连续石膏方法治疗早发性脊柱侧弯畸形

Clinical efficacies of serial casting for early onset scoliosis

目的评价利用非石膏床连续石膏治疗儿童早发性脊柱侧弯畸形的临床疗效，探讨石膏治疗早发性脊柱侧弯畸形的优缺点。方法回顾性分析从2008年1月至2013年7月在我中心就诊并进行非石膏床连续石膏固定的患儿13例，共计76次石膏矫形，平均年龄为31．6个月（5～60个月），其中7例女孩，6例男孩，将其按照年龄分为小于2岁组6例、大于2岁组7例，所有患儿侧弯角度大于25。或伴有RVAD〉20。或RVADII期。测量患儿治疗前后脊柱侧弯Cobb角度改变情况，同时测量患儿单次麻醉下吸气峰压以评估患儿呼吸情况。结果全部13例患儿最少经过4次以上石膏矫形，随访1年以上。石膏矫形治疗前脊柱侧弯Cobb平均角度（43．5±12．8）°；经过1次石膏矫形后平均Cobb角：（22．9±12．0）°；至最后随访时平均Cobb角：（20．5±7．5）°,较术前差异有统计学意义（P〈0．01）。不同年龄组间治疗前侧弯Cobb角度差异无统计学意义（P〉0．05）与最后随访时脊柱侧凸改善率差异亦无统计学意义（P=0．228）。测量患儿石膏固定前吸气峰压为（17．3±4．7）cm H2O（1cmH2O=0．098kPa），石膏固定后升高至（34．3±9．1）cmH2O，最终开窗后下降至（21．2±5．3）cmH2O，治疗后患儿吸气峰压平均升高约22．5％。其中3例有皮肤刺激征；13例均无呼吸系统症状。结论非石膏床连续石膏矫形技术对于早发性脊柱侧弯畸形患儿可以纠正Cobb角，并可以起到椎体去旋转效果，对于大年龄及侧弯严重的患儿虽无法达到完全治愈脊柱侧弯的效果，但可以延缓手术时间，降低手术风险及难度，但本研究随访时间不足，需要随访至青春期才能得到可靠的结论。

Objective To evaluate the clinical efficacies of serial casting for early onset scoliosis （EOS） （not using casting bed） and assess its advantages and disadvantages. Methods We retrospectively reviewed a total of 76 serial castings for 13 cases with EOS from January 2008 to July 2013. There were 7 females and 6 males with an average age of 31.6 （5-60） months. They were divided into 2 groups of 〈2 years old （n = 6） and 〉2 years old （n = 7）. They had curves 〉25 or rib vertebrae angle difference （RVAD） 〉20 or phase II. The spinal Cobb angles pre and post-treatment as well as the peak inspiratory pressure under intubation anesthesia were measured to evaluate the respiratory functions. Results Each patient required casting at least 4 times. The follow-up period was over 1 year. The mean Cobb angle at pre-treatment was （43.5 ± 12. 8） , （22. 9 ± 12. 0） after the first casting and （20. 5 ± 7. 5） at the final follow-up. There were significant statistical differences with pre-casting values （P〈0. 01）. The pre-casting curves had no significant statistical difference between two different age groups （P〉0. 05）. So did the correcting rate at the final follow-up（P = 0. 228）. The mean peak inspiratory pressure was （17. 3 ± 4. 7） cm H20 at pre-casting, （34. 3 ± 9. 1） cm H20 after the first casting and （20. 4± 5.6） cm H2O after windowing. There was an increase of 22. 5% after treatment. Three patients had skin irritation. No respiratory syndrome occurred. Conclusions Serial non-bed casting corrects the Cobb angle. It can also achieve derotating effect on vertebral body. Though not curing older and seriously deformed EOS patients, it may delay operation and reduce operative risks and difficulties. Follow-up till adolescence is needed for reliable clinical decision- making.