DeFrancesco Christopher J, Miller Daniel J, Cahill Patrick J, Spiegel David A, Flynn John M, Baldwin Keith D
1 Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
J Orthop Surg (Hong Kong). 2018 May-Aug;26(2):2309499018782556. doi: 10.1177/2309499018782556.
Feeding difficulties are common among patients with cerebral palsy (CP) and neuromuscular (NM) scoliosis. We theorize that posterior spinal fusion (PSF) reduces intra-abdominal pressure, resulting in improved feeding and subsequent weight gain. We hypothesized that, among nonambulatory patients with CP and NM scoliosis, we would observe significant gain in weight following PSF.
Fifty subjects with nonambulatory CP who underwent PSF for NM scoliosis were included. Age and weight were recorded for the preoperative year; on the day of surgery; and at 6-month, 1-year, and 2-year follow-up. Weights were converted to weight percentiles using CP-specific growth charts. The weight percentile distributions were compared between time points using descriptive statistics as well as regression analysis.
The average change in weight from the day of surgery to 2-year follow-up was +3.4 percentiles. Patients who started out under the 50th percentile gained an average of 17.3 percentiles in the first year after PSF ( p = 0.009). Regression analysis showed that patients with baseline weight <50th percentile tended to gain in weight percentile over the first postoperative year ( β = 1.990, p = 0.001). No trend was present among this group prior to surgery ( p = 0.692) or during the second postoperative year ( p = 0.945). No trends were noted prior to or after surgery for patients with baseline weights ≥50th percentile. No significant association was observed between curve severity (measured by preoperative Cobb angle) and weight change.
This series is the first to document significant weight gain after PSF for NM scoliosis, supporting the theory that spinal correction improves digestive function.
Prognostic level II.
喂养困难在脑瘫（CP）和神经肌肉型（NM）脊柱侧弯患者中很常见。我们推测后路脊柱融合术（PSF）可降低腹内压，从而改善喂养情况并使体重增加。我们假设，在非行走型CP和NM脊柱侧弯患者中，PSF术后体重会显著增加。
纳入50例因NM脊柱侧弯接受PSF的非行走型CP患者。记录术前一年、手术当天、术后6个月、1年和2年的年龄和体重。使用CP特异性生长图表将体重换算为体重百分位数。使用描述性统计和回归分析比较各时间点的体重百分位数分布。
从手术当天到2年随访时体重的平均变化为增加3.4个百分位数。初始体重低于第50百分位数的患者在PSF后的第一年平均体重增加了17.3个百分位数（p = 0.009）。回归分析显示，基线体重<第50百分位数的患者在术后第一年体重百分位数往往会增加（β = 1.990，p = 0.001）。该组患者在手术前（p = 0.692）或术后第二年（p = 0.945）均无此趋势。基线体重≥第50百分位数的患者在手术前后均未发现趋势。未观察到曲线严重程度（通过术前Cobb角测量）与体重变化之间存在显著关联。
本系列研究首次记录了PSF治疗NM脊柱侧弯后体重显著增加，支持了脊柱矫正可改善消化功能这一理论。
预后II级。
