支具治疗后初始Cobb角进展速率对青少年特发性脊柱侧凸患者支具疗效的预测价值

The values of initial angle velocity following bracing in the prediction of bracing outcome in adolescent idiopathic scoliosis

中文关键词:  青少年特发性脊柱侧凸  初始Cobb角进展速率  初始矫正率  支具疗效

英文关键词:Adolescent idiopathic scoliosis  Initial angle velocity  Initial correction rate  Bracing outcome

中文摘要:

  【摘要】 目的：比较行支具治疗的青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者的支具治疗后初始Cobb角进展速率（initial angle velocity，IAV）和初始矫正率与支具疗效的相关性，探讨IAV对AIS患者支具疗效的预测价值。方法：回顾性分析于我院门诊行正规支具治疗的女性AIS患者126例，其中胸主弯74例，胸腰弯52例。于患者每次随访拍摄的站立位全脊柱正位片上测量主弯的Cobb角和Risser征。另外记录患者每次随访时的实足年龄、月经状态及身高等资料。根据患者末次随访时Cobb角进展程度分为两组：进展组55例Cobb角进展≥6°；非进展组71例Cobb进展<6°。IAV定义为患者支具治疗后第一次随访时的Cobb角进展速率，初始矫正率定义为支具治疗后第一次随访时的Cobb角矫正率。采用独立样本t检验比较两组之间的差异，逻辑回归分析不同支具疗效的预测因素。结果：本组所有患者平均初诊年龄12.4±1.6岁；月经年龄12.3±1.2岁；平均初诊身高154.4±9.7cm；初诊Risser征2.1±1.7；平均初诊Cobb角24.4°±6.1°。初诊至第一次随访平均时间间隔4.1±0.6个月；初诊至末次随访平均时间间隔35.9±13.7个月（24～60个月）。末次随访时平均Cobb角29.2°±8.4°。独立样本t检验示进展组和非进展组患者初诊年龄、月经年龄、初诊身高、初诊Risser征及初诊Cobb角均无显著差异（P>0.05）。非进展组IAV显著小于进展组（-9.9°±13.8°/年 VS 5.2°±12.5°/年，P<0.001），而非进展组初始Cobb角矫正率显著大于进展组[（11.6±16.9）% VS （-5.3±16.4）%，P<0.001]。逻辑回归分析示支具疗效与IAV（OR=8.451，P=0.004）呈显著相关，而与初始矫正率（OR=2.192，P=0.139）无显著相关。结论：支具治疗后初始Cobb角进展速率与AIS患者支具疗效呈显著相关，较高的支具治疗后初始Cobb角进展速率预示较差的支具治疗效果。

英文摘要:

  【Abstract】 Objectives: To compare the correlation of initial angle velocity(IAV) following bracing and the initial correction rate with bracing outcome in adolescent idiopathic scoliosis(AIS) patients, and to evaluate the values of IAV in the prediction of bracing outcome in AIS patients. Methods: 126 braced AIS girls were included in this study. The curve patterns were single thoracic curves in 74 patients and thoracolumbar curves in 52 patients. The Cobb angle and Risser sign of each visit were measured on the standing x-rays. The following data were collected: chronologic age, stage of menses and standing height. Patients were divided into two groups: 55 patients in progressive(curve progression ≥6°) group and 71 patients in non-progressive(curve progression <6°) group. The IAV was defined as the angle velocity at the second visit following the prescription of orthosis, and the initial correction rate was defined as the correction rate of Cobb angle at the second visit. The independent t test was used for comparison and the logistic regression analysis was applied to identify the predictive factors of bracing outcome. Results: Among the 126 AIS patients, the average chronologic age, age at menarche, standing height, Risser sign and Cobb angle at the first visit was 12.4±1.6 years, 12.3±1.2 years, 154.4±9.7cm, 2.1±1.7 and 24.4°±6.1°, respectively. The average Cobb angle at the last visit was 29.2°±8.4°. The independent t test showed no significant difference between two groups including chronologic age, age at menarche, standing height, Risser sign or Cobb angle at the first visit(P>0.05). however, significant difference was found between non-progressive and progressive group in terms of IAV(-9.9°±13.8°/year VS 5.2°±12.5°/year, P<0.001) and initial correction rate[(11.6±16.9)% VS (-5.3±16.4)%，P<0.001]. Logistic regression analysis revealed that the initial AV(OR=8.451, P=0.004) was significantly correlated with the bracing outcome instead of initial correction rate(OR=2.192, P=0.139). Conclusions: The IAV serves as a better predictor for curve progression than initial correction rate in braced AIS patients. High IAV indicates high risk of failure bracing outcome.