Zhang Yong, Zhao Li, Wang Rui, Ye Zheng-xu, Jie Qiang, Sun Xiao-tang
Department of Orthopaedic, Xijing Hospital, the Fourth Military Medical University, Xi'an 710032, China.
Zhonghua Wai Ke Za Zhi. 2007 Apr 15;45(8):529-32.
To evaluate clinical outcomes of bracing and analyze related factors that influence curative effects in adolescents with idiopathic scoliosis, and to investigate indications of bracing.
Seventy-nine patients with AIS who had no history of prior therapy were treated with a brace. Several parameters were consecutive measured and documented during the period of follow-up including Cobb's angles, curve patterns, menarche status, sitting heights, standing heights, Risser sign, apical vertebral rotation, and so on.
The average period of followed-up was 30 months (12 months to 60 months). Twenty-one patients (26.6%) presented curve deterioration, 40 patients have no obvious curve change, 18 patients (22.8%) got a curve improvement. There was significantly lower percentage of curve progression and higher percentage of curve improvement in cases with Cobb's angle less than 35 degrees at the first visit (P < 0.05). The percentage of curve progression was significantly greater in the cases with apical vertebral rotation beyond grade III while the percentage of curve improvement was lower (P < 0.05). Curve patterns, Risser sign and other parameters were found to make their effects on the percentage of curve progression and improvement, which, however, was not statistically significant (P > 0.05).
Bracing can limit or improve mild and moderate curve of idiopathic scoliosis effectively, especially in cases with initial curve magnitude ranging from 20 degrees to 35 degrees . Risser sign is not a reliable parameter for measuring the outcome of bracing treatment for idiopathic scoliosis. Surgery is advised as soon as possible for the cases with initial Cobb's angles greater than 45 degrees and initial apical vertebral rotation beyond grade III early while bracing did not work.
评估支具治疗特发性脊柱侧凸青少年的临床疗效,分析影响疗效的相关因素,并探讨支具治疗的适应证。
79例未经治疗的特发性脊柱侧凸患者接受支具治疗。随访期间连续测量并记录了几个参数,包括Cobb角、侧弯类型、月经初潮状态、坐高、身高、Risser征、顶椎旋转度等。
平均随访时间为30个月(12个月至60个月)。21例患者(26.6%)出现侧弯进展,40例患者侧弯无明显变化,18例患者(22.8%)侧弯改善。首次就诊时Cobb角小于35度的患者侧弯进展百分比显著较低,侧弯改善百分比显著较高(P<0.05)。顶椎旋转超过III级的患者侧弯进展百分比显著更高,而侧弯改善百分比更低(P<0.05)。侧弯类型、Risser征和其他参数对侧弯进展和改善百分比有影响,但无统计学意义(P>0.05)。
支具能有效限制或改善特发性脊柱侧凸的轻中度侧弯,尤其是初始侧弯角度在20度至35度之间的病例。Risser征不是衡量特发性脊柱侧凸支具治疗效果的可靠参数。对于首次Cobb角大于45度且初始顶椎旋转超过III级且支具治疗无效的患者,建议尽早手术。