Danielsson Aina J, Nachemson Alf L
Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg University, Sweden.
Spine (Phila Pa 1976). 2003 Sep 15;28(18):2078-85; discussion 2086. doi: 10.1097/01.BRS.0000084268.77805.6F.
A consecutive series of patients with adolescent idiopathic scoliosis and brace-treated (BT) between 1968 and 1977 before age 21 years (BT: n = 127; 122 females and 5 males) were followed-up at least 20 years after completion of the treatment.
To determine the long-term outcome in terms of back pain and function in patients BT for adolescent idiopathic scoliosis.
Few reports on long-term outcome of back pain and function have previously been presented for consecutive groups of these patients.
One hundred ten (87%) BT patients were reexamined as part of an unbiased personal follow-up. This included a clinical examination, evaluation of curve size (Cobb method), and degenerative findings in full standing frontal and lateral radiographs. Validated questionnaires in terms of general and disease-specific quality-of-life aspects as well as present back and pain symptoms were used. One hundred nine had complete follow-up. An age- and sex-matched control group of 100 persons was randomly selected and subjected to the same examinations.
The deterioration of the curves was a mean of 7.9 degrees for all curves, excluding the only patient who underwent operation after 4 years (increase = 27 degrees). The patients had significantly more degenerative disc changes than the controls. Lumbar and thoracic back pain, although mild (2.7 on visual analogue scale), was significantly more frequent among the patients than the controls (75 vs. 47%, P = 0.0050 and 35.8 vs. 22.0%, P = 0.033, respectively). Only 24% of the patients admitted daily pain and analgesics were sparsely used. The patients had a slightly, but significantly, worse back function as measured by the Oswestry Disability Index (9.2 vs. 4.8, P = 0.0012) and general function score (7.7 vs. 4.2, P = 0.0006), but general health-related quality of life was not affected. No differences could be seen in sociodemographic variables between the groups, except for having ever been on sick leave because of the back (38% vs. 19%, P = 0.0036). Furthermore, no differences could be found between patients with different curve types (single thoracic, n = 50; lumbar, n = 19; double curves, n = 40). No correlation could be found between pain and its localization and curve size, an increase of at least 10 degrees since end of treatment, curve type, degenerative changes on any of the two lowest lumbar disc levels, body mass index, or smoking.
More than 20 years after brace treatment for AIS, minimal pain and no dysfunction occurred compared with normal controls. Compared with surgically treated patients with a mean end result similar to this group, no significant differences were found except that BT patients experience more affective components of their pain.
对1968年至1977年间21岁之前接受支具治疗（BT）的一系列连续性青少年特发性脊柱侧凸患者进行研究（BT组：n = 127；122名女性，5名男性），在治疗结束后至少随访20年。
确定青少年特发性脊柱侧凸接受支具治疗患者背痛和功能方面的长期预后。
此前很少有针对这些患者连续队列的背痛和功能长期预后的报道。
110名（87%）BT患者作为无偏倚个人随访的一部分接受复查。这包括临床检查、测量侧弯大小（Cobb法）以及在完全站立位的正位和侧位X线片上评估退变情况。使用了在一般和疾病特异性生活质量方面以及当前背痛和疼痛症状方面经过验证的问卷。109名患者有完整随访。随机选取100名年龄和性别匹配的对照组人员并进行相同检查。
所有侧弯平均恶化7.9度，不包括4年后接受手术的唯一一名患者（增加27度）。患者的椎间盘退变改变明显多于对照组。腰背部和胸背部疼痛，尽管程度较轻（视觉模拟评分2.7），但患者中疼痛发生率明显高于对照组（分别为75%对47%，P = 0.0050；35.8%对22.0%，P = 0.033）。只有24%的患者称有日常疼痛，且很少使用镇痛药。通过Oswestry功能障碍指数（9.2对4.8，P = 0.0012）和一般功能评分（7.7对4.2，P = 0.0006）测量，患者的背部功能略差但有显著差异，不过与健康相关的总体生活质量未受影响。除因背部问题曾休病假外（38%对19%，P = 0.0036），两组在社会人口统计学变量方面无差异。此外，不同侧弯类型（单胸弯，n = 50；腰弯，n = 19；双弯，n = 40）的患者之间未发现差异。未发现疼痛及其部位与侧弯大小、治疗结束后至少增加10度、侧弯类型、两个最低腰椎间盘水平的任何退变改变、体重指数或吸烟之间存在相关性。
青少年特发性脊柱侧凸支具治疗20多年后，与正常对照组相比疼痛轻微且无功能障碍。与手术治疗且最终结果平均与该组相似的患者相比，未发现显著差异，只是支具治疗患者疼痛的情感成分更多。
