Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
Spine (Phila Pa 1976). 2010 Aug 1;35(17):1607-14. doi: 10.1097/BRS.0b013e3181c7cb8c.
Retrospective cohort study.
To evaluate the clinical effectiveness of school scoliosis screening using a large and long-term-followed cohort of students in Hong Kong.
School screening for adolescent idiopathic scoliosis has been criticized as resulting in over-referrals for radiography and having low predictive values. Indeed, all but one previous retrospective cohort studies had no follow-up assessments of students until their skeletal maturity, leaving any late-developed curves undetected. The one study that completed this follow-up was well conducted but had low precisions due to its small sample size.
A total of 157,444 students were eligible for a biennial scoliosis screening, and their screening results and medical records up to 19 years of age were available. Students first had forward bending test and angle of trunk rotation (ATR) performed. Those with ATR between 5 degrees and 14 degrees or signs of adolescent idiopathic scoliosis were assessed by moiré topography regularly. Students with an ATR >or=15 degrees , >or=2 moiré lines, or significant clinical signs were referred for radiography and had their Cobb angle measured.
Of the 115,190 screened students in the cohort, 3228 (2.8%, 95% confidence interval [CI] = 2.7%-2.9%) were referred for radiography. At the final follow-up, the positive predictive values were 43.6% (41.8%-45.3%) for a Cobb angle >or=20 degrees and 9.4% (8.4%-10.5%) for needing treatment, while the sensitivities were 88.1% (86.4%-89.6%) and 80.0% (75.6%-83.9%), respectively.
This is the largest study that has demonstrated that school scoliosis screening in Hong Kong is predictive and sensitive with a low referral rate. Screening should thus be continued in order to facilitate early administration of conservative treatments.
回顾性队列研究。
评估香港大规模长期随访队列中学生脊柱侧凸学校筛查的临床效果。
青少年特发性脊柱侧凸的学校筛查因过度转诊放射检查和预测值低而受到批评。事实上，除了一项之前的回顾性队列研究外，所有研究都没有对学生进行骨骼成熟度之前的随访评估，导致任何迟发性曲线都未被发现。唯一一项完成了这项随访的研究是一项精心设计的研究，但由于样本量小，其精度较低。
共有 157444 名学生有资格接受两年一次的脊柱侧凸筛查，他们的筛查结果和 19 岁之前的病历记录都可以使用。学生首先进行前屈试验和躯干旋转角度（ATR）检查。ATR 在 5 度至 14 度之间或有青少年特发性脊柱侧凸迹象的学生定期接受云纹图评估。ATR 大于等于 15 度、大于等于 2 个云纹线或有明显临床体征的学生被转诊进行放射检查，并测量 Cobb 角。
在队列中的 115190 名筛查学生中，有 3228 名（2.8%，95%置信区间[CI]为 2.7%-2.9%）被转诊进行放射检查。在最终随访时，Cobb 角大于等于 20 度的阳性预测值为 43.6%（41.8%-45.3%），需要治疗的阳性预测值为 9.4%（8.4%-10.5%），而敏感性分别为 88.1%（86.4%-89.6%）和 80.0%（75.6%-83.9%）。
这是最大规模的研究，表明香港的学校脊柱侧凸筛查具有预测性和敏感性，转诊率低。因此，为了便于早期实施保守治疗，应继续进行筛查。
