特发性脊柱侧凸(idiopathic scoliosis,IS)指的是在冠状面上发生侧方弯曲、水平面上椎体旋转和矢状面上生理曲度改变的脊柱或躯干扭转异常的疾病[1]。按照国际脊柱侧凸研究学会(Scoliosis Research Society,SRS)定义,IS是应用Cobb法测...特发性脊柱侧凸(idiopathic scoliosis,IS)指的是在冠状面上发生侧方弯曲、水平面上椎体旋转和矢状面上生理曲度改变的脊柱或躯干扭转异常的疾病[1]。按照国际脊柱侧凸研究学会(Scoliosis Research Society,SRS)定义,IS是应用Cobb法测量站立位全脊柱正位X线片时脊柱弯曲≥10°的脊柱畸形[2]。IS在青春期进展,并随着骨骼生长而迅速恶化,其中青少年在10岁至Risser骨成熟Ⅱ期风险较高[3\|4]。国际脊柱侧凸矫形和康复治疗学会指南按照循证临床方法制定一个强度治疗方案(strength of treatments scheme,STS)[5\|6],涵盖所有可能的治疗方案。展开更多
Background:Finding an optimal treatment strategy for adolescent idiopathic scoliosis(AIS)patients remains challenging because of its intrinsic complexity.For mild to moderate scoliosis patients with lower skeletal gro...Background:Finding an optimal treatment strategy for adolescent idiopathic scoliosis(AIS)patients remains challenging because of its intrinsic complexity.For mild to moderate scoliosis patients with lower skeletal growth potential(Risser 3-5),most clinicians agree with observation treatment;however,the curve progression that occurs during puberty,the adolescent period,and even in adulthood,remains a challenging issue for clinicians.The aim of the study is to investigate the efficacy of Schroth exercise in AIS patients with lower skeletal growth potential(Risser 3-5)and moderate scoliosis(Cobb angle 20°-40°).Methods:From 2015 to 2017,data of 64 patients diagnosed with AIS in Peking University Third Hospital were reviewed.Forty-three patients underwent Schroth exercise were classified as Schroth group,and 21 patients underwent observation were classified as observation group.Outcomes were measured by health-related quality of life(HRQOL)and radiographic parameters.HRQOL was assessed using the visual analog scale(VAS)scores for back,Scoliosis Research Society-22(SRS-22)patient questionnaire.Radiographic spinopelvic parameters were obtained from anteroposterior and lateral X-rays.The pre-treatment and post-treatment HRQOL and radiographic parameters were tested to validate Schroth exercise efficacy.The inter-rater reliability of the radiographic parameters was tested using the interclass correlation coefficient(ICC).The pairedt test was used to examine HRQOL and radiographic parameters.Clinical relevance between C2-C7 sagittal vertical axis(SVA)and thoracic kyphosis was analyzed using Spearman correlation.Results:In Schroth group,VAS back score,SRS-22 pain,and SRS-22 self-image domain were significantly improved from pre-treatment 3.0±0.8,3.6±0.5,and 3.5±0.7 to post-treatment 1.6±0.6(t=5.578,P=0.013),4.0±0.3(t=-3.918,P=0.001),and 3.7±0.4(t=-6.468,P<0.001),respectively.No significant improvements of SRS-22 function domain(t=-2.825,P=0.088)and mental health domain(t=-3.174,P=0.061)were observed.The mean Cobb angle decreased from 28.9±5.5°to 26.3±5.2°at the final follow-up,despite no statistical significance was observed(t=1.853,P=0.102).The mean C2-C7 SVA value decreased from 21.7±8.4 mm to 17.0±8.0 mm(t=-1.224P=0.049)and mean T1 tilt decreased from 4.9±4.2°to 3.5±3.1°(t=2.913,P=0.011).No significant improvement of radiographic parameters and HRQOL were observed in observation group.Conclusions:For AIS patients with a Risser 3-5 and a Cobb angle 20°-40°,Schroth exercises improved HRQOL and halted curve progression during the follow-up period.Both cervical spine alignment and shoulder balance were also significantly improved after Schroth exercises.We recommend Schroth exercises for patients with AIS.展开更多
