Health-related quality of life after osteoporotic fractures

Objective: To estimate the impact of osteoporosis fractures on health-related quality of life (HRQOL) in postmenopausal women. Methods: To compare the impact on HRQOL of different osteoporotic fractures, 600 consecutive women 55–75 years old with a new fracture (inclusion fracture) were invited by mail. After exclusions by preset criteria (high-energy fractures, ongoing osteoporosis treatment, or unwillingness to participate), 303 women were included, 171 (56%) of whom had a forearm, 37 (12%) proximal humerus, 40 (13%) hip, and 55 (18%) vertebral fracture, respectively, and all were investigated and treated according to the current local consensus program for osteoporosis. In addition, HRQOL was evaluated by the SF-36 questionnaire and compared with local, age-matched reference material. Examinations were performed 82 days (median) after the fracture and 2 years later. Results: HRQOL was significantly reduced at baseline regarding all SF-36 domains after vertebral fractures and most after hip fractures, but only regarding some domains after forearm and humerus fracture. After 2 years, improvements had occurred after all types of fractures, and after forearm or humerus fracture, HRQOL was completely normalized in all domains. However, 2 years after hip fracture, HRQOL was still below normal regarding physical function, role-physical and social function, while after vertebral fracture, scores were still significantly lower for all domains, physical as well as mental. Patients with one or more previous fractures before the inclusion fracture had lower HRQOL at baseline and after 2 years, compared with those with no previous fracture. Patients with osteoporosis (T-score <–2.5 in hip or spine) had lower HRQOL than those with normal BMD. Conclusion: Vertebral and hip fractures have a considerably greater and more prolonged impact on HRQOL than forearm and humerus fractures. The number of fractures was inversely correlated to HRQOL. These differences should be taken into account when making priorities in health care programs.     

Short segment pedicle screw instrumentation and augmentation vertebroplasty in lumbar burst fractures: an experience

To assess the efficacy and feasibility of vertebroplasty and posterior short-segment pedicle screw fixation for the treatment of traumatic lumbar burst fractures. Short-segment pedicle screw instrumentation is a well described technique to reduce and stabilize thoracic and lumbar spine fractures. It is relatively a easy procedure but can only indirectly reduce a fractured vertebral body, and the means of augmenting the anterior column are limited. Hardware failure and a loss of reduction are recognized complications caused by insufficient anterior column support. Patients with traumatic lumbar burst fractures without neurologic deficits were included. After a short segment posterior reduction and fixation, bilateral transpedicular reduction of the endplate was performed using a balloon, and polymethyl methacrylate cement was injected. Pre-operative and post-operative central and anterior heights were assessed with radiographs and MRI. Sixteen patients underwent this procedure, and a substantial reduction of the endplates could be achieved with the technique. All patients recovered uneventfully, and the neurologic examination revealed no deficits. The post-operative radiographs and magnetic resonance images demonstrated a good fracture reduction and filling of the bone defect without unwarranted bone displacement. The central and anterior height of the vertebral body could be restored to 72 and 82% of the estimated intact height, respectively. Complications were cement leakage in three cases without clinical implications and one superficial wound infection. Posterior short-segment pedicle fixation in conjunction with balloon vertebroplasty seems to be a feasible option in the management of lumbar burst fractures, thereby addressing all the three columns through a single approach. Although cement leakage occurred but had no clinical consequences or neurological deficit.     

Segmental fixation of lumbar burst fractures with Cotrel-Dubousset instrumentation.

A retrospective review of 17 patients who underwent bilateral transpedicular decompression, instrumentation with a Cotrel-Dubousset construct, and posterolateral fusion with iliac crest bone graft for treatment of lumbar burst fracture is presented. All patients were followed to fusion with an average follow-up of 18.9 months. Fifteen of sixteen patients returned to preinjury occupation and/or activity. All patients reported good to excellent clinical results. The average postoperative progression of kyphosis was 11.9 degrees. There was no significant change in anterior vertebral height between the preoperative and postoperative periods. We conclude that although excellent early clinical results can be obtained using this operative strategy, the long-term effect of residual kyphosis at the fracture site is unknown.     

