Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
J Bone Joint Surg Am. 2018 May 16;100(10):811-817. doi: 10.2106/JBJS.17.00822.
Health-related quality of life in adults with idiopathic scoliosis diagnosed before maturity has been reported to be similar between brace-treated and surgically treated individuals. The aim of this study was to compare health-related quality of life in untreated, brace-treated, and surgically treated adults with idiopathic scoliosis diagnosed before skeletal maturity. Subgroup analyses were performed on the basis of age at the time of the study, age of onset, surgical characteristics, and curve magnitude.
We included 1,187 adults with juvenile or adolescent idiopathic scoliosis with a mean age (and standard deviation) of 38.8 ±12.7 years. Of these, 347 were untreated, 459 had been brace-treated, and 381 had been surgically treated. The Scoliosis Research Society-22r (SRS-22r) and EuroQol 5-Dimensions (EQ-5D) were used. Statistical analyses were performed using analysis of covariance.
The mean SRS-22r subscore was 4.15 ± 0.59 points for the untreated group, 4.10 ± 0.57 points for the previously braced group, and 4.01 ± 0.64 points for the surgically treated group (p = 0.007 adjusted for age and sex). The EQ-5D index was 0.82 ± 0.20 for the untreated group, 0.82 ± 0.20 for the previously brace-treated group, and 0.79 ± 0.24 for the surgically treated group (p = 0.026, adjusted for age and sex). Brace cessation was at the mean age of 16.2 ± 1.5 years, and the surgical procedure had been performed at the mean age of 15.3 ± 2.1 years. A more caudal fusion was associated with a lower SRS-22r subscore and EQ-5D index. No differences were observed when comparing individuals with juvenile or adolescent onset scoliosis (all p > 0.05).
Untreated adults with idiopathic scoliosis had similar health-related quality of life to previously brace-treated individuals, and they had marginally higher health-related quality of life compared with surgically treated individuals. Therefore, both surgical and brace treatments for idiopathic scoliosis could be considered successful from a health-related quality-of-life point of view in adulthood. The age of onset of idiopathic scoliosis does not seem to influence quality of life in adulthood.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
在成熟前被诊断为特发性脊柱侧凸的成年人中， brace-treated 和 surgically treated 个体的健康相关生活质量相似。本研究旨在比较未治疗、 brace-treated 和 surgically treated 特发性脊柱侧凸成年人的健康相关生活质量。根据研究时的年龄、发病年龄、手术特点和曲线幅度进行亚组分析。
我们纳入了 1187 名患有青少年特发性脊柱侧凸的成年人，平均年龄（标准差）为 38.8 ±12.7 岁。其中 347 名未治疗，459 名 brace-treated，381 名 surgically treated。使用 Scoliosis Research Society-22r（SRS-22r）和 EuroQol 5-Dimensions（EQ-5D）。使用协方差分析进行统计学分析。
未治疗组的 SRS-22r 亚评分平均为 4.15 ± 0.59 分，之前 brace-treated 组为 4.10 ± 0.57 分，手术治疗组为 4.01 ± 0.64 分（调整年龄和性别后 p = 0.007）。EQ-5D 指数未治疗组为 0.82 ± 0.20，之前 brace-treated 组为 0.82 ± 0.20，手术治疗组为 0.79 ± 0.24（调整年龄和性别后 p = 0.026）。Brace 停止的平均年龄为 16.2 ± 1.5 岁，手术的平均年龄为 15.3 ± 2.1 岁。更低位的融合与较低的 SRS-22r 亚评分和 EQ-5D 指数相关。比较青少年和青少年发病的特发性脊柱侧凸患者时，未观察到差异（所有 p > 0.05）。
未治疗的特发性脊柱侧凸成年人的健康相关生活质量与之前 brace-treated 个体相似，且与手术治疗个体相比，他们的健康相关生活质量略高。因此，从健康相关生活质量的角度来看，特发性脊柱侧凸的手术和 brace 治疗都可以被认为是成功的。特发性脊柱侧凸的发病年龄似乎不会影响成年人的生活质量。
治疗 III 级。请参阅作者说明，以获取完整的证据水平描述。