目的:通过Meta分析评价单独应用脊柱侧凸特定运动疗法(physiotherapeutic scoliosis specific exercises,PSSE)与其他保守治疗方法治疗青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)的临床疗效。方法:计算机检索建库至202...目的:通过Meta分析评价单独应用脊柱侧凸特定运动疗法(physiotherapeutic scoliosis specific exercises,PSSE)与其他保守治疗方法治疗青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)的临床疗效。方法:计算机检索建库至2023年7月PubMed、Web of Science、The Cochrane Library、WanFang Data和CNKI数据库,搜集应用PSSE疗法(PSSE疗法组)与其他保守治疗(对照组)作用于AIS的随机对照试验(RCT)研究,由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,通过Jadad评分量表对纳入研究的文献质量进行评价,采用RevMan 5.4软件对纳入文献中所报道的Cobb角、躯干旋转角(angle of trunk rotation,ATR)、国际脊柱侧凸研究学会22项问卷量表(Scoliosis Research Society-22,SRS-22)等数据进行Meta分析,并根据Cobb角度数和治疗时长进行亚组分析。结果:共纳入14篇文献,包含16个RCT(有2篇文献中分别包含2项RCT),文献质量评价结果显示纳入研究为中高质量,共包括944例AIS患者。Meta分析结果显示,与对照组相比,PSSE疗法组在降低脊柱侧凸患者Cobb角(MD=-1.64;95%CI:-2.78,-0.50;P<0.05)、ATR(MD=-1.45;95%CI:-2.58,-0.32;P<0.05)、提高SRS-22生活质量评分(MD=0.25;95%CI:0.17,0.33;P<0.05)方面更优。亚组分析结果显示,与对照组相比,PSSE疗法组持续治疗时长≤6个月(MD=-2.88;95%CI:-3.85,-1.91;P<0.05)、纳入时Cobb角<25°(MD=-2.41;95%CI:-3.51,-1.30;P<0.05)组的治疗效果更好,Cobb角度数更小。在改善ATR方面,PSSE疗法组持续治疗时长≤6个月(MD=-2.63;95%CI:-3.30,-1.96;P<0.05)与对照组相比ATR度数更低,差异有统计学意义(P<0.05)。结论:与其他保守治疗相比,PSSE疗法在改善AIS患者Cobb角、降低ATR及提高生活质量等方面具有优势,对于Cobb角<25°的轻度脊柱侧凸患者的治疗效果较好;PSSE疗法持续治疗时长≤6个月对AIS患者Cobb角及ATR的改善效果更明显。展开更多
文摘特发性脊柱侧凸(idiopathic scoliosis,IS)指的是在冠状面上发生侧方弯曲、水平面上椎体旋转和矢状面上生理曲度改变的脊柱或躯干扭转异常的疾病[1]。按照国际脊柱侧凸研究学会(Scoliosis Research Society,SRS)定义,IS是应用Cobb法测量站立位全脊柱正位X线片时脊柱弯曲≥10°的脊柱畸形[2]。IS在青春期进展,并随着骨骼生长而迅速恶化,其中青少年在10岁至Risser骨成熟Ⅱ期风险较高[3\|4]。国际脊柱侧凸矫形和康复治疗学会指南按照循证临床方法制定一个强度治疗方案(strength of treatments scheme,STS)[5\|6],涵盖所有可能的治疗方案。
基金supported by a grant from the Major Programs of Peking University Third Hospital(No.Y77491-06)。
文摘Background:Finding an optimal treatment strategy for adolescent idiopathic scoliosis(AIS)patients remains challenging because of its intrinsic complexity.For mild to moderate scoliosis patients with lower skeletal growth potential(Risser 3-5),most clinicians agree with observation treatment;however,the curve progression that occurs during puberty,the adolescent period,and even in adulthood,remains a challenging issue for clinicians.The aim of the study is to investigate the efficacy of Schroth exercise in AIS patients with lower skeletal growth potential(Risser 3-5)and moderate scoliosis(Cobb angle 20°-40°).Methods:From 2015 to 2017,data of 64 patients diagnosed with AIS in Peking University Third Hospital were reviewed.Forty-three patients underwent Schroth exercise were classified as Schroth group,and 21 patients underwent observation were