Rigo M, Reiter Ch, Weiss H-R
Instituto Elena Salvá, Barcelona, Spain.
Pediatr Rehabil. 2003 Jul-Dec;6(3-4):209-14. doi: 10.1080/13638490310001642054.
Retrospective analysis of outcome in terms of prevalence of surgery for adolescent idiopathic scoliosis in patients receiving conservative management.
To determine whether a centre with an active policy of conservative management has fewer patients who eventually undergo surgery for adolescent idiopathic scoliosis than a centre where the practice is non-intervention.
The efficacy of orthoses for the treatment of idiopathic scoliosis was called into question in a recent publication. Because the prevalence of surgery in an untreated group of patients (28.1%) was not significantly different from that in a braced group (22.4%), the authors concluded that bracing appears to make no difference. Based on prior experience, this conclusion is questioned.
Since 1991, bracing and physical therapy have been recommended for children with adolescent idiopathic scoliosis at a centre in Barcelona, Spain. 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 the Cobb angle. The prevalence of surgery was compared with that of published data from a centre where the practice is non-intervention.
From a total of 106 braced cases out of which 97 were followed up, six cases (5.6%) ultimately underwent spinal fusion. A worst case analysis, which assumes that all nine cases that were lost to follow-up had operations, brings the uppermost number of cases that could have undergone spinal fusion to 15 (14.1%). Either percentage is significant statistically when compared to the 28.1% reported surgeries from the centre with the policy of non-intervention.
If conservative management does reduce the proportion of children with adolescent idiopathic scoliosis that require surgery, it can be said to provide a real and meaningful advantage to both the patients and the community. It is contended that conservative methods of treatment should never be ruled out from scoliosis management, because they can and do offer a viable alternative to those patients who cannot or will not opt for surgical treatment.
对接受保守治疗的青少年特发性脊柱侧凸患者手术患病率的结局进行回顾性分析。
确定与采取非干预治疗方式的中心相比，积极采取保守治疗策略的中心最终接受青少年特发性脊柱侧凸手术的患者是否更少。
近期一篇出版物对支具治疗特发性脊柱侧凸的疗效提出了质疑。由于未治疗组患者的手术患病率（28.1%）与支具治疗组（22.4%）无显著差异，作者得出结论，支具治疗似乎并无效果。基于以往经验，这一结论受到质疑。
自1991年起，西班牙巴塞罗那的一个中心就建议对青少年特发性脊柱侧凸患儿采用支具治疗和物理治疗。在脊柱侧凸数据库中搜索至少15岁且末次复查时Cobb角记录完整的青少年特发性脊柱侧凸患者。将手术患病率与一个采取非干预治疗方式的中心所公布的数据进行比较。
在总共106例接受支具治疗的病例中，97例得到随访，其中6例（5.6%）最终接受了脊柱融合手术。最坏情况分析假设所有9例失访病例均接受了手术，那么可能接受脊柱融合手术的病例最多为15例（14.1%）。与采取非干预治疗策略的中心所报告的28.1%的手术率相比，这两个百分比在统计学上均具有显著性差异。
如果保守治疗确实能够降低需要手术治疗的青少年特发性脊柱侧凸患儿的比例，那么可以说它对患者和社会都具有切实且有意义的优势。有人认为，在脊柱侧凸治疗中绝不应排除保守治疗方法，因为它们能够且确实为那些不能或不愿选择手术治疗的患者提供了一种可行的替代方案。
