脊柱生长速率对行支具治疗的特发性脊柱侧凸患儿侧凸进展的预测价值

The value of spine length velocity in the prediction of curve progression in idiopathic scoliosis undergoing bracing treatment

中文关键词:  特发性脊柱侧凸  脊柱生长速率  生长潜能  侧凸进展

英文关键词:Idiopathic scoliosis  Maturity indicator  Spine length velocity  Growth potential  Cobb velocity

中文摘要:

  【摘要】 目的：分析行支具治疗的特发性脊柱侧凸（idiopathic scoliosis，IS）患儿侧凸进展速率（Cobb velocity，CV）的相关因素，并探讨脊柱生长速率（spine length velocity，SLV）对IS患儿侧凸进展的预测价值。方法：于我院门诊行正规支具治疗的女性IS患儿23例，初诊时Risser征为0，无神经系统异常。其中胸主弯19例，胸腰弯4例，平均随访3.3年。患儿每次随访均拍摄站立位全脊柱正位片及左手掌正位片，测量主弯的Cobb角、Risser征、脊柱长度及骨龄（digital skeletal age，DSA）评分。另外记录患儿每次随访时的实足年龄、月经状态及身高等资料，计算患儿每次随访时的CV、SLV及身高生长速率（height velocity，HV）。采用Spearman相关系数分析IS患儿SLV及CV的相关因素。结果：本组患儿平均初诊年龄10.8±1.3岁；月经年龄12.2±2.0岁；初诊DSA评分384.6±51.9；初诊脊柱长度311.6±23.6mm；平均初诊身高145.5±7.8cm；平均初诊Cobb角23.0°±6.9°。随访时患儿平均SLV为19.1±17.1mm/年；平均HV为5.4±4.1cm/年；平均CV为5.7°±8.1°/年。另外，SLV高峰期（大于20mm/年）与CV高峰期（大于5°/年）均发生于实足年龄10～13岁之间。Spearman相关性分析表明，SLV与实足年龄、Risser征、DSA评分、HV及CV呈显著相关（r=-0.337、-0.292、-0.199、0.374和0.456，P<0.05）；CV与实足年龄、DSA评分及HV呈显著相关（r=-0.192、-0.188和0.281，P<0.05）。结论：IS患儿侧凸进展速率与年龄、DSA评分、HV及SLV显著相关。SLV与年龄、Risser征、DSA评分及HV显著相关，是较好的评估IS患儿生长潜能和侧凸进展的指标。SLV大于20mm/年时提示较高的侧凸进展风险。

英文摘要:

  【Abstract】 Objectives: To investigate the correlative factors of Cobb velocity(CV) in idiopathic scoliosis(IS) girls, and to evaluate the value of spine length velocity(SLV) in the prediction of curve progression. Methods: Twenty-three IS girls(average age of 10.8 years) undergoing bracing treatment were included in this study. All patients were initially recruited with Risser 0 and no neurologic abnormality, and were followed up untill brace weaning. The curve patterns were single thoracic curves in 19 patients and double-main curves in 4 patients. At each visit, the following data were collected and recorded: chronologic age, stage of menses, standing height, Cobb angle of the main curve, spine length, status of triradiate cartilage, Risser sign and digital skeletal age(DSA) scores. The height velocity(HV), SLV, and CV of each visit were calculated. Correlation analysis was performed by using the Spearman coefficients. Results: The average chronologic age, DSA score, spine length, height and Cobb angle at the first visit was 10.8±1.3 years, 384.6±51.9, 311.6±23.6mm, 145.5±7.8cm and 23.0°±6.9°, respectively. The average SLV, HV and CV during follow-up was 19.1±17.1mm/year, 5.4±4.1cm/year and 5.7°±8.1°/year, respectively. In addition, the peak of both SLV(>20mm/year) and CV(>5°/year) took place during 10 and 13 years. The correlation analysis showed that SLV was significantly correlated with age, Risser sign, DSA score, HV and CV(r=-0.337, -0.292, -0.199, 0.374 and 0.456, P<0.05). Significant correlations between CV and age, DSA score and HV were observed(r=-0.192, -0.188 and 0.281, P<0.05). Conclusions: CV is significantly correlated with age, DSA score and HV in IS girls. SLV is significantly correlated with age, Risser sign, DSA score, HV and CV, which is proved to be a good predictor of CV and growth potential in IS. SLV more than 20 mm/year indicates a high risk of curve progression.