系列石膏与支具治疗对小儿先天性脊柱侧凸延迟手术的作用

Serial cast vs brace for delaying surgery in congenital scoliosis

目的 :观察支具治疗和系列石膏对小儿先天性脊柱侧凸的矫形效果,比较其在维持椎体生长以及延迟手术时间的作用。方法:收集2010年1月～2017年12月在我院行系列石膏或者支具治疗的先天性脊柱侧凸患者24例,男13例,女11例;首次治疗时年龄1.3～5.4岁(2.9±1.2岁)。其中12例采用系列石膏矫正,12例采用支具治疗。统计两组患者治疗前和末次随访时的侧凸Cobb角、胸椎后凸及腰椎前凸角、T1～T12椎体生长速度、延迟手术时间。结果:系列石膏组随访时间为16～56个月(29.2±14.3个月),佩戴石膏时间为13～23个月(18.5±3.7个月)。支具治疗组随访时间为15～46个月(26.7±12.5个月),佩戴支具时间为6～12个月(8.3±2.4个月)。系列石膏组侧凸Cobb角从术前30.1°～89.4°(56.2°±20.5°)降低至末次随访时的22.3°～78°(48.8°±18.0°)(P<0.01),矫正率为13.2%,T1～T12胸椎生长速度为0.62～0.91cm/yr(0.78±0.16cm/yr),至末次随访时4例继续系列石膏矫正治疗,6例停止系列石膏矫正改为佩戴支具维持,2例行手术治疗,延迟手术16～56个月(28.8±14.3个月);支具组侧凸Cobb角术前为25.4°～62.6°(44.2°±16.4°)末次随访时为34.8°～68.8°(55.6°±16.7°),矫正率为-21.38%,T1～T12胸椎生长速度为0.45～0.71cm/yr(0.67±0.22cm/yr),至末次随访时2例继续支具治疗,10例进行手术治疗,延迟手术6～12个月(8.3±2.4个月)。支具治疗组的侧凸矫正率、T1～T12胸椎生长速度和延迟手术时间均低于系列石膏组(P<0.01)。末次随访时两组胸椎前凸和腰椎后凸与治疗前比较均无显著性改变。结论:系列石膏和支具治疗均可延迟先天性脊柱侧凸患儿的首次手术时间,但系列石膏能更好地控制侧凸进展,更长时间延迟手术。

Objectives: To compare the outcomes of serial cast and brace in congenital scoliosis. Methods: A total of 24 congenital scoliosis was reviewed, 13 males and 11 females. The average age at first cast was 2.9±1.2 years old(1.3-5.4 years old). There were 12 cases treated with serial casting, while 12 cases with brace. Several parameters including Cobb angle, thoracic kyphosis angle, lumbar lodosis angle, growing rate of thoracic spine, surgery delaying time were evaluated. Results: In cast group, the follow-up period was 29.2±14.3(16-56) months. The average cast wearing time was 18.5±3.7(13-23) months;the Cobb angle decreased from 56.2°±20.5°(30.1°-89.4°) at pre-casting to 48.8°±18°(22.3°-78°) at final follow-up (P<0.01) with correction rate of 13.2%;the growth rate of thoracic spine was 0.78±0.16cm/year(0.62-0.91cm/year). At final follow-up, 4 cases continued serial cast procedures, 6 cases removed the cast and wore brace, 2 cases received operation. The surgery was delayed for 28.8±14.3 months. In brace group, the follow-up period was 26.7±12.5(15-46) months, the Cobb angle increased from 44.2°±16.4°(25.4°-62.6°) at pre-brace to 55.6°±16.7°(34.8°-68.8°) at final follow-up(P<0.01), with a lower correction rate when compared with cast group(-21.3%, P<0.01). The growing rate of thoracic spine was lower than that of cast group(0.67±0.22cm/yr, P<0.01). At final follow-up, 2 cases continued wearing brace, 10 cases received operation. The surgery was delayed for 8.3±2.4 months and lower than that of cast group(P<0.01). Conclusions: Serial cast and brace are able to delay the first-operation for congenital scoliosis patients, while serial cast is better to control the curve progression and postpone the first-operation.