Larsson E L, Aaro S, Ahlinder P, Oberg B
Department of Neuro Science and Locomotion, Linköping University, and Spine Centre, University Hospital, Sweden.
Eur Spine J. 1998;7(4):294-301. doi: 10.1007/s005860050078.
Preoperative evaluation of patients with paralytic scoliosis should take into account the consequences of surgery on the every day life of the patient. However, the parameters that are customarily used in these operations relate only to very narrow measures such as the angle of scoliosis or kyphosis. The aim of this study was to introduce a set of instruments appropriate for measuring both function and activities in paralytic scoliosis patients. The study took as its starting point the WHO International Classification of Impairments, Disabilities and Handicaps (ICIDH), in which an activity is described at the level of the individual and function at the level of the organ. A consecutive series of 100 paralytic scoliosis patients with 18 different diagnoses were evaluated preoperatively with a set of instruments that had been specially developed at Linköping hospital, in which the variables are classified according to the system used in the ICIDH. The set of instruments included general information and evaluation of activities and function--sitting, balance, weight distribution to sitting surface, angle of scoliosis, reaching, pain estimation, activities of daily living (ADL) Barthel and ADL Klein and Bell, care given, time spent resting, and seating supports). The results showed that patients with paralytic scoliosis constitute a heterogeneous group in activities and function. Even when the patients were grouped into four subgroups according to the Scoliosis Research Society Classification, they remained very heterogeneous. However, reaching, Klein and Bell Activities of Daily Living and pain could only evaluate patients who could understand verbal instructions. In those who could not, assessment relied more heavily on measures of function and level of dependence. It was concluded that the choice of assessment must be guided by the patient's ability to understand verbal instructions irrespective of his/her disorder. It is important to use the three levels--impairments, disabilities and handicaps-- in order to focus on the different outcomes in the two groups with respect to the patient's total situation.
对麻痹性脊柱侧弯患者进行术前评估时，应考虑手术对患者日常生活的影响。然而，这些手术中常用的参数仅涉及非常狭窄的测量指标，如脊柱侧弯或后凸的角度。本研究的目的是引入一套适用于测量麻痹性脊柱侧弯患者功能和活动的工具。该研究以世界卫生组织的《国际损伤、残疾和残障分类》（ICIDH）为出发点，其中将活动描述为个体层面的内容，将功能描述为器官层面的内容。对连续的100例患有18种不同诊断的麻痹性脊柱侧弯患者进行了术前评估，使用的是林雪平医院专门开发的一套工具，其中变量是根据ICIDH中使用的系统进行分类的。这套工具包括一般信息以及对活动和功能的评估——坐姿、平衡、坐在表面的重量分布、脊柱侧弯角度、够物能力、疼痛评估、日常生活活动（ADL）巴氏指数和ADL克莱因和贝尔指数、护理情况、休息时间以及座位支撑情况）。结果表明，麻痹性脊柱侧弯患者在活动和功能方面构成了一个异质性群体。即使根据脊柱侧弯研究学会的分类将患者分为四个亚组，他们仍然非常异质。然而，够物能力、克莱因和贝尔日常生活活动以及疼痛只能评估能够理解口头指令的患者。对于那些不能理解的患者，评估更多地依赖于功能测量和依赖程度。得出的结论是，评估的选择必须以患者理解口头指令的能力为指导，而不论其疾病如何。使用损伤、残疾和残障这三个层面很重要，以便关注两组在患者整体情况方面的不同结果。
