Kuroki Hiroshi, Inomata Naoki, Hamanaka Hideaki, Chosa Etsuo, Tajima Naoya
Department of Orthopaedic Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan.
Scoliosis. 2012 Mar 27;7:8. doi: 10.1186/1748-7161-7-8.
Although most idiopathic scoliosis patients subject to conservative treatment in daily clinical practice, there have been no ideal methods to evaluate the spinal flexibility for the patients who are scheduled the brace treatment. The purpose of this study was to investigate the value of hanging total spine x-ray to estimate the indicative correction angle by brace wearing in idiopathic scoliosis patients.
One hundred seventy-six consecutive patients with idiopathic scoliosis who were newly prescribed the Osaka Medical College (OMC) brace were studied. The study included 14 boys and 162 girls with a mean age of 13 years and 1 month. The type of curves consisted of 62 thoracic, 23 thoracolumbar, 22 lumbar, 42 double major, 14 double thoracic, and 13 triple curve pattern. We compared the Cobb angles on initial brace wearing (BA) and in hanging position (HA). Of those, 108 patients who had main thoracic curves were selected and evaluated the corrective ability of OMC brace. These subjects were divided into three groups according to the relation between BA and HA (BA < HA group, BA = HA group, and BA > HA group), and then, maturity was compared among them.
The average Cobb angle in upright position (UA) of all cases was 31.0 ± 7.8°. The average BA and HA of all cases were 20.3 ± 9.5° and 21.1 ± 8.4°, respectively. The average chronological age was lowest in BA < HA group. And also, maturity in BA < HA group was the lowest among each of them. The rate of BA < HA cases were decreased as the Risser stage of the patients were progressed.
The use of hanging total spine x-ray served as a useful tool to estimate the degree of correction possible curve within the OMC brace for main thoracic curve in idiopathic scoliosis. Maturity had some influence on the correlation between HA and BA. Namely, in immature patients, HA tended to be larger than BA. In contrast, in mature patients, HA had a tendency to be smaller than BA. With consideration for spinal flexibility based on maturity, in mature patients, larger BA than HA may be allowed. However, in immature patients, smaller BA than HA should be aimed.
尽管在日常临床实践中，大多数特发性脊柱侧凸患者接受保守治疗，但对于计划进行支具治疗的患者，尚无理想的方法来评估脊柱柔韧性。本研究的目的是探讨悬吊全脊柱X线片在评估特发性脊柱侧凸患者佩戴支具时指示性矫正角度方面的价值。
对176例新开具大阪医科大学（OMC）支具的连续特发性脊柱侧凸患者进行研究。研究包括14名男孩和162名女孩，平均年龄为13岁1个月。曲线类型包括62例胸椎型、23例胸腰段型、22例腰椎型、42例双主弯型、14例双胸弯型和13例三弯型。我们比较了初次佩戴支具时（BA）和悬吊位时（HA）的Cobb角。其中，选取108例有主要胸椎曲线的患者，评估OMC支具的矫正能力。根据BA与HA的关系将这些受试者分为三组（BA < HA组、BA = HA组和BA > HA组），然后比较它们之间的成熟度。
所有病例直立位（UA）的平均Cobb角为31.0±7.8°。所有病例的平均BA和HA分别为20.3±9.5°和21.1±8.4°。BA < HA组的平均实际年龄最低。而且，BA < HA组的成熟度在各组中也是最低的。随着患者Risser分期的进展，BA < HA病例的比例降低。
悬吊全脊柱X线片是评估特发性脊柱侧凸主要胸椎曲线在OMC支具内可能矫正程度的有用工具。成熟度对HA与BA之间的相关性有一定影响。即，在未成熟患者中，HA往往大于BA。相反，在成熟患者中，HA往往小于BA。考虑到基于成熟度的脊柱柔韧性，在成熟患者中，可允许BA大于HA。然而，在未成熟患者中，应目标是BA小于HA。
