Abstract：
BACKGROUND: Congenital and juvenile scoliosis are both early-onset deformities that develop before the age of 10. Children are treated to prevent curve progression and problems in adulthood such as back pain and a decreased quality of life but literature on long-term outcomes remains scarce.
OBJECTIVE: To evaluate the health-related quality of life (HRQoL) and potential disability of children with congenital scoliosis (CS) or juvenile idiopathic scoliosis (JIS) after a minimum of 20 years follow-up.
METHODS: Comparative cohort study.
METHODS: A consecutive cohort of CS and JIS patients were retrospectively identified from a single-center scoliosis database. Patients born between 1968 and 1981 and treated during skeletal growth were eligible for participation.
METHODS: HRQoL (SF-36, SRS-22r, ODI).
METHODS: The primary aim was to evaluate the HRQoL of CS and JIS patients using the general SF-36 questionnaire. Both patient cohorts were compared with age-matched national norms. The secondary aim was to analyze the differences between conservatively and surgically treated patients using the scoliosis-specific Scoliosis Research Society-22r questionnaire (SRS-22r) and the Oswestry Disability Index (ODI). T-tests were used for statistical comparison.
RESULTS: In total, 114 patients (67% of the eligible patients) completed the questionnaire, with a mean follow-up of 25.5±5.5 years after their final clinical follow-up. Twenty-nine patients with CS were included with a mean age of 44.4±3.8 years (79.3% female), and 85 patients with JIS with a mean age of 43.7±4.2 years (89.4% female). Of the SF-36 domains, only the vitality score (60.6±18.0 for CS and 58.1±17.6 for JIS cohort) and mental health score (70.0±18.4 for CS and 72.1±18.1 for JIS cohort) were significantly lower compared with the general population (68.6±19.3 for vitality, and 76.8±17.4 for mental health). These decreased scores were larger than the determined minimum clinically important difference threshold of 4.37. Surgically treated JIS patients had a significantly lower score on the SRS-22r pain domain than their nonsurgically treated peers (3.6±0.9 vs 4.1±0.7l p=.019). Surgically treated CS patients had a significantly higher score on the SRS-22r mental health domain than their nonsurgically treated peers (4.3±0.5 vs 3.5±1.0; p=.023). No significant differences were found in the other domains.
CONCLUSIONS: Except for vitality and mental health domains, congenital and juvenile idiopathic scoliosis patients treated during skeletal growth had similar HRQoL on most SF-36 domains in adulthood compared with national norms. Surgical treated JIS patients experienced more pain compared with brace treated patients, while braced CS patients had a significantly lower mental scores compared with surgical treated patients. These long-term outcomes are essential to inform patients and can guide shared decision-making between clinicians and patients.
OBJECTIVE: To evaluate the health-related quality of life (HRQoL) and potential disability of children with congenital scoliosis (CS) or juvenile idiopathic scoliosis (JIS) after a minimum of 20 years follow-up.
METHODS: Comparative cohort study.
METHODS: A consecutive cohort of CS and JIS patients were retrospectively identified from a single-center scoliosis database. Patients born between 1968 and 1981 and treated during skeletal growth were eligible for participation.
METHODS: HRQoL (SF-36, SRS-22r, ODI).
METHODS: The primary aim was to evaluate the HRQoL of CS and JIS patients using the general SF-36 questionnaire. Both patient cohorts were compared with age-matched national norms. The secondary aim was to analyze the differences between conservatively and surgically treated patients using the scoliosis-specific Scoliosis Research Society-22r questionnaire (SRS-22r) and the Oswestry Disability Index (ODI). T-tests were used for statistical comparison.
RESULTS: In total, 114 patients (67% of the eligible patients) completed the questionnaire, with a mean follow-up of 25.5±5.5 years after their final clinical follow-up. Twenty-nine patients with CS were included with a mean age of 44.4±3.8 years (79.3% female), and 85 patients with JIS with a mean age of 43.7±4.2 years (89.4% female). Of the SF-36 domains, only the vitality score (60.6±18.0 for CS and 58.1±17.6 for JIS cohort) and mental health score (70.0±18.4 for CS and 72.1±18.1 for JIS cohort) were significantly lower compared with the general population (68.6±19.3 for vitality, and 76.8±17.4 for mental health). These decreased scores were larger than the determined minimum clinically important difference threshold of 4.37. Surgically treated JIS patients had a significantly lower score on the SRS-22r pain domain than their nonsurgically treated peers (3.6±0.9 vs 4.1±0.7l p=.019). Surgically treated CS patients had a significantly higher score on the SRS-22r mental health domain than their nonsurgically treated peers (4.3±0.5 vs 3.5±1.0; p=.023). No significant differences were found in the other domains.
CONCLUSIONS: Except for vitality and mental health domains, congenital and juvenile idiopathic scoliosis patients treated during skeletal growth had similar HRQoL on most SF-36 domains in adulthood compared with national norms. Surgical treated JIS patients experienced more pain compared with brace treated patients, while braced CS patients had a significantly lower mental scores compared with surgical treated patients. These long-term outcomes are essential to inform patients and can guide shared decision-making between clinicians and patients.