后路短节段椎弓根钉内固定治疗胸腰椎骨折的进展

胸腰段骨折约占脊柱骨折的1/2.相当一部分患者需手术治疗,后路椎弓根螺钉内固定术是目前常用手术方式之一.椎弓根螺钉的应用,使脊柱骨折治疗发生了很大的飞跃,与以椎板或横突为固定点的骨钩相比,其具有力学强度大,稳定性高,融合效果好等优点.从微创理念讲,现已广泛开展的后路短节段椎弓根钉内固定术（short segmentpedicle instrumentation SSPI）尽管较长节段固定优越,但仍存在某些不足.有鉴于此,为尽可能克服上述不足,有学者开展了后路单节段椎弓根钉固定术,即将两对椎弓根钉分别固定于骨折椎及其相邻的正常椎体中,并用于临床,取得了较满意的治疗效果.     

后路短节段椎弓根螺钉内固定椎体间植骨融合治疗胸腰椎单椎体爆裂性骨折

目的 探讨后路短节段椎弓根螺钉内固定结合经椎间孔椎体间植骨融合治疗胸腰椎单椎体爆裂骨折的疗效.方法 对2004年1月至2007年12月采用后路短节段椎弓根钉内固定结合经椎间孔椎体间植骨融合治疗且获得随访的31例胸腰椎单椎体爆裂骨折患者的临床资料进行回顾性分析.其中T11 2例,T12 9例,L1 11例,L2 6例,L3 3例;骨折按AO分型:A2型17例,A3型14例.术前脊髓神经功能按Frankel分级标准评定:A级3例,B级7例,C级12例,D级7例,E级2例.结果 所有患者随访12～41个月,平均17.5个月.术后1周及1年矢状面后凸Cobb角、伤椎前缘高度比值及椎骨横截面侵占率较术前均明显改善,差异有统计学意义(P＜0.05);术后1年与术后1周比较差异无统计学意义(P＞0.05).脊髓神经功能除A级3例无恢复外,其他患者均有不同程度恢复.结论 后路短节段椎弓根螺钉内固定经椎间孔椎体间植骨融合术可以通过一个切口完成三柱重建,创伤较小、减压充分彻底、复位固定可靠、融合节段少,是治疗胸腰椎单椎体爆裂骨折的有效方法之一.     

Health-related quality of life after conservatively and surgically-treated paediatric proximal humeral fractures

PurposeThe health-related quality of life (HRQoL) after conservatively versus surgically treated paediatric proximal humeral fractures is poorly understood. We assessed the HRQoL after this injury and asked if HRQoL was associated with age, radiological classification or treatment chosen.MethodsWe identified 228 patients who were treated for proximal humeral fractures between 2004 and 2017. These patients completed the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) (primary outcome), the Paediatric Quality of Life Inventory (PedsQL) and questions regarding patient satisfaction. Fractures were classified radiologically following the Paediatric Comprehensive AO Classification.ResultsWe were able to follow-up on 190 children; 147 (mean age 8.7 years (0.8 to 15.7)) sustained a metaphyseal and 43 (mean age 11.6 years (3.7 to 15.8)) sustained a Salter Harris type I or II injury. Most fractures (90%) were simple, 10% were multifragmentary. In total, 137 children (72%) were treated nonoperatively, 51 (27%) were treated by elastic stable intramedullary nailing (ESIN). After a median follow-up of 7.6 years (0.8 to 14.3) there was an overall mean Quick-DASH of 4.3 (SD 9.3) for girls and 1.2 (SD 3.1) for boys. The mean function score of the PedsQL was 94.7 (SD 11.1) for girls and 98.0 (SD 6.0) for boys. The mean psychosocial score of the PedsQL was 92.0 (SD 11.1) for girls and 94.1 (SD 11.6) for boys. Most children (79%) were very satisfied with the cosmetic result and 74% were very satisfied with the treatment overall. Surgery and female sex were associated with lower satisfaction.ConclusionIn this cohort of 190 patients, where immobilization for mildly displaced fractures, and closed reduction and ESIN was used for displaced fractures, there was equally excellent mid- and long-term HRQoL when assessed by the Quick-Dash and the PedsQL.Level of EvidenceTherapeutic, Level IV     

