Graat Harm C A, Schimmel Janneke J P, Hoogendoorn Roel J W, van Hessem Lotte, Hosman Allard, de Kleuver Marinus
Department of orthopaedic surgery, Sint Maartenskliniek, Ubbergen, the Netherlands.
Department of orthopaedic surgery, Medisch Centrum Alkmaar, The Netherlands.
Spine (Phila Pa 1976). 2016 Jul 15;41(14):E869-E878. doi: 10.1097/BRS.0000000000001402.
Cohort study.
To analyze long-term clinical and radiological outcomes of surgically treated Scheuermann patients.
Long-term clinical and radiological outcomes of surgery for Scheuermann kyphosis are unknown. A single-center cohort of 33 consecutive, surgically treated (between 1991 and 1998) Scheuermann patients was studied.
Clinical and radiological data of 29 surgically treated Scheuermann patients were collected (posterior approach n = 13; combined anterior-posterior procedure n = 16), after a mean follow-up of 18 years. Oswestry Disability Index (ODI) scores were measured preoperatively (PRE) and twice postoperatively: 2 to 8 years postoperative (FU 1) and 14 to 21 years postoperative (FU 2). Visual Analog Score pain, Short Form-36 (SF-36), and EQ-5d scores were recorded at FU 2 only. Radiographs were analyzed for correction, distal and proximal junctional kyphosis, and implant failures.
Mean preoperative kyphosis of the corrected levels was 76° (range 60°-105°) and decreased to a Cobb of 58°(range 30°-105°) at FU 2. Median Visual Analog Score was 2.5 points (range 0-8) and median ODI score was 12 (range 0-62) at FU 2. The ODI score at FU 1 was significantly better as compared to PRE (P < 0.001) and FU 2 (P < 0.001). Also, anterior-posterior treated group had a significantly better ODI score as compared to the posterior-only group (P = 0.023). EQ-5d scores on mobility, usual activities, and pain/discomfort were worse compared to an age-matched population control group; however, SF-36 outcome scores were comparable.Proximal junctional kyphosis was present in 53% of patients, distal junctional kyphosis did not occur, and implant failure/removal had occurred in 69% of patients. Radiological complications do not relate with the ODI, EQ-5d, and SF-36 and 72% of the patients were satisfied.
Radiological results of this cohort were disappointing but did not relate to clinical outcome scores. Even lumbar pain could not prevent a high patient satisfaction and quality of life. Patients treated with a combined anterior-posterior approach tended to perform better.
队列研究。
分析接受手术治疗的休门病患者的长期临床和影像学结果。
休门病后凸畸形手术的长期临床和影像学结果尚不清楚。对一个单中心队列中连续33例（1991年至1998年间）接受手术治疗的休门病患者进行了研究。
收集29例接受手术治疗的休门病患者的临床和影像学数据（后路手术n = 13；前后联合手术n = 16），平均随访18年。术前（PRE）及术后两次测量奥斯威斯利功能障碍指数（ODI）评分：术后2至8年（FU 1）和术后14至21年（FU 2）。仅在FU 2时记录视觉模拟评分疼痛、简明健康状况调查量表（SF - 36）和EQ - 5d评分。分析X线片以评估矫正情况、远端和近端交界性后凸畸形以及植入物失败情况。
矫正节段术前平均后凸畸形为76°（范围60° - 105°），在FU 2时降至Cobb角58°（范围30° - 105°）。FU 2时视觉模拟评分中位数为2.5分（范围0 - 8），ODI评分中位数为12（范围0 - 62）。FU 1时的ODI评分与PRE相比显著更好（P < 0.001），与FU 2相比也显著更好（P < 0.001）。此外，前后联合治疗组的ODI评分与单纯后路组相比显著更好（P = 0.023）。与年龄匹配的人群对照组相比，EQ - 5d在活动能力、日常活动以及疼痛/不适方面的评分更差；然而，SF - 36结果评分具有可比性。53%的患者存在近端交界性后凸畸形，未发生远端交界性后凸畸形，69%的患者发生了植入物失败/取出。影像学并发症与ODI、EQ - 5d和SF - 36无关，72%的患者表示满意。
该队列的影像学结果令人失望，但与临床结局评分无关。即使存在腰痛也并未妨碍患者的高满意度和生活质量。接受前后联合手术治疗的患者往往表现更好。
3级。
