Baldwin Keith D, Cahill Patrick J, Sponseller Paul D, Abel Mark F, Spiegel David A, Flynn John M, Pahys Josh M
Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Spine Deform. 2020 Oct;8(5):1081-1087. doi: 10.1007/s43390-020-00109-1. Epub 2020 May 11.
Retrospective descriptive, multi-center study.
We hypothesize that a post-operative weight gain will result in patients who are underweight prior to surgery. Cachexia and low body mass index is common among children with cerebral palsy (CP). Many interventions are undertaken to assist the child in nourishment and to obtain a more normal body mass. Additionally, scoliosis is common among children with CP. In our practice we have noted weight gain post operatively in severely underweight children after spinal fusion.
We underwent a retrospective review of a CP cohort from a multicenter prospective registry. Percentiles on the CP specific growth chart for which each child belonged were plotted based on the patients' age, weight, gender, GMFCS level, and tube feeding status. We then assessed percentile change in patients between pre-op visit, 1 year, 2 years and for those with available data, 5 years follow up visits. Patients with under two years of follow up, patients with GMFCS III and below, and patients without weight data were excluded.
We identified a total of 211 potentially eligible patients from a multicenter prospective registry. 109 had complete 2 years data to analyze and 37 patients had full 5 years data to analyze. We found that patients under the 50th percentile pre-operatively increased their percentile on the CP growth chart for weight 12.1 percentiles (95% CI 6.7, 17.5 p value < 0.001) whereas patients that began at the 50th percentile or above on average lost 2.2 percentiles (95% CI -6.8, 2.3) though the change was not statistically significant (p value 0.330). These changes appeared stable at 5 years. Although regression analysis showed that Cobb correction and pelvic obliquity correction, and hyperlordosis were not independent predictors of the change, we noted that patients with residual curves after surgery of 40° or more experienced 13.3 percentile less weight gain than those with better corrections.
Patients with CP are at risk for cachexia, malnutrition, reflux and other GI disorders. Data presented here suggests that corrective spinal surgery may improve weight percentile in patients who start out at 50th percentile and lower. Patients with 40° or greater of residual scoliosis may benefit less from spinal fusion than those with a better correction.
II; Prognostic retrospective cohort study.
回顾性描述性多中心研究。
我们假设术后体重增加会出现在术前体重过轻的患者中。恶病质和低体重指数在脑瘫（CP）患儿中很常见。人们采取了许多干预措施来帮助患儿营养摄入并获得更正常的体重。此外，脊柱侧弯在CP患儿中也很常见。在我们的实践中，我们注意到严重体重过轻的儿童在脊柱融合术后体重增加。
我们对来自多中心前瞻性登记处的CP队列进行了回顾性研究。根据患者的年龄、体重、性别、粗大运动功能分级系统（GMFCS）水平和管饲状态，绘制每个儿童所属的CP特定生长图表的百分位数。然后，我们评估了患者在术前访视、1年、2年以及有可用数据的5年随访之间的百分位数变化。排除随访时间不足两年的患者、GMFCS III及以下的患者以及没有体重数据的患者。
我们从多中心前瞻性登记处共识别出211名潜在符合条件的患者。109名患者有完整的两年数据可供分析，37名患者有完整的五年数据可供分析。我们发现，术前处于第50百分位数以下的患者在CP体重生长图表上的百分位数增加了12.1个百分位数（95%可信区间6.7，17.5；p值<0.001），而术前处于第50百分位数或以上的患者平均下降了2.2个百分位数（95%可信区间-6.8，2.3），尽管这种变化没有统计学意义（p值0.330）。这些变化在5年时似乎稳定。虽然回归分析表明，Cobb角矫正、骨盆倾斜矫正和腰椎前凸不是变化的独立预测因素，但我们注意到，术后残留曲线为40°或更大的患者体重增加的百分位数比矫正较好的患者少13.3个百分位数。
CP患者有恶病质、营养不良、反流和其他胃肠道疾病的风险。此处呈现的数据表明，矫正性脊柱手术可能会提高术前处于第50百分位数及以下患者的体重百分位数。残留脊柱侧弯40°或更大的患者可能比矫正较好的患者从脊柱融合术中获益更少。
II级；预后回顾性队列研究。
