Sewell Mathew D, Malagelada Francesc, Wallace Charlie, Gibson Alex, Noordeen Hilali, Tucker Stewart, Molloy Sean, Lehovsky Jan
The Royal National Orthopaedic Hospital, Stanmore, London, UK.
J Pediatr Orthop. 2016 Apr-May;36(3):299-304. doi: 10.1097/BPO.0000000000000447.
Scoliosis affects 50% of children with Gross Motor Function Classification System (GMFCS) level IV or V cerebral palsy (CP). In children with complex neurodisability following intervention, the WHO considers quality of life (QoL) should be assessed to aid decision-making and assess the effects. This study assesses whether scoliosis surgery improves carer-assessed QoL for children with severe CP.
Retrospective review of 33 children (16 male:17 female) with GMFCS level IV/V CP and significant scoliosis. Fifteen underwent observational treatment during childhood, and 18 underwent surgery. Questionnaire and radiographic data were recorded over a 2-year period. The carer-completed Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaire was used to assess QoL.
In the observational group, Cobb angle and pelvic obliquity increased from 46 (40 to 60) and 8 degrees (0 to 28) to 62 (42 to 94) and 12 degrees (1 to 35). Mean CPCHILD score decreased from 50 (30 to 69) to 48 (27 to 69) (P<0.05). In the operative group, Cobb angle and pelvic obliquity decreased from 78 (52 to 125) and 14 degrees (1 to 35) to 44 (16 to 76) and 9 degrees (1 to 24). Mean CPCHILD score increased from 45 (20 to 60) to 58 (37 to 76) (P<0.05). Change in pain, and not presence of associated impairments, was the most significant factor affecting QoL changes for children in both groups. There was no difference in mobility, GMFCS level, feeding, or communication in either group before and after treatment.
Nonoperative treatment for children with GMFCS level IV/V CP and a significant scoliosis was associated with a small decrease in carer-assessed QoL over 2 years. Spinal fusion was associated with an increase in QoL. Change in pain was the most significant factor affecting QoL changes, and is therefore an important factor to consider when deciding upon surgery.
Level III-therapeutic retrospective study.
脊柱侧弯影响50%的粗大运动功能分类系统（GMFCS）IV级或V级脑瘫（CP）儿童。对于干预后患有复杂神经残疾的儿童，世界卫生组织认为应评估生活质量（QoL）以辅助决策并评估效果。本研究评估脊柱侧弯手术是否能改善重度脑瘫儿童经照料者评估的生活质量。
回顾性分析33例（男16例，女17例）GMFCS IV/V级脑瘫且有明显脊柱侧弯的儿童。15例在儿童期接受观察性治疗，18例接受手术。在2年期间记录问卷和影像学数据。使用照料者完成的《照料者优先事项及残疾儿童健康生活指数》（CPCHILD）问卷评估生活质量。
在观察组中，Cobb角和骨盆倾斜度从46°（40°至60°）和8°（0°至28°）增加到62°（42°至94°）和12°（1°至35°）。CPCHILD平均评分从50（30至69）降至48（27至69）（P<0.05）。在手术组中，Cobb角和骨盆倾斜度从78°（52°至125°）和14°（1°至35°）降至44°（16°至76°）和9°（1°至24°）。CPCHILD平均评分从45（20至60）增至58（37至76）（P<0.05）。疼痛的变化而非相关损伤的存在是影响两组儿童生活质量变化的最显著因素。两组治疗前后在活动能力、GMFCS分级、喂养或沟通方面均无差异。
GMFCS IV/V级脑瘫且有明显脊柱侧弯的儿童接受非手术治疗在2年内经照料者评估的生活质量略有下降。脊柱融合术与生活质量的提高相关。疼痛的变化是影响生活质量变化的最显著因素，因此是决定是否手术时需要考虑的重要因素。
III级——治疗性回顾性研究。
