Guo Xuzhao,Meng Zhao,Wang Fei,et al.Clinical study of plaster orthopedic treatment for idiopathic scoliosis toddlers[J].Journal of Clinical Pediatric Surgery,2020,19(02):130-134.[doi:10.3969/j.issn.1671-6353.2020.02.008]
石膏矫形治疗幼儿特发性脊柱侧弯的临床研究
- Title:
- Clinical study of plaster orthopedic treatment for idiopathic scoliosis toddlers
- Keywords:
- Idiopathic Scoliosis; Toddler; Cast; Non-operation
- 分类号:
- R726.8;R682.3;R618
- 摘要:
- 目的 介绍简易石膏床方法行石膏矫形治疗幼儿特发性脊柱侧弯,并进行效果评价。方法 选取2014年9月至2016年9月于河北省儿童医院住院治疗的25例幼儿特发性脊柱侧弯病例作为研究对象,平均年龄29.7个月(17~53个月),其中男童10例,女童15例,共行石膏矫形105次。应用去旋转石膏矫形方法并结合我院实际情况采用简易石膏床对患儿进行石膏矫形,测量并记录石膏矫形前后脊柱正位X线片上Cobb角改变情况,并对所有患儿按照性别及年龄是否≤2岁进行分组分析。结果 25例患儿石膏矫形治疗前脊柱侧弯Cobb角平均角度为(39.1±9.1)°,经过第1次石膏矫形后平均角度为(22.3±5.0)°,末次随访时平均角度为(20.3±4.3)°。第1次石膏矫形后Cobb角与矫形前相比差异有统计学意义(t=8.825,P<0.05)。随访终点时Cobb角与矫形前相比差异有统计学意义(t=9.653,P<0.05)。不同性别分组随访终点时Cobb角矫正度数差异无统计学意义(t=0.070,P=0.945)。不同年龄分组随访终点时Cobb角矫正度数差异无统计学意义(t=-0.733,P=0.471)。结论 我们采用的简易石膏床方法结合去旋转技术进行石膏矫形可以纠正幼儿特发性脊柱侧弯患儿的Cobb角,性别和年龄因素未对矫正效果产生影响。
- Abstract:
- Objective To explore the application of simple plaster bedding in the orthopedic treatment of idiopathic scoliosis toddlers and evaluate its efficacy.Methods From September 2014 to September 2016,a total of 25 idiopathic scoliosis toddlers with an average age of 29.7(17-53) months were recruited.There were 10 boys and 15 girls.They were divided into groups according to gender and age ≤ 2 years.Based upon practical orthopedic treatment with simple plaster bedding,derotational plaster or orthopedic treatment was applied.And spinal Cobb’s angle was recorded before and after treatment.Results A total of 105 plaster orthopedic operations were performed.The average Cobb’s angle was (39.1±9.1)° pre-treatment,the average angle after initial treatment (22.3±5.0)° and the average angle at the final follow-up (20.3±4.3)°.Significant difference existed between initial treatment and before treatment (t=8.825,P<0.05).Significant difference existed between the final treatment and before treatment (t=9.653,P<0.05).No significant difference existed in the degree of Cobb angle correction of the last treatment between different gender groups (t=0.070,P=0.945).No significant difference existed in the degree of Cobb’s angle correction among different age groups (t=0.733,P=0.471).Conclusion The simple plaster bedding with derotational technique can correct the Cobb’s angle of toddlers with idiopathic scoliosis.Age or gender has no effect on correction outcomes.
参考文献/References:
1 Cunin V.Early-onset scoliosiscurrent treatment[J].Orthop Traumatol Surg Res,2015,101(1):S109-S118.DOI:10.1016/j.otsr.2014.06.032.
2 Waldron SR,Poe-Kochert C,Son-Hing JP,et al.Early onset scoliosis:the value of serial risser casts[J].J Pediatr Orthop,2013,33(8):775-780.DOI:10.1097/BPO.0000000000000072.
3 Mehta MH.Growth as a corrective force in the early treatment of progressive infantile scoliosis[J].J Bone Joint Surg Br,2005,87(9):1237-1247.DOI:10.1302/0301-620X.87B9.16124.
