患者自评外观在青少年特发性脊柱侧凸的手术治疗中，所有椎弓根螺钉改善均优于杂交结构。
Patient self-assessment of appearance is improved more by all pedicle screw than by hybrid constructs in surgical treatment of adolescent idiopathic scoliosis.
机构信息
School of Medicine, University of California, San Francisco, CA 94143–0728, USA.
出版信息
Spine (Phila Pa 1976). 2011 Feb 1;36(3):248-54. doi: 10.1097/BRS.0b013e3181cdb4be.
STUDY DESIGN
A multicenter prospective cohort study.
OBJECTIVE
To compare the effect of all pedicle screw versus hybrid constructs on patient self-assessment of appearance after posterior spinal fusion with instrumentation for adolescent idiopathic scoliosis (AIS). This will contribute to future cost-effective analyses on surgical management of AIS.
SUMMARY OF BACKGROUND DATA
For surgical management of AIS, the Spinal Appearance Questionnaire (SAQ) and the Scoliosis Research Society outcomes instrument (SRS-30) are reliable surveys of patient satisfaction, but neither tool has been used to assess outcome by implant type.
METHODS
Patients received either all pedicle screws or hybrid instrumentation. Self-assessment of appearance pre- and after surgery was measured by SAQ and SRS-30. Statistical significance was evaluated through P values (P < 0.01 in the SAQ, P < 0.05 in the SRS-30) and effect sizes.
RESULTS
There were 93 patients in the all pedicle screw cohort and 61 in the hybrid cohort. There were no significant preoperative differences between the cohorts in the SAQ or SRS-30. All pedicle screw patients tended to see more improvement in shoulder level than hybrid patients in 2 separate SAQ questions (P = 0.025, Cohen's D = 0.20; P = 0.013, D = 0.24). The screw patients also tended to have better scores than hybrid patients in the category, "looking better in clothes" (P = 0.017, V = 0.24) at 2 years postoperative. All pedicle screw patients self-reported significant greater improvement than hybrid patients in the SRS-30 Appearance and Mental domains (P = 0.016, ES = 0.038; P = 0.005, ES = 0.051). There were no significant differences between cohorts in age, gender, baseline curve, or major curve magnitude.
CONCLUSION
All pedicle screw constructs lead to better self-assessment of appearance in operative treatment of AIS, as determined by SAQ and SRS-30.
研究设计
一项多中心前瞻性队列研究。
目的
比较全椎弓根螺钉与杂交结构对青少年特发性脊柱侧凸（AIS）后路脊柱融合内固定术后患者外观自我评估的影响。这将有助于对 AIS 手术治疗的未来成本效益分析。
背景资料总结
对于 AIS 的手术治疗，脊柱外观问卷（SAQ）和脊柱侧凸研究协会结果工具（SRS-30）是患者满意度的可靠评估工具，但这两种工具都没有用于评估植入物类型的结果。
方法
患者接受全椎弓根螺钉或杂交器械治疗。手术前后通过 SAQ 和 SRS-30 评估外观自我评估。通过 P 值（SAQ 中 P < 0.01，SRS-30 中 P < 0.05）和效应大小评估统计显著性。
结果
全椎弓根螺钉组 93 例，杂交组 61 例。SAQ 和 SRS-30 两组患者术前无显著差异。在 2 个独立的 SAQ 问题中，全椎弓根螺钉患者的肩部水平改善趋势优于杂交患者（P = 0.025，Cohen's D = 0.20；P = 0.013，D = 0.24）。在术后 2 年，螺钉患者在“穿着更好看”这一类别中的评分也优于杂交患者（P = 0.017，V = 0.24）。与杂交患者相比，全椎弓根螺钉患者在 SRS-30 外观和精神领域的自我报告改善更为显著（P = 0.016，ES = 0.038；P = 0.005，ES = 0.051）。两组患者在年龄、性别、基线曲线和主曲线幅度方面无显著差异。
结论
通过 SAQ 和 SRS-30，全椎弓根螺钉结构在 AIS 的手术治疗中导致更好的外观自我评估。
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