Toombs Courtney, Lonner Baron, Shah Suken, Samdani Amer, Cahill Patrick, Shufflebarger Harry, Yaszay Burt, Sponseller Paul, Newton Peter
New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA.
Department of Orthopaedic Surgery, Mount Sinai-Beth Israel Medical Center, 1st Avenue &, E 16th St, New York, NY 10003, USA.
Spine Deform. 2018 Nov-Dec;6(6):676-683. doi: 10.1016/j.jspd.2018.04.009.
Preoperative and two-year follow-up health-related quality of life (HRQOL) data were prospectively collected in 82 Scheuermann kyphosis (SK) and 995 adolescent idiopathic scoliosis (AIS) patients using the Scoliosis Research Society-22 patient questionnaire (SRS-22) outcomes instrument in a multicenter study. Visual analog scale (VAS) scores were also collected for the SK population.
This study assessed changes in HRQOL prospectively and compared them to those occurring in AIS.
There has been limited evaluation of patient-reported HRQOL changes with operative management of SK.
Median SRS values for the SK and AIS cohorts were compared using a repeated measure of analysis of variance with age as a covariate and using a Mann-Whitney U nonparametric comparison.
Kyphosis was corrected from 73.9° to 45.8° (p < .001); the major curve in AIS was corrected from 55.5 to 20.2 (p < .001). Preoperative and magnitude of radiographic correction, kyphosis apex and body mass index in SK were not correlated with baseline or change in HRQOL. SK SRS scores improved after surgery in all domains with the greatest change (2.8-4.4) in self-image (p < .001). Changes in SRS Pain, Activity, and Self-Image domains met the minimal clinically important difference. Baseline SK and AIS scores differed significantly in the Self-Image, Mental Health and Total Score domains, with SK having worse scores (p < .001). At two years postoperatively, the greatest improvements were made in Self-Image, along with Mental Health and Total Score, and the SK group achieved greater gains (p < .001). At two years postoperatively, the SK scores improved to reach equivalent values to the AIS scores. VAS scores improved from 3.69 to 1.51, and these changes were correlated with change in the Pain, Mental Health, and Total Score SRS domains (p < .001).
Surgery for SK in the adolescent population results in significant improvements in HRQOL, which outpace those of the AIS population.
Level II.
在一项多中心研究中，使用脊柱侧弯研究协会22项患者问卷（SRS - 22）结果工具，前瞻性收集了82例休门氏后凸畸形（SK）患者和995例青少年特发性脊柱侧弯（AIS）患者术前及两年随访的健康相关生活质量（HRQOL）数据。还收集了SK患者的视觉模拟量表（VAS）评分。
本研究前瞻性评估HRQOL的变化，并将其与AIS患者的变化进行比较。
关于SK手术治疗后患者报告的HRQOL变化的评估有限。
使用重复测量方差分析，以年龄作为协变量，并采用曼 - 惠特尼U非参数比较，比较SK和AIS队列的SRS中位数。
后凸畸形从73.9°矫正至45.8°（p <.001）；AIS的主弯从55.5°矫正至20.2°（p <.001）。SK患者术前、影像学矫正程度、后凸顶点和体重指数与HRQOL的基线或变化无关。SK患者术后所有领域的SRS评分均有改善，自我形象领域变化最大（2.8 - 4.4）（p <.001）。SRS疼痛、活动和自我形象领域的变化达到了最小临床重要差异。SK和AIS患者的基线自我形象、心理健康和总分领域评分差异显著，SK患者得分更低（p <.001）。术后两年，自我形象、心理健康和总分改善最大，SK组改善更大（p <.001）。术后两年，SK患者的评分提高到与AIS患者相当的水平。VAS评分从3.69改善至1.51，这些变化与疼痛、心理健康和总分SRS领域的变化相关（p <.001）。
青少年SK手术可显著改善HRQOL，且改善程度超过AIS患者。
二级。