classified as observation group.Outcomes were measured by health-related quality of life(HRQOL)and radiographic parameters.HRQOL was assessed using the visual analog scale(VAS)scores for back,Scoliosis Research Society-22(SRS-22)patient questionnaire.Radiographic spinopelvic parameters were obtained from anteroposterior and lateral X-rays.The pre-treatment and post-treatment HRQOL and radiographic parameters were tested to validate Schroth exercise efficacy.The inter-rater reliability of the radiographic parameters was tested using the interclass correlation coefficient(ICC).The pairedt test was used to examine HRQOL and radiographic parameters.Clinical relevance between C2-C7 sagittal vertical axis(SVA)and thoracic kyphosis was analyzed using Spearman correlation.Results:In Schroth group,VAS back score,SRS-22 pain,and SRS-22 self-image domain were significantly improved from pre-treatment 3.0±0.8,3.6±0.5,and 3.5±0.7 to post-treatment 1.6±0.6(t=5.578,P=0.013),4.0±0.3(t=-3.918,P=0.001),and 3.7±0.4(t=-6.468,P<0.001),respectively.No significant improvements of SRS-22 function domain(t=-2.825,P=0.088)and mental health domain(t=-3.174,P=0.061)were observed.The mean Cobb angle decreased from 28.9±5.5°to 26.3±5.2°at the final follow-up,despite no statistical significance was observed(t=1.853,P=0.102).The mean C2-C7 SVA value decreased from 21.7±8.4 mm to 17.0±8.0 mm(t=-1.224P=0.049)and mean T1 tilt decreased from 4.9±4.2°to 3.5±3.1°(t=2.913,P=0.011).No significant improvement of radiographic parameters and HRQOL were observed in observation group.Conclusions:For AIS patients with a Risser 3-5 and a Cobb angle 20°-40°,Schroth exercises improved HRQOL and halted curve progression during the follow-up period.Both cervical spine alignment and shoulder balance were also significantly improved after Schroth exercises.We recommend Schroth exercises for patients with AIS.
文摘目的:通过Meta分析评价单独应用脊柱侧凸特定运动疗法(physiotherapeutic scoliosis specific exercises,PSSE)与其他保守治疗方法治疗青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)的临床疗效。方法:计算机检索建库至2023年7月PubMed、Web of Science、The Cochrane Library、WanFang Data和CNKI数据库,搜集应用PSSE疗法(PSSE疗法组)与其他保守治疗(对照组)作用于AIS的随机对照试验(RCT)研究,由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,通过Jadad评分量表对纳入研究的文献质量进行评价,采用RevMan 5.4软件对纳入文献中所报道的Cobb角、躯干旋转角(angle of trunk rotation,ATR)、国际脊柱侧凸研究学会22项问卷量表(Scoliosis Research Society-22,SRS-22)等数据进行Meta分析,并根据Cobb角度数和治疗时长进行亚组分析。结果:共纳入14篇文献,包含16个RCT(有2篇文献中分别包含2项RCT),文献质量评价结果显示纳入研究为中高质量,共包括944例AIS患者。Meta分析结果显示,与对照组相比,PSSE疗法组在降低脊柱侧凸患者Cobb角(MD=-1.64;95%CI:-2.78,-0.50;P<0.05)、ATR(MD=-1.45;95%CI:-2.58,-0.32;P<0.05)、提高SRS-22生活质量评分(MD=0.25;95%CI:0.17,0.33;P<0.05)方面更优。亚组分析结果显示,与对照组相比,PSSE疗法组持续治疗时长≤6个月(MD=-2.88;95%CI:-3.85,-1.91;P<0.05)、纳入时Cobb角<25°(MD=-2.41;95%CI:-3.51,-1.30;P<0.05)组的治疗效果更好,Cobb角度数更小。在改善ATR方面,PSSE疗法组持续治疗时长≤6个月(MD=-2.63;95%CI:-3.30,-1.96;P<0.05)与对照组相比ATR度数更低,差异有统计学意义(P<0.05)。结论:与其他保守治疗相比,PSSE疗法在改善AIS患者Cobb角、降低ATR及提高生活质量等方面具有优势,对于Cobb角<25°的轻度脊柱侧凸患者的治疗效果较好;PSSE疗法持续治疗时长≤6个月对AIS患者Cobb角及ATR的改善效果更明显。
