Grabala Pawel, Helenius Ilkka J, Buchowski Jacob M, Shah Suken A
University Children's Hospital, Department of Pediatric Orthopedic Surgery and Traumatology, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland.
Paley European Institute, Al. Rzeczypospolitej 1, 02-972 Warsaw, Poland.
Children (Basel). 2023 Feb 3;10(2):299. doi: 10.3390/children10020299.
This study aimed to evaluate the treatment outcomes of severe idiopathic scoliosis (IS) and hypothesized that surgical treatment would have a superior impact on the health-related quality of life (HRQoL), pulmonary function (PF), back pain, and sexual function.
We retrospectively reviewed 195 consecutive patients with IS classified into severe (SG) and moderate groups (MG) with a minimum follow-up of two years.
The mean preoperative curve was 131° and 60° in the SG and MG, respectively. The mean preoperative flexibility in the bending films averaged between 22% in the SG and 41% in the MG. After definitive surgery, the main curve was corrected to 61° and 18° in the SG and MG, respectively. The mean preoperative thoracic kyphosis was 83° in the SG and 25° in the MG, which was corrected to 35° in the SG and 25° in the MG. At baseline, the percentage of predicted lung volume (FVC) was significantly lower in the SG than that in the MG (51.2% vs. 83%). The baseline percentage of the predicted FEV1 values was also significantly lower in the SG than in the MG (60.8% vs. 77%). During the two-year follow-up, the percentage of predicted FVC showed significant improvement in the SG (69.9%) ( < 0.001), and the percentage of predicted FEV1 values during the follow-up improved significantly in the SG (76.9%) ( < 0.001) compared with the MG (81%), with no statistical difference observed during the two-year follow-up. The SRS-22r showed a clinically and statistically significant improvement in the preoperative results to those of the final follow-up ( < 0.001).
Surgical treatment of severe scoliosis can be safe. It provided a mean correction of the deformity for 59% of patients and significantly improved respiratory function, with the percentage of predicted forced expiratory volume in 1 s improving by 60% and the forced vital capacity improving by 50%, resulting in clinically and statistically significant improvements in the SRS-22r, HRQoL outcome scores, and back pain (reduced from 36% to 8%), as well as improved sexual function. The planned surgical treatment can achieve a very significant deformity correction with a minimal risk of complications. The surgical treatment has a superior impact on the quality of life patients with severe spinal deformities and significantly improves function in every sphere of life.
本研究旨在评估重度特发性脊柱侧凸（IS）的治疗效果，并假设手术治疗对健康相关生活质量（HRQoL）、肺功能（PF）、背痛和性功能有更显著的影响。
我们回顾性分析了195例连续的IS患者，分为重度组（SG）和中度组（MG），最小随访时间为两年。
SG组和MG组术前平均侧弯角度分别为131°和60°。术前弯曲位X线片平均柔韧性在SG组为22%，在MG组为41%。确定性手术后，SG组和MG组主弯分别矫正至61°和18°。SG组术前平均胸椎后凸为83°，MG组为25°，SG组矫正至35°，MG组仍为25°。基线时，SG组预测肺容积（FVC）百分比显著低于MG组（51.2%对83%）。SG组预测FEV1值的基线百分比也显著低于MG组（60.8%对77%）。在两年随访期间，SG组预测FVC百分比有显著改善（69.9%）（P<0.001），随访期间SG组预测FEV1值百分比显著改善（76.9%）（P<0.001），而MG组为81%，两年随访期间无统计学差异。SRS-22r评分从术前到最终随访有临床和统计学上的显著改善（P<0.001）。
重度脊柱侧凸的手术治疗是安全的。它为59%的患者提供了平均畸形矫正，显著改善了呼吸功能，1秒用力呼气容积百分比提高了60%，用力肺活量提高了50%，导致SRS-22r、HRQoL结局评分和背痛（从36%降至8%）有临床和统计学上的显著改善，以及性功能改善。计划的手术治疗可以在并发症风险最小的情况下实现非常显著的畸形矫正。手术治疗对重度脊柱畸形患者的生活质量有更显著的影响，并显著改善生活各方面的功能。
