系列石膏及支具治疗进展型早发性脊柱侧凸的疗效分析

The effectiveness analysis of serial cast and bracing for progressive early-onset scoliosis

目的分析进展型早发性脊柱侧凸(early onset scoliosis,EOS)经系列石膏或支具保守治疗后畸形发展情况,并探讨应用系列石膏及支具矫形治疗的效果。方法回顾性分析2011年6月至2018年4月于解放军第306医院接受石膏或支具治疗至少12个月,并有完整影像资料的20例EOS患儿资料,其中男10例,女10例,初次诊断为脊柱侧凸年龄均<5岁。根据主弯度数分为石膏治疗组(Cobb角>50°)和支具治疗组(Cobb角≤50°)。对比石膏或支具治疗前、初次治疗后、末次随访时的影像资料,摄站立位全脊柱正侧位X线片,分别测量冠状位及矢状位畸形角度及平衡。采用独立样本t检验比较石膏组和支具组的一般资料及治疗效果,配对样本t检验比较治疗前后及末次随访的影像学资料。结果按照畸形减小度数≥10°为治疗有效,共9例末次随访时治疗有效。石膏4例,治疗有效率为44.44%;支具5例,治疗有效率为45.45%。3例侧凸畸形进展,均为支具治疗。治疗前主弯Cobb角为55.4°±24.36°,初次治疗后为42.35°±23.62°,差异有统计学意义(t=5.850,P=0.000);末次随访的主弯Cobb角51.8°±26.33°虽然较治疗前减小,但无统计学差异(t=1.260,P=0.223)。近端代偿弯、远端代偿弯、局部后凸、胸椎后凸、腰椎前凸、冠位偏移绝对值、矢位偏移绝对值治疗前与末次随访对比均无统计学差异,治疗前胸廓宽度(159.63±19.27)mm,初次治疗后(160.81±14.54)mm,与末次随访的(176.08±28.10)mm对比差异均有统计学意义(t治疗前vs末次=-3.942,P治疗前vs末次=0.001;t治疗后vs末次=-3.096,P治疗后vs末次=0.006);治疗前T1~12高度为(153.78±29.24)mm,初次治疗后(161.14±29.53)mm,与末次随访(175.01±36.91)mm对比,差异均有统计学意义(t治疗前vs末次=-5.950,P治疗前vs末次=0.000;t治疗后vs末次=-3.997,P治疗后vs末次=0.001),系列石膏及支具治疗保留胸廓的发育。结论系列石膏及支具治疗在EOS的早期治疗中是一种可行的保留生长发育的治疗方式,即使不能纠正畸形,也可控制年龄患儿的畸形进展,延迟最终的手术时机。

Objective To define radiographic features that response to serial casting and bracing for progressive early-onset scoliosis (EOS). Methods A retrospective study of a total of 20 patients (10 females and 10 males) with complete radiographic data diagnosed as progressive early onset scoliosis treated with serial cast or brace for at least 12 months in the 306th Hospital of PLA from June 2011 to April 2018. Ages at initial diagnosis were all less than 5 years old. They were divided into two groups according to the main curve degree, those with cobbs angles more than 50 degree treated with serial cast, or else with brace. All the cases have radiographs of pretreatment, posttreatment, and last follow-up, and anteroposterior (lateral) film of the full length spine in standing position were taken to evaluate magnitudes and balance of coronal and sagittal malformations. We compared the general data of the two groups by independent sample t test and that of pretreatment, posttreatment and the last follow-up by paired-sample t test. Results According to the effective standard of not less than 10 degrees improvement, 9 of them were effective, 4 cast and 5 brace, the effective rates were 44.44% and 45.45%, 3 cases from brace group progressed. The magnitudes of the main curve improved significantly after the first treatment of cast and brace (55.4±24.36 vs 42.35±23.62) degree (t=5.850, P=0.000), and at the last follow up, the curve decreased slightly compared of that before interventions (55.4±24.36 vs 51.8±26.33). The compensatory curves, segmental kyphosis, thoracic kyphosis, lumbar lordosis, balance of both coronal and sagittal also had no significant differences between the primal and the latest follow up. The widths 159.63±19.27 mm, 160.81±14.54 mm, 176.08±28.10 mm (t=3.942, P=0.001;t=-3.096, P=0.006) and heights 153.78±29.24 mm, 161.14±29.53 mm, 175.01±36.91 mm of the thoracic were significantly different between pre-posttreatment and the last follow up (t=-5.950, P=0.000;t=-3.997, P=0.001). Serial cast and brace application can preserve the growth of the thorax. Conclusion Serial cast and brace are viable growth friendly methods to deal with progressed EOS, Although a cure improvement cannot be always expected, they can stabilize relatively large curves in young children and may help delay eventual surgical intervention.