青少年椎弓根峡部裂的自然病史及中期随访
Benign Natural History of Spondylolysis in Adolescence With Midterm Follow-Up.
作者信息
Sousa Ted, Skaggs David L, Chan Priscella, Yamaguchi Kent T, Borgella Jerald, Lee Christopher, Sawyer Jeffrey, Moisan Alice, Flynn John M, Gunderson Melissa, Hresko M Timothy, D'Hemecourt Pierre, Andras Lindsay M
机构信息
Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #69, Los Angeles, CA 90027, USA.
Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #69, Los Angeles, CA 90027, USA.
出版信息
Spine Deform. 2017 Mar;5(2):134-138. doi: 10.1016/j.jspd.2016.10.005.
STUDY DESIGN
Retrospective chart review.
OBJECTIVES
To use the Micheli Functional Scale to assess adolescent patients with spondylolysis treated conservatively at midterm follow-up.
SUMMARY OF BACKGROUND
Spondylolysis is a common source of back pain for adolescents and is generally managed with bracing and physical therapy. There is little data regarding the results of conservative management of spondylolysis over time.
METHODS
Four major academic pediatric institutions performed a retrospective chart review of patients from 5 to 21 years of age with the initial diagnosis of spondylolysis. Inclusion criteria were patients who initially underwent conservative management and had a minimum of 2 years' follow-up. The patients were contacted and asked to complete the Micheli Functional Scale Survey.
RESULTS
A total of 295 patients with the diagnosis of spondylolysis were identified and contacted. Sixty-one subjects with spondylolysis completed the follow-up survey. Sixty of 61 respondents (98%) answered questions regarding their current pain level. Thirty-five of 60 (58.3%) reported no pain (0/10) and 47/60 (78%) rated their pain at 3 or less, whereas 22% (13/60) rated their pain as 4 or higher. There was no correlation with pain ratings on the follow-up survey and radiographic healing at initial management. Of the 61 patients, 50 returned to sports (82%), 8 did not return (13%), and 5 returned to most but not all of their sports (8%). No correlation was observed between radiographic healing and return to sports (p = .4885).
CONCLUSION
Using a validated functional scale, this study demonstrated that with conservative management of spondylolysis a majority of patients at an average of 8 years out self-report a return to sports (90%), though many reported continued pain (42%) and interference with activities (67%). There was no correlation observed between radiographic evidence of healing and pain or return to sports with a mean follow-up of 8 years.
LEVEL OF EVIDENCE
Multicenter retrospective case series.
研究设计
回顾性病历审查。
目的
运用米凯利功能量表对接受保守治疗的脊柱裂青少年患者进行中期随访评估。
背景概述
脊柱裂是青少年背痛的常见原因，一般采用支具和物理治疗。关于脊柱裂保守治疗随时间推移的结果的数据较少。
方法
四家主要的学术儿科机构对5至21岁初诊为脊柱裂的患者进行回顾性病历审查。纳入标准为最初接受保守治疗且至少随访2年的患者。联系这些患者并要求他们完成米凯利功能量表调查。
结果
共识别并联系了295例诊断为脊柱裂的患者。61例脊柱裂患者完成了随访调查。61名受访者中有60名（98%）回答了关于他们当前疼痛程度的问题。60名中有35名（58.3%）报告无疼痛（0/10），47/60（78%）将他们的疼痛评为3分或更低，而22%（13/60）将他们的疼痛评为4分或更高。随访调查中的疼痛评分与初始治疗时的影像学愈合情况无相关性。61例患者中，50例恢复运动（82%），8例未恢复（13%），5例恢复了大部分但并非所有运动（8%）。影像学愈合与恢复运动之间未观察到相关性（p = 0.4885）。
结论
本研究使用经过验证的功能量表表明，脊柱裂采用保守治疗后，大多数患者平均在8年后自我报告恢复运动（90%），尽管许多患者报告仍持续疼痛（42%）且活动受到影响（67%）。平均随访8年时，愈合的影像学证据与疼痛或恢复运动之间未观察到相关性。
证据水平
多中心回顾性病例系列。
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