青少年特发性脊柱侧凸治疗后的最低20年健康相关生活质量和手术率
Minimum 20-Year Health-Related Quality of Life and Surgical Rates After the Treatment of Adolescent Idiopathic Scoliosis.
作者信息
Larson A Noelle, Baky Fady, Ashraf Ali, Baghdadi Yaser M, Treder Vickie, Polly David W, Yaszemski Michael J
机构信息
Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
出版信息
Spine Deform. 2019 May;7(3):417-427. doi: 10.1016/j.jspd.2018.09.003.
STUDY DESIGN
Longitudinal cohort.
OBJECTIVES
To determine the patient-reported functional outcomes and need for related surgical procedures in a US cohort of adolescent idiopathic scoliosis (AIS) patients with minimum 20-year follow-up.
SUMMARY OF BACKGROUND DATA
There is limited information regarding the long-term outcomes of scoliosis treatment in the US population.
METHODS
A novel population of patients who underwent pediatric treatment for AIS with minimum 20-year follow-up was identified. Search of a single-center diagnostic registry generated 337 patients who fulfilled the inclusion criteria (AIS, curve magnitude >35°, and childhood treatment with bracing, surgery, or observation from 1975 to 1992). Any additional spine surgery as well as EQ5D, ODI, SRS 22, SAQ were determined. A total of 180 patients were included (mean of 30-year follow-up, range 20-37). Childhood treatment entailed bracing (41 patients), surgery (103 patients), and observation (36 patients).
RESULTS
During the study period, only 1 of the 41 bracing patients underwent additional scoliosis-related spine surgery, whereas 5 of the 36 patients in the observation cohort underwent scoliosis surgery as adults. Seven of 103 childhood surgical patients required additional revision surgery as adults. Fifteen patients (4 braced, 7 fusion, and 4 observed) underwent chest wall surgery as adults. SRS scores were around 10% worse compared to population-based controls, with the exception of SRS mental health scores, which were similar to controls. Overall, 5.6% of patients were on disability, with no difference between operative and nonoperative groups.
CONCLUSION
We found a low rate of adult scoliosis surgery in the braced population, and a low rate of revision surgery at the 30-year follow-up in patients undergoing spine fusion for AIS between 1975 and 1992. No detected differences in patient-reported outcomes were found between the braced, surgical, and observed populations at a mean of 30 years' follow-up.
LEVEL OF EVIDENCE
Level III, therapeutic.
研究设计
纵向队列研究。
目的
确定在美国一组接受至少20年随访的青少年特发性脊柱侧凸（AIS）患者中，患者报告的功能结局以及相关手术治疗的需求。
背景数据总结
关于美国人群脊柱侧凸治疗的长期结局信息有限。
方法
确定了一组接受小儿AIS治疗且随访至少20年的新患者群体。通过检索单中心诊断登记册，筛选出337名符合纳入标准的患者（AIS、侧弯角度>35°，且在1975年至1992年期间接受过支具治疗、手术治疗或观察）。确定任何额外的脊柱手术以及EQ5D、ODI、SRS 22、SAQ等指标。共纳入180名患者（平均随访30年，范围20 - 37年）。儿童期治疗包括支具治疗（41例患者）、手术治疗（103例患者）和观察（36例患者）。
结果
在研究期间，41例接受支具治疗的患者中只有1例接受了额外的脊柱侧凸相关脊柱手术，而观察队列中的36例患者中有5例成年后接受了脊柱侧凸手术。103例儿童期接受手术治疗的患者中有7例成年后需要额外的翻修手术。15例患者（4例支具治疗、7例融合手术和4例观察患者）成年后接受了胸壁手术。与基于人群的对照组相比，SRS评分总体差约10%，但SRS心理健康评分与对照组相似。总体而言，5.6%的患者存在残疾，手术组和非手术组之间无差异。
结论
我们发现接受支具治疗的人群中成人脊柱侧凸手术率较低，在1975年至1992年期间接受AIS脊柱融合手术的患者在30年随访时翻修手术率较低。在平均30年的随访中，接受支具治疗、手术治疗和观察的人群之间在患者报告的结局方面未发现差异。
证据级别
三级，治疗性。
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