Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain.
Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain.
Spine (Phila Pa 1976). 2018 Jul 1;43(13):913-918. doi: 10.1097/BRS.0000000000002476.
Retrospective comparative analysis of data collected prospectively in an adult spine deformity (ASD) multicenter database.
To evaluate the impact of the iliac screws on the quality of life of ASD patients compared with those instrumented above the pelvis (L5/S1/S2).
The impact on patient's daily activities and functions, of immobilizing the sacroiliac joint with iliac screws for the treatment of ASD is still underexplored.
Inclusion criteria were ASD patients with a long arthrodesis of at least eight levels and whose lowest instrumented vertebrae (LIV) were L5 or below. We analyzed the following preoperative and 2 years' follow-up variables: age, Cobb angle, coronal and sagittal alignment, number of instrumented levels, Oswestry Disability Index (ODI), Core Outcome Measures Index (COMI), Scoliosis Research Society-22 (SRS-22), and Short Form 36 (SF-36) questionnaires. Statistical analysis was performed with Mann-Whitney U test, and Wilcoxon test.
A total of 129 patients were included, and separated into two groups: "Iliac Yes," with the LIV at the Ilium (N = 104), and "iliac No," with the LIV at L5/S1/S2 (N = 25). Patients instrumented with Iliac screws were older (x = 66 vs. 56 yr, P = 0.008), and had lower Cobb magnitude (x = 31° vs. 45°, P = 0.019). No statistically significant differences were found in the health related quality of life (HRQOL) questionnaires prior to surgery or at 2-years' follow up. The "Iliac Yes" group significantly improved all radiographic and HRQOL scores parameters 2 years after surgery (P < 0.005). While the "Iliac No" group failed to significantly improve (coronal balance, sagittal vertical axis, SF-36 Physical functioning, SF-36 General health, and COMI) (P > 0.05) CONCLUSION.: ASD patients instrumented with iliac screws significantly improved all their HRQOL questionnaires 2 years after surgery. The 2 years' postoperative HRQOL scores were similar in both groups, regardless of the sacroiliac joint immobilization. Therefore, with the currently available tools, we cannot state that iliac instrumentation has a negative influence on patient's quality of life.
对成人脊柱畸形（ASD）多中心数据库中前瞻性收集的数据进行回顾性比较分析。
评估与骨盆以上（L5/S1/S2）固定相比，髂骨螺钉对 ASD 患者生活质量的影响。
对于 ASD 患者，使用髂骨螺钉固定骶髂关节以治疗脊柱畸形对其日常生活和功能的影响仍未得到充分探索。
纳入标准为至少融合 8 个节段且最低固定椎体（LIV）为 L5 或以下的 ASD 患者。我们分析了以下术前和 2 年随访变量：年龄、Cobb 角、冠状面和矢状面排列、固定节段数、Oswestry 功能障碍指数（ODI）、核心结局测量指数（COMI）、脊柱侧凸研究协会 22 项（SRS-22）和 36 项简短健康调查问卷（SF-36）。采用 Mann-Whitney U 检验和 Wilcoxon 检验进行统计学分析。
共纳入 129 例患者，分为两组：“髂骨螺钉固定组”（LIV 在髂骨，N=104）和“无髂骨螺钉固定组”（LIV 在 L5/S1/S2，N=25）。使用髂骨螺钉固定的患者年龄更大（x=66 岁比 56 岁，P=0.008），Cobb 角更小（x=31°比 45°，P=0.019）。术前和 2 年随访时，两组患者的健康相关生活质量（HRQOL）问卷均无统计学差异。“髂骨螺钉固定组”在术后 2 年所有影像学和 HRQOL 评分参数均显著改善（P<0.005）。而“无髂骨螺钉固定组”未能显著改善（冠状平衡、矢状垂直轴、SF-36 躯体功能、SF-36 总体健康和 COMI）（P>0.05）。
使用髂骨螺钉固定的 ASD 患者在术后 2 年显著改善了所有 HRQOL 问卷。两组患者的 2 年术后 HRQOL 评分相似，无论骶髂关节是否固定。因此，根据目前的工具，我们不能说髂骨器械对患者的生活质量有负面影响。
4 级
