Bunge Eveline M, Juttmann Rikard E, van Biezen Frans C, Creemers Huub, Hazebroek-Kampschreur Alice A J M, Luttmer Bert C F, Wiegersma P Auke, de Koning Harry J
Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Pediatrics. 2008 Jan;121(1):9-14. doi: 10.1542/peds.2006-3673.
The aim of this study was to test the hypothesis that screening for scoliosis is effective in reducing the need for surgical treatment.
The study was a case-control study. A total of 125 consecutive patients who were treated surgically for idiopathic scoliosis between January 2001 and October 2004 and who were born on or after January 1, 1984, were invited; 108 agreed to participate. A total of 216 control subjects were selected randomly and anonymously, matched with respect to age and gender. For 279 adolescents, exact screening exposure and outcomes could be analyzed. Case subjects were recruited from 4 university and 6 nonuniversity Dutch hospitals; control subjects were recruited from all 37 municipal health services in The Netherlands.
Screen-detected patients received diagnoses at a significantly younger age than did otherwise-detected patients (10.8 +/- 2.6 vs 13.4 +/- 1.7 years). In total, 32.8% of the surgically treated patients had been screened between 11 and 14 years of age, compared with 43.4% of the control subjects. The odds ratio for being exposed to screening was 0.64. In total, 28% of the patients were diagnosed as having scoliosis before 11 years of age.
Our results showed no evidence that screening for scoliosis reduced the need for surgery. Abolishing screening seems justified, especially because the effectiveness of early treatment with bracing is still strongly debated. A randomized, controlled trial on the effectiveness of treating patients with idiopathic scoliosis with bracing is urgently needed.
本研究旨在检验脊柱侧弯筛查能有效减少手术治疗需求这一假设。
本研究为病例对照研究。邀请了2001年1月至2004年10月期间因特发性脊柱侧弯接受手术治疗且于1984年1月1日及以后出生的125例连续患者；108例同意参与。随机选取216名对照者并进行匿名处理，使其在年龄和性别上匹配。对279名青少年，可分析确切的筛查暴露情况和结果。病例组患者来自4家荷兰大学医院和6家非大学医院；对照组来自荷兰所有37个市政卫生服务机构。
经筛查发现的患者确诊时年龄显著低于其他方式发现的患者（10.8±2.6岁对13.4±1.7岁）。接受手术治疗的患者中，共有32.8%在11至14岁之间接受过筛查，而对照组这一比例为43.4%。接受筛查的比值比为0.64。共有28%的患者在11岁之前被诊断为脊柱侧弯。
我们的结果表明，没有证据显示脊柱侧弯筛查能减少手术需求。取消筛查似乎合理，尤其是因为早期支具治疗的有效性仍存在激烈争议。迫切需要针对特发性脊柱侧弯患者支具治疗有效性开展一项随机对照试验。