Health-related quality of life evaluated by the eight-item short form after cardiovascular surgery

Purpose  

Owing to advances in cardiovascular surgery, patients with cardiovascular disease require improvement of health-related quality of life (QOL) than before. We measured the QOL of patients undergoing cardiovascular surgery using the eight-item Short Form (SF-8) and assessed its usefulness.     

单节段与短节段椎弓根内固定治疗胸腰段单椎体骨折的疗效比较

现已广泛开展的后路短节段椎弓根钉内固定术(shortsegment peclicle instrumentation,SSPI)尽管较长节段固定优越,但仍存在内固定失败、矫正丢失、多融合一个节段、加速邻近节段退变等不足,且有学者认为随着融合节段的增多,邻近关节突关节退变愈严重~([1]).近年来,为进一步减少融合节段,有学者开展了后路单节段椎弓根钉内固定术(monosegment pedicle instrumentation,MSPI)~([2]).本文回顾性分析自2003年3月至2006年6月我院对91例胸腰椎骨折患者分别采用伤椎置钉单节段椎弓根内固定~([3])与短书段椎弓内固定椎间植骨融合的治疗情况,疗效满意,现报告如下.     

Health-related quality of life after gastric banding

BACKGROUND: Bariatric surgery ameliorates obesity-associated diseases, resulting in psychological and social benefits. Long-term studies of its effects on quality of life (QOL) assessed with well established instruments are lacking. This prospective study investigated the long-term effects of gastric banding on health-related QOL using an obesity-specific validated measure. METHODS: The Health Related Quality of Life (HRQL) questionnaire was completed by 50 severely obese patients before surgery and at 1, 2.5 and 5 years after gastric banding. Ninety-eight subjects with normal weight, matched for age, sex and education, also completed the HRQL questionnaire as controls. RESULTS: Surgery was successful in all patients. Mean excess weight loss after 1, 2.5 and 5 years was 42.1, 42.2 and 41.6 per cent respectively. General wellbeing, health distress, depression, perceived attractiveness and self-worth improved significantly over the 5 years and, except for general wellbeing, were still improving after 5 years. There were increases in physical activity and work productivity. Successful weight loss was the main determinant of general wellbeing and health distress, and these were adversely affected by band-related complications. In subjects with a body mass index below 30 kg/m(2), scores improved to values for subjects of normal weight. CONCLUSION: Bariatric surgery resulted in sustained improvement in health-related QOL even though not all excess weight was lost. Normalization of health-related QOL may necessitate greater weight losses.     

Health-related quality of life after cardiac surgery

Health-related quality of life (HRQOL) assessments are designed to reflect a patient's perspective of how a disease has affected their overall health status. Patient-centered outcomes are of value both for risk assessment and as an outcome measure. Strategies for analyzing HRQOL data are inconsistent primarily because the data frequently do not meet underlying assumptions of traditional methods for statistical analyses and require a careful analytic approach.     

Health-related quality of life after radical cystectomy

Herein, we review the assessment of quality-of-life (QoL) in radical cystectomy (RC) patients, summarize the result of studies for different surgical approaches, and provide an overview of patient management, as well as other considerations. In this review article, we reviewed the QoL research and research tools for patients undergoing RC, including urinary diversion methods, gender differences, and surgical methods (open surgery vs. robotic surgery). This narrative review focused primarily on articles indexed in PubMed, Embase, Scopus, and Google Scholar databases. We did not used formal search strategy and meta-analysis was not performed.     

