Desai Vineet M, Bowen Margaret, Anari Jason B, Flynn John M, Yaszay Burt, Sponseller Paul, Abel Mark, Pahys Joshua, Cahill Patrick J
Department of Orthopaedics, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Division of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle, WA, USA.
Spine Deform. 2025 Jan;13(1):195-204. doi: 10.1007/s43390-024-00974-0. Epub 2024 Sep 26.
Cerebral Palsy (CP) often presents with a sweeping thoracolumbar scoliosis and pelvic obliquity. With severe pelvic obliquity, the ribs come into contact with the high side of the oblique pelvis, termed rib-on-pelvis deformity (ROP). ROP can result in costo-iliac impingement, or pain associated with ROP, and can also adversely affect breathing and sitting balance. The goal of this study was to evaluate whether CP patients with ROP have worse health-related quality of life (HRQOL) before surgery and a greater improvement in HRQOL after surgery.
A retrospective analysis of a prospectively collected, multicenter, international registry was performed for all nonambulatory patients with CP treated with spinal fusion with at least two-year follow-up. HRQOL was measured via the Caregiver Priorities & Child Health Index of Life with Disabilities (CPCHILD) questionnaire domains (0 = most disability, 100 = least disability). ROP was defined as having a rib distal to the superior portion of the iliac crest on preop upright radiographs. The ROP group and control group without ROP were compared regarding six domain scores and total score of CPCHILD. Multiple linear regression was used to control for curve apex location, major coronal Cobb angle, type of tone, and pelvic obliquity.
340 patients met inclusion criteria (52% female, mean age 14.0 years). The mean major coronal Cobb angle was 81 degrees and mean pelvic obliquity was 22 degrees. 176 patients (51.8%) had ROP while 164 patients (48.2%) did not. ROP was independently associated with worse preoperative Positioning/Transfers/Mobility (PTM), Comfort & Emotions (C&E), and total CPCHILD score via the CPCHILD questionnaire (p < 0.05). Patients with preoperative ROP experienced a greater improvement in the C&E and PTM domains as well as total CPCHILD score than patients without ROP (p < 0.05).
CP patients with rib-on-pelvis deformity experience more pain and worse HRQOL than patients without this deformity. These patients experienced a greater improvement in HRQOL after spinal fusion measured via the CPCHILD questionnaire.
脑瘫（CP）常伴有明显的胸腰段脊柱侧凸和骨盆倾斜。严重骨盆倾斜时，肋骨会与倾斜骨盆的高位侧接触，称为肋-骨盆畸形（ROP）。ROP可导致肋-髂撞击或与ROP相关的疼痛，还会对呼吸和坐姿平衡产生不利影响。本研究的目的是评估患有ROP的CP患者术前的健康相关生活质量（HRQOL）是否更差，以及术后HRQOL的改善是否更大。
对前瞻性收集的多中心国际登记处中所有接受脊柱融合术治疗且至少随访两年的非行走型CP患者进行回顾性分析。通过照顾者优先事项与残疾儿童生活健康指数（CPCHILD）问卷领域（0 = 残疾程度最高，100 = 残疾程度最低）来测量HRQOL。ROP定义为术前站立位X线片上肋骨位于髂嵴上缘远端。比较ROP组和无ROP的对照组在CPCHILD的六个领域得分和总分。采用多元线性回归来控制曲线顶点位置、主要冠状面Cobb角、肌张力类型和骨盆倾斜度。
340例患者符合纳入标准（52%为女性，平均年龄14.0岁）。主要冠状面Cobb角平均为81度，骨盆倾斜度平均为22度。176例患者（51.8%）有ROP，164例患者（48.2%）无ROP。通过CPCHILD问卷，ROP与术前较差的定位/转移/活动能力（PTM）、舒适度与情绪（C&E）以及CPCHILD总分独立相关（p < 0.05）。术前有ROP的患者在C&E和PTM领域以及CPCHILD总分方面的改善比无ROP的患者更大（p < 0.05）。
与无肋-骨盆畸形的患者相比，患有肋-骨盆畸形的CP患者经历更多疼痛且HRQOL更差。通过CPCHILD问卷测量，这些患者在脊柱融合术后HRQOL有更大改善。
