Cheneau支具佩戴依从性对青少年特发性脊柱侧凸患者生存质量及疗效的影响

The influence of Cheneau brace treatment compliance on the health-related quality of life and efficacy in adolescent idiopathic scoliosis

中文关键词:  青少年特发性脊柱侧凸  Cheneau支具  依从性  侧凸进展  生存质量

英文关键词:Adolescent idiopathic scoliosis  Cheneau brace  Compliance  Curve progression  Quality of life

中文摘要:

  【摘要】 目的：探讨Cheneau支具佩戴依从性与高侧凸进展风险青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者侧凸进展的关系，比较不同依从性患者的健康相关生存质量。方法：2007年1月~2012年12月，在我院行Cheneau支具治疗的高侧凸进展风险AIS患者73例，初诊时平均年龄为12.8±1.2岁，平均主弯Cobb角31.4°±6.0°，平均Risser征为0.7±0.8级。所有患者每3~6个月定期复查，行临床及影像学检查，摄站立位脊柱全长正侧位X线片。在末次随访时每位患者填写健康相关生存质量问卷量表。侧凸进展定义为末次随访Cobb角大于初诊6°以上或治疗期间建议行矫形手术（Cobb角>45°），其余为非进展。依从定义为患者每天坚持佩戴支具时间≥22h直至随访终止，否则视为不依从。随访结束后根据患者依从性不同将患者分为2组，应用独立样本t检验和卡方检验分析依从性对患者侧凸进展及健康相关生存质量的影响。结果：平均随访时间为1.8±0.8年。根据依从性定义，47例（64%）患者被纳入依从组，26例（36%）纳入不依从组。依从组患者末次随访时主弯Cobb角（28.9°±11.7°）明显小于不依从组（38.6°±11.6°），有统计学差异（P＜0.01）。依从组侧凸进展率明显低于不依从组（OR 5.7，95%CI 1.9~16.8，P＜0.01）。末次随访时不依从组自我形象/外观、精神健康、治疗满意度三个维度的得分均低于依从组（P<0.01）；不依从组患者欧洲五维健康量表得分亦明显低于依从组（P<0.01）。结论：良好的支具佩戴依从性可降低高侧凸进展风险AIS患者的侧凸进展率，提高患者健康相关生存质量。

英文摘要:

  【Abstract】 Objectives: To discuss the association between Cheneau brace treatment compliance and curve progression of high-risk adolescent idiopathic scoliosis(AIS). To compare the health-related quality of life in different compliant patients. Methods: 73 high-risk AIS patients who were treated with Cheneau brace from January 2007 to December 2012 were reviewed retrospectiovely． These patients had a mean age of 12.8±1.2 years, a mean main curve of 31.4°±6.0° and a mean Risser grade of 0.7±0.8 before bracing treatment. All patients were followed up at intervals of 3 to 6 months. Clinical and radiological results were assessed at each follow-up assessment. Standing radiographs with PA and lateral views were obtained. All patients were asked to answer a standardized health-related quality of life questionnaire at weaning. Curve progression was defined that Cobb angle greater than 6° compared with bracing initiation or aggravated to more than 45°(indicative for surgery). Compliance was defined as brace wear ≥22h daily until weaning. Patients were divided into two groups according to compliance. Group t-tests and Chi-square were performed to evaluate the influence of Cheneau brace treatment compliance on the health-related quality of life and curve progression. Results: The mean follow-up time was 1.8±0.8 years. 47(64%) patients were registered as compliance, while 26(36%) were non-compliant. The compliant group had a lower mean major curve Cobb angle than the non-compliant group(28.9°±11.7° vs 38.6°±11.6°, P<0.01). 8/47 compliers and 14/26 non-compliers had curve progression ≥6°（OR=5.7, 95%CI: 1.9-16.8）. SRS-22 scores regarding self-image, mental health and satisfaction for the brace treatment were significantly better in compliant patients(P<0.01). EuroQol scores were significantly lower in non-compliant patients(P<0.01). Conclusions: Good brace compliance reduces curve progression and improves the health-related quality of life in patients with high-risk AIS.