色努支具治疗青少年特发性脊柱侧凸的疗效及影响因素分析

Observation on the curative effect and analysis of influencing factors of Cheneau brace in the treatment of adolescent idiopathic scoliosis

中文关键词:  青少年特发性脊柱侧凸  支具治疗  初始支具矫正率

英文关键词:Adolescent idiopathic scoliosis  Brace treatment  In-brace correction

中文摘要:

  【摘要】 目的：观察色努支具治疗青少年特发性脊柱侧凸的疗效，探究影响疗效的相关因素。方法：2016年1月~2018年6月采用色努支具治疗的青少年特发性脊柱侧凸患者49例，其中女性46例，男性3例，治疗初始年龄12.6±1.3岁（10~15岁），初始主弯Cobb角32.5°±6.9°（20°~45°），初始Risser征2.2±1.6。收集患者的临床资料：年龄、每日佩戴时间等信息；影像学资料：初始、佩戴支具即刻和随访的系列脊柱全长X线片。通过佩戴支具即刻X线片计算初始支具矫正率。评估治疗后结果：Cobb角减少≥6°定义为“改善”，Cobb角变化5°以内定义为“稳定”，Cobb角增大≥6°定义为“进展”，前两者为治疗成功。观察初始支具矫正率在各组结果中的差异；分析畸形进展的患者相关因素：畸形严重程度（20°~29°，30°~39°及40°~45°三组）、Risser征（0~4）和侧凸类型（胸弯、胸腰弯/腰弯、双主弯三种类型）；并分析影响初始支具矫正率的可能因素。结果：49例患者平均治疗2.0±1.0年，所有患儿每天支具佩戴时间在18~20h以上，依从性良好。随访2.0±1.0年（1~5年），末次随访时年龄14.6±1.4岁，Risser征4.2±0.6，末次随访Cobb角28.5°±9.6°；其中畸形改善31例，畸形稳定14例，支具治疗的总体成功率为91.8%（45/49）；畸形进展4例，其中3例畸形超过45°。初始支具矫正率平均（64.9±23.6）%，其在改善组、稳定组和进展组分别为（69.5±23.2）%、（61.5±23.7）%和（42.5±10.0）%，初始支具矫形率和各组结果存在中等强度相关性（相关系数0.318，P=0.026）；有序多分类Logistic回归显示支具矫正率对结果存在正向影响，差异有统计学意义（P=0.045）。分析畸形进展的患者相关因素发现：畸形严重和骨骼成熟度低是畸形进展的危险因素（P=0.016和P=0.010），不同侧凸类型的畸形进展率没有统计学差异（P=0.124），但4例进展患儿均发生在胸段侧凸（3例胸弯，1例双主弯），胸腰弯/腰弯无进展病例。多因素分析显示，畸形程度越低，初始支具矫正率越高（P=0.001）；侧凸类型和Risser征对矫正率无显著影响（P＞0.05）。结论：色努支具是治疗青少年特发性脊柱侧凸的有效方法，初始支具矫正率是影响结果的重要因素，初始支具矫正率越高治疗效果越优；畸形程度严重（>40°）和骨骼成熟度低（Risser 0）的胸段侧凸患儿，畸形进展的可能性更大。

英文摘要:

  【Abstract】 Objectives: To study the efficacy of Cheneau brace in the treatment of adolescent idiopathic scoliosis and investigate the related factors affecting the outcomes. Methods: Patients diagnosed with adolescent idiopathic scoliosis(AIS) and treated with Cheneau brace from January 2016 to June 2018 were reviewed. 49 patients(46 females and 3 males) were included in the study. The average initial treatment age was 12.6±1.3y(10-15y), the initial Risser sign was 2.2±1.6, and the initial main curve Cobb angle was 32.5°±6.9°(20°-45°). The clinical data including age and daily wearing time and radiological data of full-length X-ray films of spine at the beginning, immediately after bracing and follow-up were evaluated. In-brace correction was calculated using immediate X-ray film after bracing. The outcomes were evaluated as "improved" (reduction of Cobb angle ≥6°), "stable unchanged" (Progression or reduction of Cobb angle within 5°), and "worsened"(Cobb angle ≥6° progression), and the outcomes of "improved" and "stable" were considered as successful. The influencing factors for deformity progress were analyzed, including treatment factor of in-brace correction and patients′ factors, such as deformity magnitude(20°-29°, 30°-39° and 40°-45°), Risser sign (0-4), and curve type (thoracic curve, thoracolumbar/lumbar curve, and double major curve). Meanwhile, the potential factors affecting the in-brace correction rate were also analyzed. Results: Of all the patients, the average treatment duration was 2.0±1.0 years. All children wore braces for more than 18-20 hours per day, with good compliance. The average age of patients in the last follow-up was 14.6±1.4 years, the Risser sign was 4.2±0.6, and the Cobb angle was 28.5°±9.6°. Deformity improved in 31 cases, deformity unchanged in 14 patients, and the successful rate was 91.8%(45/49). Deformity progressed in 4 cases, of which 3 cases were more than 45°. The average In-brace correction was (64.9±23.6)%, which was (69.5±23.2)%, (61.5±23.7)% and (42.5±10.0)% in the improved group, the stable group and the worsened group, respectively. There was a moderate correlation between the initial orthosis rate and the results of each group(correlation coefficient 0.318, P=0.026); Ordinal multinomial logistic regression showed that the brace correction rate had a positive effect on the results, and the difference was statistically significant(P=0.045). By analyzing the patients′ factors for deformity progression, it was found that deformity magnitude and bone maturity were risk factors for deformity progression(P=0.016 and P=0.010). There was no significant difference in the rate of deformity progression among different curve types(P=0.124). However, the 4 cases of progressive deformity all occurred in thoracic region (3 cases of thoracic curve and 1 case of double major curve), no progress occurred in thoracolumbar curve/lumbar curve. Multivariate analysis showed that the lower the degree of deformity, the higher in-brace correction(P=0.001); the curve type and Risser score had no significant effect on in-brace correction. Conclusions: Cheneau brace serves as an effective method for the treatment of adolescent idiopathic scoliosis. In-brace correction rate is an important factor affecting the outcomes, that is the higher the in-brace correction rate, the better the treatment results. Thoracic region curve with severe deformity (>40°) and low level of skeletal maturity(Risser 0) are more likely to progress.