Goldberg C J, Moore D P, Fogarty E E, Dowling F E
Children's Research Centre and Orthopaedic Department, Our Lady's Hospital for Sick Children, Dublin, Ireland.
Spine (Phila Pa 1976). 2001 Jan 1;26(1):42-7. doi: 10.1097/00007632-200101010-00009.
Retrospective analysis of outcome in terms of incidence of surgery for adolescent idiopathic scoliosis during a period when bracing was not practiced.
To determine whether centers with an active bracing policy have lower numbers undergoing surgery for adolescent idiopathic scoliosis than a center where nonintervention is the practice.
Two major recent publications have claimed that bracing significantly improves the outcome in adolescent idiopathic scoliosis. However, one had no control subjects and the other did not examine the final status of the subjects under review. While statistically significant differences in progression have been observed, what will convince patients to submit to an onerous treatment is the conviction that it will make a substantial difference, such as the avoidance of surgery.
Since 1991, bracing has not been recommended for children with adolescent idiopathic scoliosis at this center. The scoliosis database was searched for patients with adolescent idiopathic scoliosis who were at least 15 years of age at last review and who had adequate documentation of curve parameters. The incidence of surgery was compared with that of published data from other centers.
A total of 153 children, 11 boys and 142 girls, fitted the criteria. Forty-three of these (28.1%) have undergone surgery. This was not statistically different from the surgery rate reported from an active bracing center.
If bracing does not reduce the proportion of children with adolescent idiopathic scoliosis who require surgery for cosmetic improvement of their deformity, it cannot be said to provide a meaningful advantage to the patient or the community. Recent studies notwithstanding, the question of the efficacy of orthoses in idiopathic scoliosis remains unresolved.
对在未采用支具治疗期间青少年特发性脊柱侧凸手术发生率的结果进行回顾性分析。
确定实施积极支具治疗策略的中心与采取非干预策略的中心相比，接受青少年特发性脊柱侧凸手术的人数是否更少。
最近的两篇主要文献称，支具能显著改善青少年特发性脊柱侧凸的治疗效果。然而，一篇文献没有对照受试者，另一篇则未检查所研究受试者的最终状况。虽然已观察到进展方面存在统计学显著差异，但能让患者接受繁重治疗的是坚信这会带来实质性改变，比如避免手术。
自1991年起，本中心不建议对青少年特发性脊柱侧凸患儿采用支具治疗。在脊柱侧凸数据库中搜索年龄至少15岁且有充分曲线参数记录的青少年特发性脊柱侧凸患者。将手术发生率与其他中心公布的数据进行比较。
共有153名儿童符合标准，其中11名男孩，142名女孩。这些患者中有43名（28.1%）接受了手术。这与积极采用支具治疗的中心报告的手术率在统计学上无差异。
如果支具不能降低因美观原因需要手术矫正畸形的青少年特发性脊柱侧凸患儿的比例，那么就不能说它对患者或社会具有实际优势。尽管有近期研究，但特发性脊柱侧凸矫形器的疗效问题仍未解决。
