性别对青少年特发性脊柱侧凸患者支具治疗效果的影响

Sex-related effect of bracing treatment for adolescent idiopathic scoliosis

中文关键词:  青少年特发性脊柱侧凸  支具治疗  性别  进展  影响因素

英文关键词:Adolescent idiopathic scoliosis  Ｂrace treatment  Ｓex  Progression  Influence factor

中文摘要:

  【摘要】 目的：比较男、女性青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者支具治疗的效果，探讨性别因素对支具治疗效果的影响。方法：2003年7月~2009年7月在我院完成支具治疗的男性AIS患者19例（A组），初诊时平均年龄14.0±2.0岁，平均主弯Cobb角28.8°±5.7°，初始Boston支具治疗6例，Milwaukee支具治疗13例；随机抽取同时期完成支具治疗的女性AIS患者57例（B组），初诊时平均年龄13.0±1.4岁，平均主弯Cobb角29.4°±6.1°，初始Boston支具治疗17例，Milwaukee支具治疗40例。定义末次随访时Cobb角大于初诊6°或治疗期间建议行矫形手术者为侧凸进展。结果：两组初诊时Risser征（P=0.786）、Cobb角（P=0.790）、弯型分布（P=0.350）和应用支具类型分布（P=0.350）等无显著性差异。A组和B组平均支具治疗时长分别为2.1±0.7年和2.5±0.9年，平均依从性分别为84.4%±7.6%和87.1%±5.7%。A组患者中发生侧凸进展8例（42%），其中需手术治疗者6例（32%）；B组中侧凸进展12例（21%），其中需手术治疗者10例（18%）。男性患者侧凸进展比例高于女性，但统计学差异不明显（P＝0.071）。两组中，生长发育状态低下、侧凸Cobb角大及主胸弯型患者侧凸进展比例高。结论：支具治疗可有效控制多数AIS患者的侧凸进展，女性患者支具治疗效果可能好于男性患者。

英文摘要:

  【Abstract】 Objective：To compare the sex-related efficiency of bracing treatment for adolescent idiopathic scoliosis.Method：Form July 2003 to July 2009，76 AIS patients experiencing bracing treatment were enrolled in this study.All patients were assigned into male group（n=19，group A） and female group（n=57，group B）.Patients in group A averagely aged of 14.0±2.0 years with a initial major curve of 28.8°±5.7°，and those in group B had an average age of 13.0±1.4 years with Cobb angle 29.4°±6.1°.Six patients were treated with Boston brace and 13 with Milwaukee brace in group A，while 17 with Boston brace and 40 with Milwaukee brace in group B respectively.Curve progression was defined as Cobb angle greater than 45° or increment over than 6° compared with before bracing which is indicative for surgery，otherwise was defined as non-progression.Result：The Risser grade，Cobb angle of major curve，distribution of curve pattern and brace type were showed no difference in both groups.The duration of bracing averaged 2.1±0.7 years and 2.5±0.9 years and the treatment compliance averaged 84.4%±7.6% and 87.1%±5.7% for group A and B respectively.Eight patients（42%） in group A were found with curve progression，and six of them（32%） were indicative for surgery. 12 patients（21%） in group B were found with curve progression，and ten of them（18%） were indicative for surgery.Lower growth status，larger Cobb angle and main thoracic curve were noted with higher progression rate in both groups.Conclusion：Bracing treatment is effective to prevent curve progression in most AIS patients，however its efficiency might remain lower for male than for female.