4 曹隽,张学军.先天性脊柱侧弯诊疗中的热点与共识[J].临床小儿外科杂志,2018,17(9):641-644.DOI:10.3969/j.issn.1671-6353.2018.09.001. Cao J,Zhang XJ.Hotspots and consensus in the diagnosis and treatment of congenital scoliosis[J].J Clin Ped Sur,2018,17(9):641-644.DOI:10.3969/j.issn.1671-6353.2018.09.001.
5 Stasikelis PJ,Carpenter AM.Result of casting in severe curves in infantile scoliosis[J].J Pediatr Orthop,2018,38(4):e186-e189.DOI:10.1097/BPO.0000000000001140.
6 Corona J,Miller DJ,Downs J,et al.Evaluating the extent of clinical uncertainty among treatment options for patients with early-onset scoliosis[J].J Bone Joint Surg Am,2013,95(10):e67.DOI:10.2106/JBJS.K.00805.
7 Dimeglio A,Canavese F,Bonnel F.Normal growth of the spine and thorax[M]//The growing spine.Springer,Berlin,Heidelberg,2016:47-82.DOI:10.1007/978-3-662-48284-14.
8 Halanski MA,Harper BL,Cassidy JA,et al.Three solutions to a single problem:alternative casting frames for treating infantile idiopathic scoliosis[J].J Spinal Disord Tech,2013,26(5):274-280.DOI:10.1097/BSD.0b013e3182440dce.
9 Karol LA.The natural history of early-onset scoliosis[J].J Pediatr Orthop,2019,39(6):S38-S43.DOI:10.1097/BPO.0000000000001351.
10 Skaggs DL,Akbamia BA,Flynn JM,et al.A classification of growth friendly spine implants[J].J Pediatr Orthop,2014,34(3):260-274.DOI:10.1097/BPO.0000000000000073.
11 Poe-Kochert C,Shannon C,Pawelek JB,et al.Final fusion after growing-rod treatment for early onset scoliosis:is it really final?[J].J Bone Joint Surg Am,2016,98(22):1913-1917.DOI:10.2106/JBJS.15.01334.
12 Jain A,Sponseller PD,Flynn JM,et al.Avoidance of "final" surgical fusion after growing-rod treatment for early-onset scoliosis[J].J Bone Joint Surg Am,2016,98(13):1073-1078.DOI:10.2106/JBJS.15.01334.
13 Johnston CE,McClung AM,Thompson GH,et al.Comparison of growing rod instrumenmation versus serial cast treatment for early-onset scoliosis[J].Spine Deform,2013,1(5):339-342.DOI:10.1016/j.jspd.2013.05.006.
14 Gussous YM,Tarima S,Zhao S,et al.Serial derotational casting in idiopathic and non-idiopathic progressive early-onset scoliosis[J].Spine deformity,2015,3(3):233-238.DOI:10.1016/j.jspd.2014.10.001.
15 于凌佳,徐宏文,荀福兴,等.连续石膏方法治疗早发性脊柱侧弯畸形[J].中华小儿外科杂志,2015,36(2):2145-2149.DOI:10.3760/crna.j.issn.0253-3006.2015.02.016. Yu LJ,Xu HW,Xun FX,et al.Clinical efficacies of serial casting for early-onset scoliosis[J].Chin J Pediatr Surg,2015,36(2):2145-2149.DOI:10.3760/crna.j.issn.0253-3006.2015.02.016.
16 Welborn MC,D’Astous J,Bratton S,et al.Infantile idiopathic scoliosis:factors affecting EDF casting success[J].Spine Deform,2018,6(5):614-620.DOI:10.1016/j.jspd.2018.01.007.
17 Foley G,Aubin CE,Patent S,et al.Physical significance of the rib vertebra angle difference and its 3-dimensional counterpart in early-onset scoliosis[J].Spine Deform,2013,1(4):259-265.DOI:10.1016/j.jspd.2013.04.003.
18 Fletcher ND,Bruce RW.Early onset scoliosis:current concepts and controversies[J].Curr Rev Musculoskelet Med,2012,5(2):102-110.DOI:10.1007/s12178-012-9116-0.
19 Vutskits L,Xie Z.Lasting impact of general anesthesia on the brain:Mechanisms and relevance[J].Nat Rev Neurosci,2016,17(11):705-717.DOI:10.1038/nrn.2016.128.
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备注/Memo
收稿日期:2019-05-06。
基金项目:河北省医学适用技术跟踪项目(编号:G2018084)
通讯作者:孟钊,Email:mz285@163.com