Li Haixia,Wu Jigong,Song Lizhi,et al.Title Clinical study of brace in the treatment of progressive early-onset scoliosis[J].Journal of Clinical Pediatric Surgery,2021,20(01):24-28.[doi:10.12260/lcxewkzz.2021.01.005]
支具治疗进展型早发性脊柱侧弯的临床研究
- Title:
- Title Clinical study of brace in the treatment of progressive early-onset scoliosis
- Keywords:
- Scoliosis/SU; Scoliosis/CN; Stents; Spine/GD
- 分类号:
- R726.8;R682.3
- 摘要:
- 目的 分析进展型早发性脊柱侧弯（early onset scoliosis，EOS）经支具保守治疗后畸形发展情况，并探讨支具矫形在此类患者中的疗效。方法 以战略支援部队特色医学中心脊柱外科接受支具治疗至少2年且影像资料完整的19例EOS患者为研究对象，其中男12例，女7例。根据随访结果分为有效组和无效组，末次随访Cobb角与治疗前相比改善超过10°为治疗有效，未超过10°为治疗无效。支具治疗前、初次治疗后、末次随访时拍摄站立位全脊柱正（侧）位X线片，分别测量冠状位及矢状位畸形角度及平衡。结果 19例支具治疗前平均Cobb角（40±10.4）°（20°~55°）、初次治疗后主弯Cobb角（28.15±14.78）°，末次随访主弯Cobb角（31.63±18.04）°，初次治疗后及末次随访均较治疗前明显好转（P<0.05）。两组末次随访时的胸廓宽度及胸椎高度均较支具治疗前明显增加，特发性EOS较先天性EOS治疗效果更好（P<0.05）。另外，顶椎位于胸腰段或腰段较顶椎位于胸段者效果更好（P<0.05）。初次治疗后两组间主弯矫正率差异无统计学意义（P>0.05），末次随访时差异具有统计学意义（P<0.05）。结论 对于部分进展型早发性脊柱侧弯，支具治疗可作为保守治疗的选择之一，其中一些病例可得到满意矫形，即使部分病例不能避免手术，支具治疗也可在不影响胸廓发育的前提下适当延后手术时间。
- Abstract:
- Objective To analyze the deformity development of early onset scoliosis (EOS) after conservative treatment with brace,and to explore the effect of brace in this kind of patients.Methods 19 children with EOS,12 males and 7 females were retrospectively analyzed,all patients had been treated with brace for at least 2 years and had complete imaging data.According to the follow-up results,the patients were divided into effective group and ineffective group,10 or more degrees improvement in Cobb angle from baseline was defined to be effective,otherwise,the treatment was ineffective.Anterior and lateral radiographs of the whole spine in standing position before the brace,after the first brace and at the last follow-up were available.The coronal and sagittal deformity angles and balance were measured.Results The average Cobb angle of 19 patients before treatment was 40±10.4 degrees (20-55 degrees),The main Cobb angle was corrected to 28.15±14.78 degrees in first bracing,and 31.63±18.04 degrees after brace removal at latest follow-up.The Cobb angle after the first brace and at the last follow-up were significantly corrected (P<0.05).The chest width and height of thoracic vertebrae in both groups were significantly increased at the last follow-up.Patients diagnosed as idiopathic early-onset scoliosis tend to have a better result compared to congenital scoliosis (P<0.05),and those with the apical vertebra located in thoracolumbar or lumbar also reached a significantly satisfied improvement than that in thoracic (P<0.05),even though with a similar initial Cobb angle,sex,age of initial treatment,and the duration of follow up.The Cobb angle correction has no significant difference between the two groups at initial bracing (P>0.05),whereas,differences were apparent at the latest follow-up(P<0.05).Conclusion For patients of progressive early-onset scoliosis,Bracing is an efficient nonsurgical alternative,some of them can be cured,if not,eventual surgical intervention can be delayed for a period of time without restrictions on thoracic.
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备注/Memo
收稿日期:2021-01-06。
基金项目:首都临床诊疗技术研究及示范应用（编号：Z191100006619057）
通讯作者:吴继功,Email:docwjg@126.com