Health-related quality of life after prostate brachytherapy

Brachytherapy for prostate cancer has become a widely used treatment. Increasingly, urologists are becoming conscious of quality‐of‐life issues relating to treatment. This mini‐review by authors from the University of Virginia looks at this important issue, reminding readers that patients are often willing to choose a treatment which will less certainly ensure a longer life‐expectancy, but which will more certainly guarantee a better quality of life. Other mini‐reviews in this section describe the technique and complications of transurethral surgery for bladder tumours, the mechanisms of vasculogenic erectile dysfunction after renal transplantation, and laparoscopic radical cystectomy and urinary diversion.     

Health-related quality of life after hip replacement

Abstract Total hip replacement is widely known to be effective in the management of pain and functional status. Instead, less is known regarding patients perspective through the measurement of health-related quality of life. A retrospective study was conducted to evaluate patient-relevant outcomes in a homogeneous sample of patients who underwent total hip replacement. Long-term results were evaluated through a self-administered questionnaire and clinical examination. We were able to re-contact 84.8% of patients at the follow-up, at an average of 7.35 years. The results confirm the value of the treatment of hip arthritis, demonstrating the impact of hip replacement on physical function and pain and consequently on the improvement of quality of life.     

Factors influencing the quality of life after burst fractures of the thoracolumbar transition

Introduction Dorsal stabilisation has represented the standard procedure for the treatment of burst fractures of the thoracolumbar spine for a long time, but in the last few years the combined dorsoventral stabilisation has gained in significance due to its higher mechanical stability. However, there are no data yet available indicating whether the patients benefit from the combined operation with regard to their postoperative quality of life and what the advantages are in comparison with the dorsal procedures. Therefore, the question was researched in the framework of a matched-pairs analysis of patients suffering from an unstable fracture of the thoracolumbar transition.Materials and methods From a consecutive series of patients treated in our clinic between 1995 and 2000, 10 patients with combined and 10 patients with a purely dorsal stabilisation were selected and included in the study. Their quality of life was summed up in retrospect with the SF-36 questionnaire. The X-rays were analysed, and the Cobb angle as well as the sagittal index were calculated. Only patients with burst fractures of the thoracolumbar transition without accompanying co-morbidity and neurological deficits were included in the study. Both of the treated groups were matched with regard to sex, age and radiological patterns of injury.Results Patients who had undergone only a dorsal stabilisation showed a significant loss of correction according to the sagittal index at the time of the examination (0.88±0.02 postoperative vs 0.77±0.03 at 4 years postoperatively, p=0.01). In the group of patients treated with the combined therapy, there was no statistically relevant loss of correction with regard to the sagittal vertebral profile. The SF-36 questionnaire showed a reduced quality of life in both groups compared with an age-referenced norm population, especially concerning the parameters of bodily health. No statistically relevant difference was observed between the two groups. Further, there was no statistically relevant association between the parameters of the SF-36 and the clinical and radiological data. After performing several regression analyses it could be shown that the patients mental health is a strong predictor of the postoperative vitality (r=0.803, p<0.01). However, none of the remaining parameters was able to predict the postoperative quality of life.Conclusion The patients in this study showed a reduced quality of life, independent of the method of surgical treatment. Although better radiological results could be seen for the combined procedure, regarding the postoperative quality of life no advantage could be proved compared with the dorsally stabilized patients. Furthermore, there was no relation between the radiological results and the quality of life parameters. Therefore, it can be assumed that the injury itself seems to be the main cause of the decreased quality of life after a burst fracture of the thoracolumbar transition.     

Health-related quality of life and subjective outcome after shoulder replacement for proximal humeral fractures

Shoulder replacement has increased exponentially in recent decades, and previous studies have documented the effectiveness of this procedure. Pain relief, physical functional level, and health-related quality of life, however, were often not assessed. To our knowledge, no published articles have assessed quality of life in shoulder replacement for fracture. The main purpose of this study was to assess the patient-relevant outcomes in patients who underwent shoulder replacement for proximal humeral fractures. Standardized quality of life and shoulder-specific, self-administered questionnaires were used. On the Medical Outcomes Study Short Form 36 Health Survey, as expected, we observed a lower score in the domain compared with healthy Italian subjects. A surprising finding was that in the General Health and Role-Emotional domains, our sample had a better picture than the healthy one, probably because patients had experienced severe trauma and major surgery previously. These data represent the first step toward the definition of outcome for this procedure. This study does not address the necessity of therapy, but if this were included in future publications, it might provide useful data for therapeutic recommendations.     

