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Tratamento cirúrgico da escoliose severa : diferentes abordagens em múltiplos tempos operatórios
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Introdução: A escoliose é uma deformidade tridimensional da coluna, que afeta os planos coronal e sagital e inclui um componente rotacional. Pode causar dor, assimetria corporal e afetar a autoimagem. Com etiologia variada, 80% dos casos são idiopáticos. A classificação considera a idade, deformidade e localização, e o tratamento varia de vigilância a cirurgia, conforme a gravidade.
Métodos: Foram analisados 188 pacientes com escoliose operados entre 2004-2023 na Unidade Local de Saúde Santa Maria. Incluíram-se os doentes submetidos a correção cirúrgica em dois tempos com curvas escolióticas graves, excluindo-se aqueles com registos/arquivo clínico incompleto, curva major <75° e doentes que realizaram correção cirúrgica incluindo uma via anterior. Foram colhidos dados sobre a classificação etiológica, procedimentos cirúrgicos e internamento.
Resultados: O estudo analisou 12 pacientes (10 femininos e 2 masculinos) com idade média à data da cirurgia de 14 anos e escoliose de etiologia neuromuscular, idiopática ou congénita. Todos os doentes realizaram duas cirurgias, com 1 tempo de libertação, osteotomias, instrumentação e um tempo final de estabilização definitiva, intervalados por um período variável de tração. Registou-se um tempo cirúrgico total médio de 457 minutos, perdas hemáticas médias de 943 ml, havendo um período de tração médio total de 28,1 dias. A hospitalização média foi de 35,8 dias, com 3,3 dias nos cuidados intensivos. Registaram-se quatro complicações pós-operatórias. A correção média da curvatura major foi de 60,5%, reduzindo o ângulo de Cobb inicial de 112,5° para 44,4°, com uma perda de correção média de 2.2° após dois anos de seguimento.
Conclusão: Este estudo indica que a correção da escoliose severa em duas etapas por via posterior é uma opção válida, segura e proporcionando boas correções da deformidade, implicando a necessidade de um tempo de internamento prolongado e o apoio multidisciplinar de um centro diferenciado.
Introduction: Scoliosis is a three-dimensional deformity of the spine that affects the coronal and sagittal planes and includes a rotational component. It can cause pain, body asymmetry, and impact self-image. With varied etiology, 80% of cases are idiopathic. Classification considers age, deformity, and location, and treatment ranges from surveillance to surgery, depending on severity. Methods: A total of 188 patients with scoliosis operated on between 2004-2023 at the Local Health Unit of Santa Maria were analyzed. Were included patients who underwent two-stage surgical correction for severe scoliotic curves, excluding those with incomplete clinical records/files, major curve <75° and patients who underwent surgical correction including an anterior approach. Data were collected on etiological classification, surgical procedures, and hospitalization. Results: The study analyzed 12 patients (10 females and 2 males) with a mean age at surgery of 14 years and scoliosis of neuromuscular, idiopathic or congenital etiology. All patients underwent two surgeries, with the first stage involving release, osteotomies, instrumentation, and the final stage involving definitive stabilization, separated by a variable traction period. The average total surgical time was 457 minutes, with an average blood loss of 943 ml, and a total average traction period of 28.1 days. The average hospitalization was 35.8 days, with 3.3 days in intensive care. Four postoperative complications were recorded. The average correction of the major curve was 60.5%, reducing the initial Cobb angle from 112.5° to 44.4°, with an average correction loss of 2.2° after two years of follow-up. Conclusion: This study indicates that severe scoliosis correction in two stages via the posterior approach is a valid and safe option, providing good deformity corrections, requiring a prolonged hospitalization period and multidisciplinary support from a specialized center.
Introduction: Scoliosis is a three-dimensional deformity of the spine that affects the coronal and sagittal planes and includes a rotational component. It can cause pain, body asymmetry, and impact self-image. With varied etiology, 80% of cases are idiopathic. Classification considers age, deformity, and location, and treatment ranges from surveillance to surgery, depending on severity. Methods: A total of 188 patients with scoliosis operated on between 2004-2023 at the Local Health Unit of Santa Maria were analyzed. Were included patients who underwent two-stage surgical correction for severe scoliotic curves, excluding those with incomplete clinical records/files, major curve <75° and patients who underwent surgical correction including an anterior approach. Data were collected on etiological classification, surgical procedures, and hospitalization. Results: The study analyzed 12 patients (10 females and 2 males) with a mean age at surgery of 14 years and scoliosis of neuromuscular, idiopathic or congenital etiology. All patients underwent two surgeries, with the first stage involving release, osteotomies, instrumentation, and the final stage involving definitive stabilization, separated by a variable traction period. The average total surgical time was 457 minutes, with an average blood loss of 943 ml, and a total average traction period of 28.1 days. The average hospitalization was 35.8 days, with 3.3 days in intensive care. Four postoperative complications were recorded. The average correction of the major curve was 60.5%, reducing the initial Cobb angle from 112.5° to 44.4°, with an average correction loss of 2.2° after two years of follow-up. Conclusion: This study indicates that severe scoliosis correction in two stages via the posterior approach is a valid and safe option, providing good deformity corrections, requiring a prolonged hospitalization period and multidisciplinary support from a specialized center.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Escoliose severa Cirurgia em dois tempos Abordagem anterior Abordagem posterior Resultado do tratamento Ortopedia