Evaniew Nathan, Devji Tahira, Drew Brian, Peterson Devin, Ghert Michelle, Bhandari Mohit
Division of Orthopaedics, Department of Surgery, McMaster University, 293 Wellington St N, Suite 110, Hamilton, ON L8L 8E7 Canada.
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada.
Scoliosis. 2015 Jan 9;10(1):1. doi: 10.1186/s13013-014-0026-3. eCollection 2015.
Scoping reviews are innovative studies that can map a range of evidence to convey the breadth and depth of a large field. An evidence-based approach to the wide spectrum of surgical interventions for scoliosis is paramount to enhance clinical outcomes. The objectives of this scoping review were to identify critical knowledge gaps and direct future research.
This study was completed according to the methodology of Arksey and O'Malley. Two reviewers performed duplicate systematic screening of eligibility. Studies were classified according to patient age, scoliosis etiology, outcomes reported, study design, and overall research theme.
There were 1763 eligible studies published between 1966 and 2013. The literature focused on adolescents (83% of studies) with idiopathic scoliosis (72%). There was a dominance of observational designs (88%), and a paucity of randomized trials (4%) or systematic reviews (1%). Fifty six percent of studies were conducted in North America, followed by 23% in Europe and 18% in Asia. Few high-level studies investigated surgical indications, surgical approaches, surgical techniques, or implant selection. Patient important outcomes including function, health-related quality of life, pain, and rates or re-operation were infrequently reported.
Current research priorities are to (1) undertake high-quality knowledge synthesis and knowledge translation activities; (2) conduct a series of planning meetings to engage clinicians, patients, and methodologists; and (3) clarify outcome reporting and strategies for methodological improvement. Higher-quality studies are specifically needed to inform surgical indications, surgical approaches, surgical techniques, and implant selection. Engaging global partners may increase generalizability.
范围综述是一种创新性研究，可梳理一系列证据以展现某一广阔领域的广度和深度。采用循证方法处理脊柱侧弯的广泛外科干预措施对于改善临床疗效至关重要。本范围综述的目的是识别关键知识空白并指导未来研究。
本研究按照阿克西和奥马利的方法完成。两名评审员对纳入标准进行了重复的系统筛选。研究根据患者年龄、脊柱侧弯病因、报告的结局、研究设计和总体研究主题进行分类。
1966年至2013年间共发表了1763项符合条件的研究。文献主要关注青少年（占研究的83%）特发性脊柱侧弯（占72%）。观察性设计占主导（88%），随机试验（4%）或系统评价（1%）较少。56%的研究在北美进行，其次是欧洲的23%和亚洲的18%。很少有高级别研究调查手术指征、手术入路、手术技术或植入物选择。很少报告患者的重要结局，包括功能、健康相关生活质量、疼痛以及再次手术率。
当前的研究重点是：（1）开展高质量的知识整合和知识转化活动；（2）召开一系列规划会议，让临床医生、患者和方法学家参与；（3）明确结局报告和方法改进策略。尤其需要高质量的研究来为手术指征、手术入路、手术技术和植入物选择提供依据。吸引全球合作伙伴可能会提高研究结果的普遍性。
