青少年特发性脊柱侧凸患者结束支具治疗后侧凸进展的危险因素分析

Risk factors contributing to further deterioration in patients with adolescent idiopathic scoliosis after brace treatment

目的研究青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者结束支具治疗后侧凸进展的危险因素,为AIS的科学、合理使用支具治疗提供理论依据。方法纳入2013-03-2016-03于我院支具治疗的164例青少年特发性脊柱侧凸患者,结束支具治疗后随访24个月,以侧凸Cobb进展≥5°诊断为支具治疗后侧凸进展,设为进展组,侧凸Cobb进展<5°设为非进展组。调查两组患者初诊年龄、性别、初诊Cobb角等病历资料,通过Logistic回归分析探究AIS患者结束支具治疗后侧凸进展的独立危险因素。结果 AIS患者结束支具治疗后侧凸进展38例,进展率23.17%,平均侧凸Cobb角(6.84±0.87)°,未进展126例,平均侧凸Cobb角(3.77±0.65)°;两组初发Cobb角、顶椎旋转度、站高增长速度、女性初潮年龄、Risser征的差异有统计学意义(P<0.05);Logistic回归分析证实:初发Cobb角≥35°、顶椎旋转度≥Ⅲ度、女性初潮年龄<12岁、站高增长速度>30 mm/年,均是AIS患者结束支具后侧凸进展的独立危险因素。结论 AIS患者结束支具治疗后侧凸进展发生率较高,初发Cobb角≥35°、顶椎旋转度≥Ⅲ度、站高增长速度>30 mm/年、女性初潮年龄<12岁均会增加侧凸进展风险。

Objective To investigate the risk factors contributing to further deterioration in patients with adolescent idiopathic scoliosis(AIS) after brace treatment, and to provide a theoretical basis for scientific and rational use of braces in AIS treatment.Methods From March 2013 to March 2016, 164 AIS patients received brace treatment in our hospital were selected and followed up for 24 months. Patients with Cobb’s angle ≥5° were included into progression group. Cobb’s angle < 5° was set as non-progression group. The medical records at the first visit including age, gender, and initial Cobb’s angle were investigated. Then, the independent risk factors contributing to further deterioration were analyzed by the Logistic regression analysis. Results Among 164 AIS patients,38 patients(23.17%) had curve progression and with a mean Cobb angle of(6.84±0.87)°, 126 patients had non-progression and with a mean Cobb angle of(3.77 ±0.65)°. There were statistically significant differences between the two groups in Cobb angle, vertebral rotation, high growth rate of station, age of meniscus and Risser sign(P<0.05). Logistic regression analysis demonstrated that incipient Cobb angle ≥35°, top vertebral rotation ≥ Ⅲ, female menarche age <12 years old, standing high growth speed >30 mm/year, were independent risk factors of the curve progression after brace weaning in patients with AIS. Conclusion AIS patients have relatively high risk of curve progression after brace weaning, and Cobb ’s angle at the initial visit ≥35°, apical vertebral rotation ≥Ⅲ, standing high growth speed > 30 mm/year, menarche age <12 years old will increase the risk.