新的运动障碍对成人脊柱畸形手术后 HRQOL 的影响：Scoli Risk 1 前瞻性研究的亚组分析。
Impact of New Motor Deficit on HRQOL After Adult Spinal Deformity Surgery: Subanalysis From Scoli Risk 1 Prospective Study.
机构信息
Department of Neurosurgery and Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA.
Norton Leatherman Spine Center, Louisville, KY.
出版信息
Spine (Phila Pa 1976). 2021 Apr 1;46(7):E450-E457. doi: 10.1097/BRS.0000000000003852.
STUDY DESIGN
International, multicenter, prospective, longitudinal observational cohort.
OBJECTIVE
To assess how new motor deficits affect patient reported quality of life scores after adult deformity surgery.
SUMMARY OF BACKGROUND DATA
Adult spinal deformity surgery is associated with high morbidity, including risk of new postoperative motor deficit. It is unclear what effect new motor deficit has on Health-related Quality of Life scores (HRQOL) scores.
METHODS
Adult spinal deformity patients were enrolled prospectively at 15 sites worldwide. Other inclusion criteria included major Cobb more than 80°, C7-L2 curve apex, and any patient undergoing three column osteotomy. American Spinal Injury Association (ASIA) scores and standard HRQOL scores were recorded pre-op, 6 weeks, 6 months, and 2 years.
RESULTS
Two hundred seventy two complex adult spinal deformity (ASD) patients enrolled. HRQOL scores were worse for patients with lower extremity motor score (LEMS). Mean HRQOL changes at 6 weeks and 2 years compared with pre-op for patients with motor worsening were: ODI (+12.4 at 6 weeks and -4.7 at 2 years), SF-36v2 physical (-4.5 at 6 weeks and +2.3 at 2 years), SRS-22r (0.0 at 6 weeks and +0.4 at 2 years). Mean HRQOL changes for motor-neutral patients were: ODI (+0.6 at 6 weeks and -12.1 at 2 years), SF-36v2 physical (-1.6 at 6 weeks and +5.9 at 2 years), and SRS-22r (+0.4 at 6 weeks and +0.7 at 2 years). For patients with LEMS improvement, mean HRQOL changes were: ODI (-0.6 at 6 weeks and -16.3 at 2 years), SF-36v2 physical (+1.0 at 6 weeks and +7.0 at 2 years), and SRS-22r (+0.5 at 6 weeks and +0.9 at 2 years).
CONCLUSION
In the subgroup of deformity patients who developed a new motor deficit, total HRQOLs and HRQOL changes were negatively impacted. Patients with more than 2 points of LEMS worsening had the worst changes, but still showed overall HRQOL improvement at 6 months and 2 years compared with pre-op baseline.Level of Evidence: 3.
研究设计
国际、多中心、前瞻性、纵向观察队列。
目的
评估成人脊柱畸形手术后新的运动缺陷如何影响患者报告的生活质量评分。
背景资料总结
成人脊柱畸形手术相关发病率高，包括新的术后运动缺陷的风险。尚不清楚新的运动缺陷对健康相关生活质量评分（HRQOL）的影响。
方法
在全球 15 个地点前瞻性地招募成人脊柱畸形患者。其他纳入标准包括主要 Cobb 角大于 80°，C7-L2 曲线顶点，以及任何接受三柱截骨术的患者。术前、术后 6 周、6 个月和 2 年记录美国脊髓损伤协会（ASIA）评分和标准 HRQOL 评分。
结果
共纳入 272 例复杂成人脊柱畸形（ASD）患者。下肢运动评分（LEMS）较低的患者 HRQOL 评分较差。运动恶化患者与术前相比，术后 6 周和 2 年 HRQOL 变化的平均值为：ODI（6 周时增加 12.4，2 年时减少 4.7），SF-36v2 生理（6 周时减少 4.5，2 年时增加 2.3），SRS-22r（6 周时增加 0.0，2 年时增加 0.4）。运动中立患者的平均 HRQOL 变化为：ODI（6 周时增加 0.6，2 年时减少 12.1），SF-36v2 生理（6 周时减少 1.6，2 年时增加 5.9），SRS-22r（6 周时增加 0.4，2 年时增加 0.7）。LEMS 改善的患者，平均 HRQOL 变化为：ODI（6 周时减少 0.6，2 年时减少 16.3），SF-36v2 生理（6 周时增加 1.0，2 年时增加 7.0），SRS-22r（6 周时增加 0.5，2 年时增加 0.9）。
结论
在新发生运动缺陷的畸形患者亚组中，总 HRQOL 和 HRQOL 变化受到负面影响。LEMS 恶化超过 2 分的患者变化最严重，但与术前基线相比，6 个月和 2 年后仍总体 HRQOL 改善。
证据水平
3。
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