Maruyama Toru, Kitagawa Tomoaki, Takeshita Katsushi, Mochizuki Keiichi, Nakamura Kozo
Department of Orthopaedic Surgery, Teikyo University, School of Medicine, Tokyo, Japan.
Pediatr Rehabil. 2003 Jul-Dec;6(3-4):215-9. doi: 10.1080/13638490310001642748.
Since 1986, the authors have been conducting conservative treatment for idiopathic scoliosis with the combination of brace treatment and physical treatment (side shift exercise and hitch exercise). A total of 328 female patients with adolescent idiopathic scoliosis who were at least 10 years of age at the first visit, with Cobb angle of 10 degrees at the minimum and followed until after 15 years of age or skeletal maturity were included. The average Cobb angle was 32.4 degrees and the average age was 13.8 years at the first visit. Surgery was recommended when curvature progressed to >50 degrees. Twenty of 328 patients (6.1%) with more severe curves to begin with (mean Cobb angle at admission of 48.5 +/- 9.3 degrees ) progressed to 62.2 +/- 8.5 degrees and were treated with spinal fusion by the age of 16.0 +/- 2.6 years. The remaining 308 patients, of comparable age at inception of treatment but with a smaller original mean Cobb angle (32.4 +/- 11.1 degrees ), showed no significant increase in magnitude of curvature (mean 33.6 +/- 11.5 degrees ) by the time of discharge (18.6 +/- 3.1 years). The fact that curvature magnitude was maintained at <35 degrees means that these patients will have a good prognosis for avoiding dramatic progression during adulthood.
自1986年以来，作者一直采用支具治疗与物理治疗（侧方移位运动和挺举运动）相结合的方法对特发性脊柱侧弯进行保守治疗。纳入了328例首次就诊时年龄至少10岁、Cobb角最小为10度且随访至15岁以后或骨骼成熟的青少年特发性脊柱侧弯女性患者。首次就诊时平均Cobb角为32.4度，平均年龄为13.8岁。当侧弯进展至>50度时建议手术治疗。328例初始侧弯更严重（入院时平均Cobb角为48.5±9.3度）的患者中有20例（6.1%）进展至62.2±8.5度，并在16.0±2.6岁时接受了脊柱融合术治疗。其余308例患者在治疗开始时年龄相仿，但初始平均Cobb角较小（32.4±11.1度），出院时（18.6±3.1岁）侧弯程度无显著增加（平均为33.6±11.5度）。侧弯程度维持在<35度这一事实意味着这些患者在成年期避免显著进展将有良好的预后。