摘要：
背景：先天性和青少年脊柱侧凸都是早发性畸形，在10岁之前发展。儿童接受治疗以防止曲线进展和成年期问题，如背痛和生活质量下降，但关于长期结果的文献仍然很少。
目的：评估先天性脊柱侧凸（CS）或青少年特发性脊柱侧凸（JIS）患儿在至少20年随访后的健康相关生活质量（HRQoL）和潜在残疾。
方法：比较队列研究患者样本：从单中心脊柱侧凸数据库中回顾性确定连续的CS和JIS患者队列。1968年至1981年出生并在骨骼生长期间接受治疗的患者有资格参与。
方法：HRQoL(SF-36，SRS-22r，ODI）方法：主要目的是使用一般SF-36问卷评估CS和JIS患者的HRQoL。将两个患者队列与年龄匹配的国家规范进行比较。次要目的是使用脊柱侧凸特异性脊柱侧凸研究协会22r问卷（SRS-22r）和Oswestry残疾指数（ODI）分析保守治疗和手术治疗患者之间的差异。使用T检验进行统计学比较。
结果：总计，114名患者（占符合条件的患者的67％）完成了问卷调查，最终临床随访后平均随访25.5±5.5年。纳入29例CS患者，平均年龄为44.4±3.8岁（79.3％为女性），85例JIS患者，平均年龄43.7±4.2岁（89.4％为女性）。在SF-36领域中，与普通人群相比，只有活力评分（CS为60.6±18.0，JIS队列为58.1±17.6）和心理健康评分（CS为70.0±18.4，JIS队列为72.1±18.1）显着降低（活力为68.6±19.3，心理健康为76.8±17.4）。这些降低的分数大于确定的最小临床重要差异阈值4.37。手术治疗的JIS患者在SRS-22r疼痛领域的评分明显低于非手术治疗的同龄人（3.6±0.9vs.4.1±0.7lp=0.019)。手术治疗的CS患者在SRS-22r心理健康领域的得分明显高于非手术治疗的同龄人（4.3±0.5vs.3.5±1.0；p=0.023）。在其他领域没有发现显著差异。
结论：除了活力和心理健康领域，在骨骼生长过程中接受治疗的先天性和青少年特发性脊柱侧凸患者在成年期大多数SF-36领域的HRQoL与国家标准相似.与支具治疗的患者相比，手术治疗的JIS患者经历了更多的疼痛，与接受手术治疗的患者相比，接受支撑的CS患者的心理评分显着降低。这些长期结果对于告知患者至关重要，并且可以指导临床医生和患者之间的共同决策。
目的：评估先天性脊柱侧凸（CS）或青少年特发性脊柱侧凸（JIS）患儿在至少20年随访后的健康相关生活质量（HRQoL）和潜在残疾。
方法：比较队列研究患者样本：从单中心脊柱侧凸数据库中回顾性确定连续的CS和JIS患者队列。1968年至1981年出生并在骨骼生长期间接受治疗的患者有资格参与。
方法：HRQoL(SF-36，SRS-22r，ODI）方法：主要目的是使用一般SF-36问卷评估CS和JIS患者的HRQoL。将两个患者队列与年龄匹配的国家规范进行比较。次要目的是使用脊柱侧凸特异性脊柱侧凸研究协会22r问卷（SRS-22r）和Oswestry残疾指数（ODI）分析保守治疗和手术治疗患者之间的差异。使用T检验进行统计学比较。
结果：总计，114名患者（占符合条件的患者的67％）完成了问卷调查，最终临床随访后平均随访25.5±5.5年。纳入29例CS患者，平均年龄为44.4±3.8岁（79.3％为女性），85例JIS患者，平均年龄43.7±4.2岁（89.4％为女性）。在SF-36领域中，与普通人群相比，只有活力评分（CS为60.6±18.0，JIS队列为58.1±17.6）和心理健康评分（CS为70.0±18.4，JIS队列为72.1±18.1）显着降低（活力为68.6±19.3，心理健康为76.8±17.4）。这些降低的分数大于确定的最小临床重要差异阈值4.37。手术治疗的JIS患者在SRS-22r疼痛领域的评分明显低于非手术治疗的同龄人（3.6±0.9vs.4.1±0.7lp=0.019)。手术治疗的CS患者在SRS-22r心理健康领域的得分明显高于非手术治疗的同龄人（4.3±0.5vs.3.5±1.0；p=0.023）。在其他领域没有发现显著差异。
结论：除了活力和心理健康领域，在骨骼生长过程中接受治疗的先天性和青少年特发性脊柱侧凸患者在成年期大多数SF-36领域的HRQoL与国家标准相似.与支具治疗的患者相比，手术治疗的JIS患者经历了更多的疼痛，与接受手术治疗的患者相比，接受支撑的CS患者的心理评分显着降低。这些长期结果对于告知患者至关重要，并且可以指导临床医生和患者之间的共同决策。
