色努支具治疗青少年特发性脊柱侧凸的疗效及弯型变化分析

Analysis of the efficacy of Cheneau brace in the treatment of adolescent idiopathic scoliosis and evolution of the curve types during brace treatment

中文关键词:  青少年特发性脊柱侧凸  色努支具  弯型  保守治疗

英文关键词:Adolescent idiopathic scoliosis  Cheneau brace  Curve type  Conservative treatment

中文摘要:

  【摘要】 目的：分析色努支具治疗青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）的临床疗效，探讨治疗过程中的弯型变化。方法：2016年10月～2021年11月采用色努支具治疗AIS患者75例，其中女性69例，男性6例，初始年龄11.9±1.0岁，初始主弯Cobb角29.8°±8.5°，初始Risser征≤2级。收集患者的临床及影像学资料，包括年龄、性别、初潮时间、每日佩戴时长、初次治疗前和末次随访时的脊柱全长X线片。所有患者随访至结束支具治疗后1年。使用主弯分型和改良Lenke分型（modified Lenke classification system，mLenke）统计患者弯型，分析不同弯型患者的支具疗效和弯型变化情况。结果：所有患者经过25.7±10.8个月的支具治疗，结束支具治疗时年龄14.2±1.2岁，主弯Cobb角27.6°±12.0°。其中63例患者侧凸控制，12例患者侧凸进展，23例患者接受手术治疗。主腰弯型患者支具成功率和侧凸控制率高于主胸弯患者（P=0.043，P=0.003）。各mLenke分型患者的支具治疗成功率及侧凸控制率存在差异（P<0.001，P=0.005），其中，Ⅴ型患者支具成功率和侧凸控制率最高，Ⅳ型患者支具治疗成功率最低，Ⅱ型患者侧凸控制率最低。支具治疗前后，各主弯分型患者数量比例存在差异（P=0.019），各mLenke分型患者数量比例无统计学差异（P=0.071）。各主弯分型（P<0.001）和各mLenke分型（P=0.020）的弯型变化率存在差异。两种弯型分类系统中，弯型变化患者和未变化患者的支具治疗成功率和侧凸控制率未见明显差异。结论：不同弯型AIS患者的色努支具疗效存在差异，以胸弯为主弯的患者相较于以腰弯为主弯的患者支具疗效较差；治疗过程中患者可能发生以主弯上移为趋势的弯型变化；不同弯型患者的弯型变化率和弯型转归不同，弯型变化也可发生于侧凸控制或矫正的患者中。

英文摘要:

  【Abstract】 Objectives: To analyze the clinical efficacy of Cheneau brace in adolescent idiopathic scoliosis(AIS) patients and to discuss the changes of curve type during the treatment. Methods: 75 patients with AIS treated with Cheneau brace from October 2016 to November 2021 were included. There were 69 females and 6 males, averaged 11.9±1.0 years old when starting to wear the brace, with a mean initial main curve Cobb angle of 29.8°±8.5° and an initial Risser′s sign≤2. Clinical and imaging data were collected, including age, gender, menarche age, time of daily wear, and full-length radiographs of the spine before initial treatment and at the final follow-up. All the patients were followed up for 1 year after finishing brace treatment. The curve types of the patients were counted using the main curve type and the modified Lenke classification system(mLenke), and changes in curve types and the efficacy of bracing in patients with different curve types were analyzed. Results: After 25.7±10.8 months of brace treatment, the patients averaged 14.2±1.2 years old when finishing brace treatment, and the mean main Cobb angle was 27.6°±12.0°. Among the patients, scoliosis was controlled in 63 while progressed in 12, and 23 patients were treated surgically. The rates of success of brace and control of curve were higher in patients with main lumbar curve than those in patients with main thoracic curve(P=0.043, P=0.003). There was a difference in the rate of brace success and control of curve in patients with each mLenke classification(P<0.001, P=0.005). The highest rates of brace success and control of curve were found in patients of mLenke type Ⅴ, while mLenke type Ⅳ patients had the lowest success rate of brace treatment success and mLenke type Ⅱ patients had the lowest rate of control of curve. Before and after brace treatment, there was a difference in the proportion of patients with each main curve type(P=0.019), and the proportion of patients with each mLenke classification had no statistical difference(P=0.071). There were differences in the rate of change of curve type in each main curve type and each mLenke classification both(P<0.001, P=0.020). No significant differences were seen in the rates of success of brace treatment and control of curve between patients with and without change in curve type under the two curve type classifications. Conclusions: The efficacy of Cheneau brace varies among AIS patients with different curve types. Patients with a main thoracic curve tend to have a poor response to bracing compared with patients of main lumbar curve; During the treatment with Cheneau brace, the patient′s curve types may change, and the overall trend of curve type change is upward shifting of the main curve. The rate and outcome of curve type changes vary among patients with different curve types, and curve type changes may also occur in curve controlled or corrected patients.