Avendano John P, ElNemer William, Núñez-Pereira Susana, Sponseller Paul D
Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5223, Baltimore, MD, 21287, USA.
Department of Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Spine Deform. 2025 Mar;13(2):561-568. doi: 10.1007/s43390-024-01006-7. Epub 2025 Jan 7.
Few studies have investigated quality-of-life (QoL)-related outcome measures in adolescent idiopathic scoliosis (AIS) patients over long-term follow-up. We investigated whether patients with any given Lenke type improved relative to other types and whether selective fusions resulted in better QoL-related outcome measures.
We utilized the Harms Study Group database to select patients with AIS who underwent posterior spinal fusion (PSF) with Scoliosis Research Society questionnaire-22 revised (SRS-22r) scores at minimum 10-year follow-up. Characteristics and SRS-22r were quantified by Lenke type and compared using ANOVA and Tukey post hoc tests. Multivariate analyses were conducted to identify the predictive value of Lenke types on QoL-related outcomes. Sub-group analysis split cohorts into those who underwent selective vs. non-selective fusion(s).
110 patients were available at minimum 10-year follow-up. Types 3, 4, and 6 curves generally demonstrated lower SRS-22r scores both preoperatively and at long-term follow-up. Independent of Lenke type, total SRS-22r, along with self-image and satisfaction, showed consistent improvement relative to pre-op at 10-year follow-up, whereas pain, mental health, and general function showed a slight worsening. Sub-group analyses revealed no significant differences in SRS-22r scores between selective and non-selective fusion groups.
At 10-year follow-up, total SRS-22r, self-image, and satisfaction scores stayed consistently improved relative to preoperative status over time, while pain, general function, and mental health declined from 2 years onward. Increased age may play a role in enhancing self-image and satisfaction while worsening general function, pain, and mental health. Selectively vs. non-selectively fusing a patient should not hinge on fear of impacting patients' QoL-related measures, as our data suggest improvement in total SRS-22r, self-image, and satisfaction regardless.
III.
很少有研究在长期随访中调查青少年特发性脊柱侧凸（AIS）患者与生活质量（QoL）相关的结局指标。我们研究了任何给定Lenke类型的患者相对于其他类型是否有所改善，以及选择性融合是否会带来更好的与QoL相关的结局指标。
我们利用Harms研究组数据库选择接受后路脊柱融合术（PSF）的AIS患者，这些患者在至少10年的随访中有脊柱侧凸研究学会问卷22修订版（SRS-22r）评分。通过Lenke类型对特征和SRS-22r进行量化，并使用方差分析和Tukey事后检验进行比较。进行多变量分析以确定Lenke类型对与QoL相关结局的预测价值。亚组分析将队列分为接受选择性融合与非选择性融合的患者。
110例患者有至少10年的随访数据。3型、4型和6型曲线在术前和长期随访中总体上SRS-22r评分较低。与Lenke类型无关，SRS-22r总分以及自我形象和满意度在10年随访时相对于术前均持续改善，而疼痛、心理健康和总体功能略有恶化。亚组分析显示，选择性融合组和非选择性融合组的SRS-22r评分无显著差异。
在10年随访时，SRS-22r总分、自我形象和满意度评分相对于术前状态随时间持续改善，而疼痛、总体功能和心理健康从2年起下降。年龄增加可能在增强自我形象和满意度的同时，使总体功能、疼痛和心理健康恶化。选择性融合与非选择性融合患者不应基于担心影响患者与QoL相关的指标，因为我们的数据表明无论如何SRS-22r总分、自我形象和满意度都会改善。
III级。
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