIS patients had better radiographic correction compared to AdIS. Though no difference was found in perioperative outcomes and complications, these findings emphasize the importance of counseling patients regarding the optimal timing of surgical correction.