脑瘫儿童脊柱融合术后的健康相关生活质量及照顾者负担
Health-Related Quality of Life and Care Giver Burden Following Spinal Fusion in Children With Cerebral Palsy.
作者信息
DiFazio Rachel L, Miller Patricia E, Vessey Judith A, Snyder Brian D
机构信息
Orthopedic Center, Boston Children's Hospital, Boston, MA.
William F. Connell School of Nursing, Boston College, Chestnut Hill, MA.
出版信息
Spine (Phila Pa 1976). 2017 Jun 15;42(12):E733-E739. doi: 10.1097/BRS.0000000000001940.
STUDY DESIGN
A prospective longitudinal cohort.
OBJECTIVE
The objective of this study was to evaluate changes in caregivers' perceptions of health-related quality of life (HRQOL) and caregiver burden in children with severe cerebral palsy (CP) following spinal fusion.
SUMMARY OF BACKGROUND DATA
Progressive scoliosis is common in nonambulatory children with CP; the utility of spine fusion has been long debated and prospective evaluations of patient reported outcomes are limited.
METHODS
Children 3 to 21 years old, gross motor classification system (GMFCS) IV-V CP, scheduled for spine fusion were enrolled consecutively from September 2011 to March 2014. Caregivers completed the CPCHILD and ACEND pre-operatively and at 6 weeks, 3, 6, 12, and 24 months postoperatively. Changes in CPCHILD and ACEND scores from preoperative to 1 and 2 years after surgery were assessed using paired t tests. Correlations between preoperative Cobb angle and CPCHILD and ACEND scores were evaluated using Pearson's correlation analysis.
RESULTS
Twenty-six GMFCS IV-V CP patients with severe scoliosis treated with spine fusion were included. Mean age was 14 years, 50% male, and 46% had instrumentation to the pelvis. Average preoperative Cobb angle was 68.9° (SD 25.68) with an average improvement of 76%. The CPCHILD score increased by 9.8 points above baseline [95% confidence interval (95% CI): 3.4-16.2] at 1 year postoperatively (P = 0.005). However, at 2 years, the CPCHILD score regressed to baseline (P = 0.40). ACEND scores did not change from baseline scores at 1-year (P = 0.09) and 2-year (P = 0.72) follow-up, reflecting that caregiver burden is little changed by spine fusion. There was no correlation between preoperative Cobb angle and CPCHILD score (P = 0.52) or ACEND score (P = 0.56) at 1-year or 2-year follow-up (P = 0.69, P = 0.90). Children with Cobb angle ≤75° experienced more improvement 1 year after surgery than children with Cobb angle >75°.
CONCLUSION
HRQOL improves 1 year following spine fusion but regresses to baseline after 2 years. Caregiver burden was unchanged following spine fusion.
LEVEL OF EVIDENCE
研究设计
前瞻性纵向队列研究。
目的
本研究的目的是评估脊柱融合术后重度脑瘫（CP）患儿的照料者对健康相关生活质量（HRQOL）的认知变化以及照料者负担。
背景数据总结
进行性脊柱侧弯在非行走型CP患儿中很常见；脊柱融合术的效用长期以来一直存在争议，且对患者报告结局的前瞻性评估有限。
方法
2011年9月至2014年3月，连续纳入计划进行脊柱融合术的3至21岁、粗大运动功能分类系统（GMFCS）IV - V级的CP患儿。照料者在术前以及术后6周、3个月、6个月、12个月和24个月完成CPCHILD和ACEND问卷。使用配对t检验评估从术前到术后1年和2年CPCHILD和ACEND评分的变化。使用Pearson相关分析评估术前Cobb角与CPCHILD和ACEND评分之间的相关性。
结果
纳入26例接受脊柱融合术治疗的GMFCS IV - V级重度脊柱侧弯CP患者。平均年龄为14岁，50%为男性，46%的患者融合至骨盆。术前平均Cobb角为68.9°（标准差25.68），平均改善76%。术后1年，CPCHILD评分比基线提高9.8分[95%置信区间（95%CI）：3.4 - 16.2]（P = 0.005）。然而，在2年时，CPCHILD评分回归至基线（P = 0.40）。在1年（P = 0.09）和2年（P = 0.72）随访时，ACEND评分与基线评分无变化，表明脊柱融合术对照料者负担影响不大。在1年或2年随访时，术前Cobb角与CPCHILD评分（P = 0.52）或ACEND评分（P = 0.56）之间无相关性（P = 0.69，P = 0.90）。Cobb角≤75°的患儿术后1年比Cobb角>75°的患儿改善更明显。
结论
脊柱融合术后1年HRQOL改善，但2年后回归至基线。脊柱融合术后照料者负担未改变。
证据级别
2级。
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