支具治疗青少年特发性脊柱侧凸的临床随访

A clinical follow-up study on treatment of adolescent idiopathic scoliosis with brace

目的评价支具治疗青少年特发性脊柱侧凸的临床疗效,分析影响疗效的相关因素,并探讨支具治疗的适应证。方法对79例接受支具治疗的青少年特发性脊柱侧凸患者进行随访,记录患者的 Cobb 角,侧凸类型,女性患者初潮与否,坐高,站高,Risser 征,顶椎旋转度等。结果随访12～60个月,平均23.9个月。末次随访时21例(26.6%)畸形明显进展,40例(50.6%)畸形维持或稍进展,18例(22.8%)畸形改善。初诊时原发弯 Cobb 角>45°组侧凸进展率较 Cobb 角≤35°组高,侧凸改善率较 Cobb 角≤35。组低(P<0.05);顶椎旋转度Ⅲ°以上组侧凸进展率较0～Ⅱ°组高,侧凸改善率较0～Ⅱ°组低(P<0.05)。侧凸类型、Risser征等参数不同的患者畸形进展和改善的比率均存在不同程度的差别,但差异不具有显著性(P>0.05)。结论矫形支具能够有效控制或改善轻、中度特发性脊柱侧凸畸形。单独借助Risser征预测侧凸畸形变化趋势并不可靠。初始 Cobb 角>45°,顶椎旋转度在Ⅲ°以上的患者,如果支具治疗的效果不佳,应考虑尽早手术矫形。

Objective To evaluate clinical outcomes of bracing and analyze related factors that influence curative effects in adolescents with idiopathic scoliosis, and to investigate indications of bracing. Methods Seventy-nine patients with AIS who had no history of prior therapy were treated with a brace. Several parameters were consecutive measured and documented during the period of follow-up including Cobb＇s angles, curve patterns, menarche status, sitting heights, standing heights, Risser sign, apical vertebral rotation, and so on. Results The average period of followed-up was 30 months （ 12 months to 60 months）. Twenty-one patients （26. 6% ） presented curve deterioration,40 patients have no obvious curve change,18 patients （22. 8% ） got a curve improvement. There was significantly lower percentage of curve progression and higher percentage of curve improvement in cases with Cobb＇s angle less than 35°at the first visit （ P 〈 0. 05 ）. The percentage of curve progression was significantly greater in the cases with apical vertebral rotation beyond grade Ⅲ while the percentage of curve improvement was lower（ P 〈 0. 05 ）. Curve patterns, Risser sign and other parameters were found to make their effects on the percentage of curve progression and improvement, which, however, was not statistically significant （ P 〉 0. 05 ）. Conclusion Bracing can limit or improve mild and moderate curve of idiopathic scoliosis effectively , especially in cases with initial curve magnitude ranging from 20°to 35°. Risser sign is not a reliable parameter for measuring the outcome of bracing treatment for idiopathic scoliosis. Surgery is advised as soon as possible for the cases with initial Cobb＇s angles greater than 45°and initial apical vertebral rotation beyond grade Ⅲ early while bracing did not work.