Zebracki Kathy, Thawrani Dinesh, Oswald Timothy S, Anadio Jennifer M, Sturm Peter F
Shriners Hospitals for Children, Chicago, IL, USA.
J Pediatr Orthop. 2013 Sep;33(6):624-7. doi: 10.1097/BPO.0b013e318288b77f.
Patients with idiopathic scoliosis, although otherwise healthy, often have significant concerns about their self-image and appearance. In a group of juveniles and adolescents, this can impact adjustment in school, functioning in peer groups, and general sense of well-being. There are limited data to help physicians reliably and precisely identify those who are at higher risk of poor emotional adjustment even after spine deformity correction. The purpose of this study was to determine the predictors of emotional maladjustment in juvenile and adolescent patients after surgical correction of idiopathic scoliosis.
A total of 233 juveniles, mean age 11.26 ± 1.02 (range, 8 to 12) years and 909 adolescents, mean age 14.91 ± 1.61 (range, 13 to 21) years, who underwent surgical correction for idiopathic scoliosis and who were participating in a prospective longitudinal multicenter database, were enrolled in the study. Participants completed the Scoliosis Research Society-22 (SRS-22) questionnaire before surgery and 2 years postoperatively. Radiographs were used to measure Cobb angle and surface measurements were used to determine decompensation and trunk shift.
Adolescents reported poorer mental health preoperatively (P<0.05) and 2 years postoperatively (P<0.001) than juveniles; however, both groups reported improved mental health (P<0.001) and self-image (P<0.01) postoperatively. Mental health 2 years postoperatively was predicted by preoperative self-image (P<0.05), mental health (P<0.001), and main thoracic Cobb angle (P<0.05) in the juvenile group. Within the adolescent group, mental health 2 years postoperatively was predicted by preoperative mental health (P<0.001); self-image 2 years postoperatively was predicted by preoperative mental health (P<0.01) and self-image (P<0.001).
Self-image and mental health are significantly improved after spine deformity correction in juveniles and adolescents with idiopathic scoliosis. However, consistent with normative development, adolescents are at higher risk for emotional maladjustment than juveniles. Surgical decision making in scoliosis correction should take the emotional status of the patient into consideration.
特发性脊柱侧弯患者尽管在其他方面健康，但通常对自身形象和外观极为关注。在青少年群体中，这可能会影响他们在学校的适应情况、在同伴群体中的社交功能以及整体幸福感。即便在脊柱畸形矫正后，也仅有有限的数据可帮助医生可靠且精确地识别出那些情绪适应不良风险较高的患者。本研究的目的是确定特发性脊柱侧弯青少年患者手术矫正后情绪适应不良的预测因素。
共有233名青少年（平均年龄11.26±1.02岁，范围8至12岁）和909名青少年（平均年龄14.91±1.61岁，范围13至21岁）参与了本研究，他们均因特发性脊柱侧弯接受了手术矫正且参与了一个前瞻性纵向多中心数据库。参与者在手术前和术后2年完成了脊柱侧弯研究协会-22（SRS-22）问卷。通过X光片测量Cobb角，通过体表测量确定失代偿和躯干偏移情况。
青少年在术前（P<0.05）和术后2年（P<0.001）报告的心理健康状况比儿童差；然而，两组在术后均报告心理健康状况（P<0.001）和自我形象（P<0.01）有所改善。儿童组术后2年的心理健康状况可由术前自我形象（P<0.05）、心理健康状况（P<0.001）和胸主弯Cobb角（P<0.05）预测。在青少年组中，术后2年的心理健康状况可由术前心理健康状况（P<0.001）预测；术后2年的自我形象可由术前心理健康状况（P<0.01）和自我形象（P<0.001）预测。
特发性脊柱侧弯青少年患者脊柱畸形矫正后，自我形象和心理健康状况有显著改善。然而，与正常发育情况一致，青少年比儿童有更高的情绪适应不良风险。脊柱侧弯矫正手术的决策应考虑患者的情绪状况。
