波士顿支具治疗晚发性青少年特发性脊柱侧凸的长期疗效
Long-term results after Boston brace treatment in late-onset juvenile and adolescent idiopathic scoliosis.
作者信息
Lange Johan Emil, Steen Harald, Gunderson Ragnhild, Brox Jens Ivar
机构信息
Orthopaedic and Radiological Department, Rikshospitalet, Oslo University Hospital, Norway.
出版信息
Scoliosis. 2011 Aug 31;6:18. doi: 10.1186/1748-7161-6-18.
BACKGROUND
It is recommended that research in patients with idiopathic scoliosis should focus on short- and long-term patient-centred outcome. The aim of the present study was to evaluate outcome in patients with late-onset juvenile or adolescent idiopathic scoliosis 16 years or more after Boston brace treatment.
METHODS
272 (78%) of 360 patients, 251 (92%) women, responded to follow-up examination at a mean of 24.7 (range 16 - 32) years after Boston brace treatment. Fifty-eight (21%) patients had late-onset juvenile and 214 had adolescent idiopathic scoliosis. All patients had clinical and radiological examination and answered a standardised questionnaire including work status, demographics, General Function Score (GFS) (100 - worst possible) and Oswestry Disability Index (ODI) (100 - worst possible), EuroQol (EQ-5D) (1 - best possible), EQ-VAS (100 - best possible), and Scoliosis Research Society - 22 (SRS - 22) (5 - best possible).
RESULTS
The mean age at follow-up was 40.4 (31-48) years. The prebrace major curve was in average 33.2 (20 - 57)°. At weaning and at the last follow-up the corresponding values were 28.3 (1 - 58)° and 32.5 (7 - 80)°, respectively. Curve development was similar in patients with late-onset juvenile and adolescent start. The prebrace curve increased > 5° in 31% and decreased > 5° in 26%. Twenty-five patients had surgery. Those who did not attend follow-up (n = 88) had a lower mean curve at weaning: 25.4 (6-53)°. Work status was 76% full-time and 10% part-time. Eighty-seven percent had delivered a baby, 50% had pain in pregnancy. The mean (SD) GFS was 7.4 (10.8), ODI 9.3 (11.0), EQ-5D 0.82 (0.2), EQ-VAS 77.6 (17.8), SRS-22: pain 4.1 (0.8), mental health 4.1 (0.6), self-image 3.7 (0.7), function 4.0 (0.6), satisfaction with treatment 3.7 (1.0). Surgical patients had significantly reduced scores for SRS-physical function and self-image, and patients with curves ≥ 45° had reduced self-image.
CONCLUSION
Long-term results were satisfactory in most braced patients and similar in late-onset juvenile and idiopathic adolescent scoliosis.
背景
建议针对特发性脊柱侧凸患者的研究应聚焦于以患者为中心的短期和长期结果。本研究的目的是评估接受波士顿支具治疗16年或更长时间后的晚发性青少年或青少年特发性脊柱侧凸患者的治疗结果。
方法
360例患者中有272例（78%），其中251例（92%）为女性，在接受波士顿支具治疗后平均24.7年（范围16 - 32年）接受了随访检查。58例（21%）患者为晚发性青少年特发性脊柱侧凸，214例为青少年特发性脊柱侧凸。所有患者均接受了临床和放射学检查，并回答了一份标准化问卷，包括工作状态、人口统计学信息、总体功能评分（GFS）（满分100分，分数越低越差）、奥斯威斯利残疾指数（ODI）（满分100分，分数越低越差）、欧洲五维度健康量表（EQ - 5D）（满分1分，分数越高越好）、EQ视觉模拟量表（EQ - VAS）（满分100分）以及脊柱侧凸研究学会-22项问卷（SRS - 22）（满分5分）。
结果
随访时的平均年龄为4 ~ 4（31 - 48）岁。支具治疗前主弯平均角度为33.2（20 - 57）°。在停用支具时和最后一次随访时，相应角度分别为28.3（1 - 58）°和32.5（7 - 80）°。晚发性青少年和青少年起病的患者曲线发展情况相似。支具治疗前曲线增加>5°的患者占31%，减少>5°的患者占26%。25例患者接受了手术。未参加随访者（n = 88）在停用支具时的平均曲线角度较低：25.4（6 - 53）°。工作状态为全职者占76%，兼职者占10%；87%的患者已生育，50%在孕期有疼痛。平均（标准差）GFS为7.4（10.8），ODI为9.3（11.0），EQ - 5D为0.82（0.2），EQ - VAS为77.6（17.8），SRS - 22：疼痛维度4.1（0.8），心理健康维度4.1（0.6），自我形象维度3.7（0.7），功能维度4.0（0.6），对治疗的满意度维度3.7（1.0）。接受手术的患者SRS身体功能和自我形象评分显著降低，曲线≥45°者自我形象评分降低。
结论
大多数接受支具治疗的患者长期结果令人满意，晚发性青少年特发性脊柱侧凸和青少年特发性脊柱侧凸结果相似。
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