未治疗的Scheuermann 后凸畸形的长期随访。

Long-term follow-up of untreated Scheuermann's kyphosis.

机构信息

Scottish National Spine Deformity Service, Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh, EH9 1LF, UK.

Department of Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh Edinburgh, 51 Little France Crescent, Edinburgh, EH14 4SA, UK.

出版信息

Spine Deform. 2021 Nov;9(6):1633-1639. doi: 10.1007/s43390-021-00354-y. Epub 2021 Jul 1.

DOI:10.1007/s43390-021-00354-y

PMID:34212306

Abstract

STUDY DESIGN

Long-term cross-sectional study.

OBJECTIVES

To investigate the long-term effects of untreated Scheuermann's kyphosis on quality of life, and its relationship to radiographic parameters of spinal deformity. Previous studies reported reduced self-image, increased pain and impaired physical status. Little is known of the long-term impact of sagittal plane deformity in untreated SK.

METHODS

One hundred and thirteen consecutive untreated patients with SK were identified from a national service database prior to 2000, when surgery was not offered at this unit. 81 of these patients were available for evaluation; 66 (81%) consented to questionnaire and clinical evaluation, and 47 (58%) consented to additional radiological evaluation. Health-related quality of life (HRQoL) was compared to normative population values. Mean age was 45.1 years (31-65), and mean follow-up was 27 years (16-36). 57 patients had thoracic kyphosis and 9 had thoracolumbar deformity.

RESULTS

SRS-22 and SF-36 scores were lower, and ODI was greater in patients with untreated SK compared to normative population values. Kyphosis progressed from mean 66° at skeletal maturity to 78° (p < 0.001) after mean follow-up of 27 years. Long-term progression of untreated SK was 0.45°/year (n = 47). Multilinear regression showed good correlation between increasing SVA and worse ODI scores (r = 0.59; p = 0.001). Increasing SVA also correlated with worse function, pain and mental health scores reported by SRS-22, and with worse physical function and bodily pain scores reported by SF-36. Increasing CL correlated with worse SF-36 physical function scores. Increasing cSVA and increasing TK correlated with worse SRS-22 self-image scores.

CONCLUSION

SRS-22 and SF-36 scores were lower, and ODI was greater in patients with untreated SK compared to normative data. Long-term progression of untreated SK was 0.45°/year (n = 47). Increasing SVA correlated with worse SF-36 physical function, SRS-22 function, SRS-22 pain and higher ODI scores. Total kyphosis (TK) and cSVA were independent predictors of low SRS self-image.

LEVEL OF EVIDENCE

III.

摘要

研究设计

长期横断面研究。

目的

研究未经治疗的Scheuermann 后凸畸形对生活质量的长期影响，并探讨其与脊柱畸形放射学参数的关系。既往研究报道，未经治疗的Scheuermann 后凸畸形患者自我形象降低、疼痛增加和身体功能受损。然而，对于未经治疗的 SK 矢状面畸形的长期影响知之甚少。

方法

在 2000 年之前，我们从全国服务数据库中确定了 113 例未经治疗的 SK 连续患者，当时本单位不提供手术治疗。其中 81 例患者可进行评估；66 例（81%）同意接受问卷调查和临床评估，47 例（58%）同意进行额外的放射学评估。将健康相关生活质量（HRQoL）与正常人群值进行比较。平均年龄为 45.1 岁（31-65 岁），平均随访时间为 27 年（16-36 年）。57 例患者存在胸椎后凸，9 例存在胸腰椎后凸。

结果

与正常人群值相比，患有未经治疗的 SK 的患者 SRS-22 和 SF-36 评分较低，ODI 较高。在平均 27 年的随访后，脊柱后凸从骨骼成熟时的平均 66°进展至 78°（p<0.001）。未经治疗的 SK 的长期进展为 0.45°/年（n=47）。多元线性回归显示，SVA 增加与 ODI 评分下降具有良好的相关性（r=0.59；p=0.001）。SVA 的增加还与 SRS-22 报告的功能、疼痛和心理健康评分下降以及 SF-36 报告的身体功能和躯体疼痛评分下降相关。CL 的增加与 SF-36 身体功能评分下降相关。cSVA 和 TK 的增加与 SRS-22 自我形象评分下降相关。

结论

与正常人群值相比，患有未经治疗的 SK 的患者 SRS-22 和 SF-36 评分较低，ODI 较高。未经治疗的 SK 的长期进展为 0.45°/年（n=47）。SVA 的增加与 SF-36 身体功能、SRS-22 功能、SRS-22 疼痛和更高的 ODI 评分下降相关。总后凸（TK）和 cSVA 是 SRS 自我形象评分较低的独立预测因素。