越大越好：胸廓高度增加与骨骼成熟时健康相关生活质量的提高有关。
Bigger is better: larger thoracic height is associated with increased health related quality of life at skeletal maturity.
作者信息
Roye Benjamin D, Simhon Matthew E, Matsumoto Hiroko, Garg Sumeet, Redding Gregory, Samdani Amer, Smith John T, Sponseller Paul, Vitale Michael G
机构信息
Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA.
Department of Pediatric Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA.
出版信息
Spine Deform. 2020 Aug;8(4):771-779. doi: 10.1007/s43390-020-00095-4. Epub 2020 Mar 11.
STUDY DESIGN
Cross sectional OBJECTIVES: The purpose of this study is to evaluate the association between thoracic height and health-related quality of life (HRQoL) at skeletal maturity in patients with EOS. Current literature suggests a minimum thoracic height of 18 cm to 22 cm to avoid poor pulmonary function and related health outcomes.
METHODS
Patients with EOS who reached skeletal maturity from 2005 to 2018 were identified in two registries including 32 centers. Thoracic height from T1 to T12 at skeletal maturity and Early Onset Scoliosis 24 Item Questionnaire (EOSQ-24) scores were collected. The EOSQ-24 domains included HRQoL of patients, parental impact, financial impact and patient and parental satisfaction.
RESULTS
469 patients (mean age: 14.9, female: 77.4%) were identified. 29% patients were of congenital etiology, 20.3% neuromuscular, 13.6% syndromic, 34.8% idiopathic, and 2.3% other. When patients were grouped by thoracic height at skeletal maturity, all EOSQ-24 domains increased after a threshold of 18 cm. When stratified by etiology, the 18 cm cutoff held for patients with congenital, neuromuscular and syndromic EOS. The cutoff for idiopathic EOS was 20 cm. For all patients, after the threshold was met, HRQoL continued to improve with increases in thoracic height at skeletal maturity. A subset of 169 patients for which arm span measurements were available was also identified and their thoracic heights were normalized. When grouped by the percentage of expected thoracic height attained, EOSQ-24 domains increased after a threshold of 80%.
CONCLUSIONS
Once 18 cm of actual thoracic height or 80% of expected thoracic height is achieved, HRQoL continues to improve as thoracic height increases in skeletally mature patients with non-idiopathic EOS. Patients with idiopathic EOS had a higher threshold, possibly due to their larger average size and higher care giver expectations for HRQoL.
LEVEL OF EVIDENCE
Level III.
研究设计
横断面研究
目的
本研究旨在评估早发性脊柱侧弯（EOS）患者骨骼成熟时胸廓高度与健康相关生活质量（HRQoL）之间的关联。当前文献表明，胸廓高度至少为18厘米至22厘米可避免肺功能不佳及相关健康后果。
方法
在包括32个中心的两个登记处中识别出2005年至2018年达到骨骼成熟的EOS患者。收集骨骼成熟时从T1至T12的胸廓高度以及早发性脊柱侧弯24项问卷（EOSQ - 24）得分。EOSQ - 24领域包括患者的HRQoL、对父母的影响、经济影响以及患者和父母的满意度。
结果
共识别出469例患者（平均年龄：14.9岁，女性：77.4%）。29%的患者病因是先天性的，20.3%是神经肌肉性的，13.6%是综合征性的，34.8%是特发性的，2.3%是其他原因。当根据骨骼成熟时的胸廓高度对患者进行分组时，在胸廓高度达到18厘米的阈值后，所有EOSQ - 24领域的得分均有所增加。按病因分层时，18厘米的临界值适用于先天性、神经肌肉性和综合征性EOS患者。特发性EOS的临界值为20厘米。对于所有患者，在达到阈值后，随着骨骼成熟时胸廓高度的增加，HRQoL持续改善。还识别出了169例可获得臂展测量值的患者子集，并对他们的胸廓高度进行了标准化。当按达到预期胸廓高度的百分比进行分组时，在达到80%的阈值后，EOSQ - 24领域的得分增加。
结论
对于骨骼成熟的非特发性EOS患者，一旦实际胸廓高度达到18厘米或达到预期胸廓高度的80%，随着胸廓高度的增加，HRQoL会持续改善。特发性EOS患者的阈值更高，这可能是由于他们的平均体型更大以及护理人员对HRQoL的期望更高。
证据级别
三级
Zotero 插件