Boston矫形器治疗青少年特发性脊柱侧凸的疗效分析

Using the Boston brace to treat idiopathic spinal scoliosis in adolescence

目的研究Boston矫形器对青少年特发性脊柱侧凸(AIS)的临床治疗效果。方法选择1997年3月至2002年12月使用Boston矫形器治疗并得到随访的AIS患者108例,观察并比较患者治疗前、后的Cobb角、顶椎偏离中线距离(AVT)、顶椎旋转度(AVR)、躯干位移(TS)以及肺活量(VC)、第1秒用力呼气容积占用力肺活量的百分比(FEV1／FVC)、每分钟最大通气量(MVV)、残气量(RV)等指标,分析并评价Boston矫形器的疗效。结果矫形器治疗前,脊柱侧凸的Cobb角为(38．2±10．8)°,矫形器治疗2年后Cobb角平均为(24．4±8．9)°,治疗前、后比较差异有统计学意义(P<0．01),矫正率为36．1％。矫形器治疗后, AVT、AVR和TS与治疗前比较,有显著改善(P<0．01);而肺功能各项指标(包括VC、FEV1／FVC、MVV和RV)的正常率并无明显改变(P>0．05)。Risser。征Ⅰ度(包括0度)患者矫正率分别与Risser征Ⅱ度、Ⅲ度患者比较,差异均有统计学意义(P<0．05)。除3例患者因出现侧凸进展改行手术矫形外,其他患者侧凸畸形均得到显著改善,肺功能无明显损害。结论Boston矫形器对AIS的临床治疗有效,Risser征可以作为预测AIS矫形器矫形效果的指标之一。

Objective To evaluate the clinical efficacy of the Boston brace in treating adolescent idiopathic seoliosis （AIS）. Methods One hundred and eight cases of AIS were treated with Boston braces from May 1997 to Dee 2002. Thirty-four were male and 74 were female, with the mean age being 11.8 years. 44, 28, 24 and 12 patients were Risser sign 0 to Ⅲ degree, respectively. The follow-up periods ranged from 6 to 24 months. Clinical and radiologieal data, including Cobb＇s angle, apical vertebral translation, apical vertebral rotation, trunk shift and pulmonary function, were recorded to evaluate the therapeutic effects. Results All the patients were followed up and three had operative intervention because of increasing curvature. The treatment with the Boston brace could significantly prevent curve progression. The Cobb＇s angle also decreased from 38.2°to 24.4° on average （corrective rate： 36.1% ）. Apical vertebral translation, apical vertebral rotation and trunk shift were significantly improved （ P 〈 0.01 ）. Indices of pulmonary function, including vital capacity （ VC）, and forced expiratory volume in one second as a fraction of forced vital capacity （FEV1/FVC） did not decrease significantly. The corrective rate among the Risser sign Ⅰ group was significantly higher than among the sign Ⅱ and Ⅲ groups （P 〈 0.05）. There were no obvious complications. Conclusions The Boston brace can be used for AIS. Its accurate application could avoid the need for surgical correction. Risser sign can be used as an index to predict the corrective effects of AIS treatment with the Boston brace.