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脊椎矯正手術對早發性脊椎側彎兒童熱量與體重變化-病例系列分析

Effect of Scoliosis Surgery on Calorie Intake and Weight of Children With Premature Scoliosis: A Case Series

Abstracts


早發性脊椎側彎影響到兒童與青少年的營養狀況及正常成長,病人需接受多次脊椎側彎矯正手術。目前臺灣尚無此族群營養相關之研究,故本研究採病例系列回顧不同脊椎延長手術期間對早發性脊椎側彎兒童熱量與體重之變化。回顧自2014年6月至2017年6月,14位早發性脊椎側彎兒童類型分別為6位先天性(congenital)、2位神經肌肉性(neuromuscular)、3位其他綜合症(syndromic)、3位特發性(idiopathic),並接受不同手術方式:8位採胸廓鈦肋擴大術(vertical expandable prosthetic titanium rib, VEPTR II)、4位延長式鋼桿植入(growing rods)、1位截骨矯正(ponte osteotomy)及1位半椎體切除術(hemivertebrae resection),於術前1週及術後3~5天給予2次營養諮詢,追蹤術後1、3、6月的體位與攝食量變化。長期追蹤資料採用廣義估計方程式(generalized estimating equation, GEE)進行分析,術後6個月體重皆顯著高於術前,先天性類型術後體重增加較神經肌肉性、綜合症狀和特發性組更多。影響個案術後體重增加因素為側彎疾病的型態與使用之手術方式(p < 0.05)。2次的營養諮詢,可使術後1~6個月先天性組的體重顯著增加,但手術的方式、接受諮詢時的年齡與天生疾病的型態還是影響術後體重增加的主因,本研究因個案數少與追蹤時間較短,未來還需要更多研究支持,以改善不同型態早發性脊椎側彎兒童成長。

Parallel abstracts


Premature scoliosis impedes the nutritional status and normal growth of children and adolescents. Patients with premature scoliosis are required to receive scoliosis surgery multiple times. Because no research on the nutritional status of patients with premature scoliosis has been reported in Taiwan, this study performed a case series to review the changes in the calorie intake and weight of children with premature scoliosis during different stages of their spinal lengthening procedures. We included 14 children with premature scoliosis from June 2014 to June 2017, of whom 6 had congenital scoliosis, 2 had neuromuscular scoliosis, 3 had syndromic scoliosis, and 3 had idiopathic scoliosis. Among these children, 8 underwent vertical expandable prosthetic titanium rib surgery, 4 underwent growing rod surgery, 1 underwent Ponte osteotomy, and 1 underwent hemivertebra resection. Nutritional counseling was provided to these children 1 week before and 3-5 days after their chiropractic adjustments, and the changes in their physical status and food intake 1, 3, and 6 months after the surgery were recorded. Long-term follow-up data were analyzed using the generalized estimating equation approach. The children's body weight 6 months after the surgery were significantly higher than those before the surgery, with the highest weight gain observed in children with congenital scoliosis. The factors influencing the children's postoperative weight gain were the types of scoliosis and scoliosis surgery methods (p < 0.05). Accordingly, preoperative and postoperative nutritional counseling was associated with significant weight gain in children with congenital scoliosis 1-6 months after their scoliosis surgery. However, the surgical method, age at receiving nutritional counseling, and type of congenital scoliosis substantially affected their postoperative weight gain. The study limitations include small sample size and short follow-up duration. Further research is required to improve children's growth with different types of premature scoliosis.

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