女性青少年特发性脊柱侧凸患者停止支具治疗后的侧凸进展及其相关因素

Curve progression after brace weaning in female adolescent idiopathic scoliosis

中文关键词:  青少年特发性脊柱侧凸  停支具  侧凸进展  SRS标准  女性

英文关键词:Adolescent idiopathic scoliosis  Brace weaning  Curve progression  SRS  Female

中文摘要:

  【摘要】 目的：分析发育成熟的女性青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患儿在停止支具治疗后长期随访中的侧凸进展情况，并探讨其相关因素。方法：回顾性分析于我院门诊就诊符合SRS（scoliosis research society）支具治疗标准的女性AIS患儿130例，初诊年龄11.8±1.4岁（10~14岁）。所有患儿均随访至支具治疗结束后至少2年，且至少具有佩戴支具后初次随访、停止支具治疗时、停止支具治疗后6个月、1年、2年及末次随访时的资料。在每次随访时的全脊柱正位X线片上测量主弯侧凸Cobb角，并评估侧凸进展超过5°的患儿及比例、侧凸进展度数和进展速率。末次随访时侧凸进展超过5°定义为侧凸进展，采用独立样本t检验比较侧凸进展组和非进展组患儿的初诊年龄、月经初潮年龄、初诊Cobb角、初始矫正率、停止支具治疗年龄。结果：与停止支具治疗时相比，停止支具治疗后6个月、1年、2年及末次随访时的侧凸进展超过5°的患儿分别为33例（25.4%）、42例（32.3%）、61例（46.9%）和63例（48.5%）；侧凸进展度数分别为2.0°±4.4°、3.2°±5.0°、4.9°±5.5°和5.1°±6.9°；侧凸进展速率分别为0.33°±0.71°/月、0.20°±0.41°/月、0.14°±0.29°/月和0.01°±0.19°/月。停止支具治疗后侧凸非进展组和进展组患儿的初诊年龄、月经初潮年龄、初诊Cobb角、初始矫正率、停止支具治疗时年龄等无显著性差异（P>0.05），而停止支具治疗时的Cobb角有统计学差异（P<0.05）。结论：行支具治疗的AIS患儿停止支具治疗后仍有较高的侧凸进展风险，停止支具治疗后的6个月内为侧凸进展高风险和高速率期；停止支具治疗时的侧凸Cobb角越大发生侧凸进展的风险越高。

英文摘要:

  【Abstract】 Objectives: To investigate the curve progression after brace weaning in adolescent idiopathic scoliosis(AIS) girls, and to evaluate the potential indicators for curve progression after brace weaning. Methods: One hundred and thirty AIS girls fulfilling the Scoliosis Research Society(SRS) bracing criteria were included with an average age of 11.8±1.4 years(10-14 years). All the AIS girls were followed up regularly until at least 2 years after brace weaning. The demographics and radiographs at initial visit, brace weaning, 6m after weaning, 1y after weaning, 2y after weaning and the last follow-up were available for each patient. At each time point, the following parameters were calculated: percentage of patients with curve progression >5°, the mean progressive magnitude and rate. Curve progression after brace weaning was defined as increase in Cobb angle >5° at the last follow-up. Comparison between progressive and non-progressive groups was performed by using the independent t test. Results： Compared with brace weaning, at 6m, 1y, 2y and the last follow-up after brace weaning, the percentages of patients with curve progression >5° were 25.4%(33 cases), 32.3%(42 cases), 46.9%(61 cases) and 48.5%(63 cases); the mean progression magnitudes were 2.0°±4.4°, 3.2°±5.0°, 4.9°±5.5° and 5.1°±6.9°; the mean progression rates were 0.33°±0.71°/m, 0.20°±0.41°/m, 0.14°±0.29°/m and 0.01°±0.19°/m. No significant difference was found in age at initial visit, menarche age, Cobb angle at initial visit, initial correction rate, age at brace weaning between non-progressive and progressive group(P>0.05); and significant difference was found in Cobb angle at brace weaning(P<0.05) between two groups. Conclusions: AIS girls have relatively high risk of curve progression after brace weaning, and the highest rate of curve progression occurs within 6m after brace weaning. High Cobb angle at brace weaning indicates high risk of curve progression after brace weaning.