Health-related quality of life in patients before and after surgery for a herniated lumbar disc

We investigated the pre-operative and one-year post-operative health-related quality of life (HRQOL) outcome by using a Euroqol (EQ-5D) questionnaire in 263 patients who had undergone surgery for herniation of a lumbar disc. Data from the National Swedish Register for lumbar spinal surgery between 2001 and 2002 were used and, in addition, a comparison between our cohort and a Swedish EQ-5D population survey was performed. We analysed the pre- and post-operative quality of life data, age, gender, smoking habits, pain and walking capacity.The mean age of the patients was 42 years (20 to 66); 155 (59%) were men and 69 (26%) smoked. Pre-operatively, 72 (17%) could walk at least 1 km compared with 200 (76%) postoperatively.The mean EQ-5D score improved from 0.29 to 0.70, and the HRQOL improved in 195 (74%) of the patients. The pre-operative score did not influence the post-operative score. In most patients, all five EQ-5D dimensions improved, but did not reach the level reported by an age- and gender-matched population sample (mean difference 0.17). Predictors for poor outcome were smoking, a short pre-operative walking distance, and a long history of back pain.     

短节段椎弓根钉棒固定治疗无神经损伤胸腰椎骨折对长期生活质量的影响

目的:评估椎弓根钉棒固定手术对无神经症状胸腰椎骨折患者的长期生活质量影响。方法:自2007年1月至2010年10月,采用短节段椎弓根钉棒固定治疗无神经损伤胸腰椎骨折患者55例。其中男35例,女20例;年龄7~75岁,平均(44.0±10.5)岁。患者临床症状以胸腰部疼痛为主,无神经损伤症状,影像学主要表现为受伤椎体楔形变或椎体变扁,高度丢失。采用ODI、EQ-5D及SF-36这3种反应健康相关生活质量量表评定生活质量。结果:55例患者手术顺利,术后切口均Ⅰ期愈合,胸腰部活动功能完全或基本恢复,术后影像学示骨折均愈合,未发现螺钉松动、断钉、断棒现象。55例患者均完成随访问卷,平均随访时间为4.2年(3~6年)。ODI得分25.8±18.7,高于普通人群(P<0.05);计算所得EQ-5D指数得分0.70,低于正常中国人群相应得分(P<0.05);与正常中国人群相比,患者在SF-36问卷中8项的得分都明显降低(P<0.05)。结论:与正常中国人群相比,手术治疗无神经症状胸腰椎骨折患者的健康相关生活质量偏低,应引起重视。     

Health-related quality of life after Ivor Lewis esophagectomy

Purpose

Transthoracic Ivor Lewis esophagectomy is a surgical standard therapy for esophageal carcinoma. The aim of this study was to assess health-related quality of life (HRQL) in mid- and long-term survivors.

Methods

Patients with cancer-free survival of at least 12 months after esophageal resection for cancer were identified from a prospectively maintained database. EORTC questionnaires were sent out to assess health-related general (QLQ-C30) and esophageal cancer-specific (QLQ-OES18) quality of life (QOL). A numeric score was calculated in each conceptual area and compared with reference data.

Results

One hundred forty-seven patients completed the self-rated questionnaires. They were 121 men and 26 women with a mean age of 63.4 (21–83) years; median FU was 39 (12–139) months. Global health status, functional scales, and symptom scores were significantly reduced compared with healthy reference populations. Also, there was no significant impact of tumor histology, neoadjuvant treatment, minimally invasive approach, or duration of follow-up on HRQL. However, more than half of the patients reported a HRQL similar to that of the healthy reference population.

Conclusions

Despite the major psychosocial and physiological impacts of the disease, more than 50 % of mid- and long-term survivors of the Ivor Lewis procedure for esophageal cancer have a HRQL similar to that of the healthy reference population.