Sun Xu, Zhu Ze-zhang, Qiu Yong, Wang Bin, Li Wei-guo, Zhu Feng, Yu Yang, Qian Bang-ping, Ma Wei-wei
Department of Orthopaedics, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
Zhonghua Wai Ke Za Zhi. 2008 Jul 15;46(14):1066-9.
To investigate whether initial bone mineral status acts as a predictor factor in evaluating the early outcome of brace treatment in adolescent idiopathic scoliosis (AIS) girls.
Seventy-seven girls with AIS, aged 10 - 15 years old, were included in this study. A standardized bracing protocol was performed in these girls, and the early outcomes of brace treatment were evaluated at over-1-year follow-up. Girls with a progressed scoliosis and those with a non-progressed scoliosis were identified. The associations between the outcome and the indices before bracing, including age, menstrual status, Risser grade, bone mineral density (BMD) status, curve magnitude and curve pattern were assessed using univariate analysis. A multiple Logistic stepwise regression was used to determine the risk factors in curve progression in AIS girls treated with brace treatment.
There were 16 girls (21%) with a progressed scoliosis and 61 girls (79%) with a non-progressed scoliosis, respectively. In the girls with a progressed scoliosis, higher ratios of subjects were found with pre-menarchal status (chi(2) = 9.628, P = 0.004), lower Risser grade (chi(2) = 4.565, P = 0.037), main thoracic scoliosis (chi(2) = 4.009, P = 0.045), a larger curve (chi(2) = 1.685, P = 0.194), as well as osteopenia (chi(2) = 3.828, P = 0.050), as compared with those with a non-progressed scoliosis. During brace treatment, besides pre-menarchal status, a larger Cobb angle, and a main thoracic scoliosis, osteopenia (OR = 5.362, P = 0.022) was identified as the risk factor in curve progression in AIS girls, as revealed by the multiple Logistic regression analysis.
Osteopenia might be an independent risk factor in the curve progression during brace treatment. The analysis of initial BMD status before bracing may help to predict the outcome of brace treatment.
探讨初始骨矿物质状态是否可作为评估青少年特发性脊柱侧凸（AIS）女孩支具治疗早期疗效的预测因素。
本研究纳入77例年龄在10至15岁的AIS女孩。对这些女孩实施标准化的支具治疗方案，并在随访1年以上时评估支具治疗的早期疗效。确定脊柱侧凸进展的女孩和未进展的女孩。采用单因素分析评估治疗结果与支具治疗前各项指标之间的关联，这些指标包括年龄、月经状态、Risser分级、骨密度（BMD）状态、侧弯度数和侧弯类型。采用多元Logistic逐步回归分析确定接受支具治疗的AIS女孩侧弯进展的危险因素。
分别有16例（21%）女孩脊柱侧凸进展，61例（79%）女孩脊柱侧凸未进展。在脊柱侧凸进展的女孩中，月经初潮前状态的受试者比例更高（χ² = 9.628，P = 0.004）、Risser分级更低（χ² = 4.565，P = 0.037）、胸主弯（χ² = 4.009，P = 0.045）、侧弯度数更大（χ² = 1.685，P = 0.194）以及存在骨质减少（χ² = 3.828，P = 0.050），与脊柱侧凸未进展的女孩相比。在支具治疗期间，多元Logistic回归分析显示，除月经初潮前状态、Cobb角更大和胸主弯外，骨质减少（OR = 5.362，P = 0.022）被确定为AIS女孩侧弯进展的危险因素。
骨质减少可能是支具治疗期间侧弯进展的独立危险因素。支具治疗前对初始BMD状态进行分析可能有助于预测支具治疗的效果。
