青少年特发性脊柱侧凸支具治疗结束后近期矫正丢失及影响因素

Loss of correction at short-term follow-up after bracing for patients with adolescent idiopathic scoliosis

中文关键词:  特发性脊柱侧凸  青少年  支具

英文关键词:Idiopathic scoliosis  Adolescent  Brace

中文摘要:

  【摘要】 目的：观察青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）支具治疗结束后短期内侧凸的矫正丢失情况，并探讨其影响因素。方法：选取2002年10月～2007年12月在我院完成规范化支具治疗后短期随访的AIS患者84例，其中男4例，女80例。初诊时年龄10～15岁，平均12.8岁；Risser征0～3级，平均1.6级；主弯Cobb角20°～43°，平均29.5°。胸腰双主弯36例，单胸弯22例，单胸腰弯或腰弯26例。所有患者在初诊、复查时均摄佩带支具前后站立位全脊柱正位X线片。分别测定不同时期侧凸Cobb角，记录侧凸类型、Risser征、患者的生理年龄及月经初潮时间，分析去除支具后侧凸的矫正丢失情况及影响因素。结果：AIS患者支具治疗后主弯Cobb角的平均矫正率为12.4％，其中14例（16.7％）患者在治疗期间出现脊柱侧凸进展，不同弯型脊柱侧凸的侧凸矫正率、进展率比较差异无显著性（P＞0.05）。支具治疗结束时主弯Cobb角10°～37°，平均25.5°，明显小于初诊时的29.5°（P<0.05），停用支具后6～18个月主弯Cobb角为27.2°，与支具治疗结束时比较无显著性差异 （P＞0.05）。停用支具后，有15例（17.6％）患者出现脊柱侧凸进展，不同弯型脊柱侧凸进展差异无统计学意义（P＞0.05）；侧凸进展的患者在支具治疗时主弯Cobb角的平均矫正率为23.3％，明显高于未出现侧凸进展患者的10.6％，且差异具有统计学意义（P<0.05）。停用支具时不同Cobb角组后期出现侧凸进展的概率无显著性差异（P＞0.05）。结论：支具治疗能够有效控制AIS患者侧凸的进展。在结束支具治疗后短期内随访侧凸矫正基本稳定，但仍有一小部分患者会出现侧凸进展，这种进展与弯型、侧凸的严重程度无关，可能与支具治疗期间侧凸的矫正率较大有关。

英文摘要:

  【Abstract】 Objective：To investigate the loss of correction at short-term follow-up after bracing for patients with adolescent idiopathic scoliosis（AIS）.Method：Eighty-four AIS patients（4 males and 80 females），undergoing bracing according to standard treatment protocol from October 2002 to December 2007 and followed-up for short-term after bracing，were enrolled in this study.The mean age at initial admission was 12.8 years（range，from 10 to 15 years），the mean Risser sign was 1.6（range from 0 to 3） and the mean Cobb angle for major curve was 29.5°（range，from 20° to 43°）.36 patients had double major curve，22 had single thoracic curve and 26 had either single thoracolumbar or single lumbar curve.All patients took the standing long-cassette anteroposterior radiographs of spine at intervals of 3 to 6 months and 6 to 18 months after bracing.The curve type，chronologic age，Risser sign and menarcheal status were recorded respectively.Cobb angles were measured at initial admission and every timepoint of follow-up.The loss of correction was calculated and analyzed.Result：The average correction rate of bracing for AIS was 12.4％，14 patients（16.7％） were noted with curve progression.No significance difference of correction and curve progression rate was found between different curve patterns.The mean major Cobb angle at the end of bracing was 25.5°（range，10°-37°），which showed no significant difference compared with the final off-brace follow-up of 27.2°（P＞0.05），but significantly lower than the initial admission of 29.5°（P<0.05）.After brace treatment，15 patients（17.6％） were observed having curve progression.No significant difference was observed with regarding to the rate of curve progression between different curve patterns（P＞0.05）.Of all the patients with off-brace curve progression，the correction rate of major curve at bracing was 23.3％ and statistically higher than that with no off-brace curve progression（10.6％）.The curve magnitude during off-brace had no effect on the overall rate of curve progression.Conclusion：The curve progression of AIS can be effectively prevented in most AIS patients by bracing according to standard treatment protocol.Curve magnitude is stable at early stage after bracing. However，curve progression is still present in some patients，which is probably associated with more curve correction due to bracing rather than curve patterns and curve magnitude.