Negrini Stefano, Donzelli Sabrina, Lusini Monia, Zaina Fabio
Physical and Rehabilitation Medicine, University of Brescia, Italy.
Stud Health Technol Inform. 2012;176:354-7.
Since the beginning of history of Medicine, it has been possible to learn from the worst and best results of treatments. Our aim was to verify which patients can reach the best and worst results during conservative treatment.
All AIS patients with more than 2 visits included in a prospective clinical database started in September 2003 were reviewed on August 31st 2010. A cut-off of 20 degrees (improvement or worsening) from the first observation was used to select patients. Patients were analysed for diagnosis, morphology, Cobb degrees at start, curve improved/worsened, treatment, gender, Body Mass Index, clinical parameters.
Out of 1886 consecutive patients, 62 (3.3%) changed 20° or more: 26 (1.4%) improved (range 20-34°), 36 (1.9%) progressed (20-60°). Relative Risk of progression of 20° or more was increased more than 10 times in cases of thoracic curve or secondary scoliosis, 5 times for Moe scoliosis and BMI <15 kg/mq, 3 times for age <12 years, and congenital or juvenile scoliosis. Relative Risk of improvement of 20° statistically was increased more than 3 times in cases of previous exercises, female gender, thoracolumbar curve or scoliosis, ISICO treatment, and age <12 years.
Not all our results correspond to the usually reported prognostic factors in ample case series, but it must be taken into account that only wide variations (20° or more) have been considered here. In this population we had 1.9% of patients who improved at least 20° with conservative treatment, and this is notable as well. Finally, since these results are not similar to what would be expected according to the known natural history, conservative treatment appears able to change it.
自医学史开端以来，人们就能够从治疗的最差和最佳结果中汲取经验。我们的目的是验证哪些患者在保守治疗期间能够获得最佳和最差结果。
对2003年9月开始纳入前瞻性临床数据库且就诊次数超过2次的所有AIS患者，于2010年8月31日进行回顾性分析。以首次观察时度数变化20度（改善或加重）为界来选择患者。对患者的诊断、形态、起始时的Cobb角、侧弯改善/加重情况、治疗方法、性别、体重指数、临床参数进行分析。
在1886例连续患者中，62例（3.3%）度数变化20度或以上：26例（1.4%）改善（范围为20 - 34度），36例（1.9%）进展（20 - 60度）。胸弯或继发性脊柱侧弯患者中，20度或以上进展的相对风险增加超过10倍；Moe脊柱侧弯且体重指数<15 kg/m²的患者，相对风险增加5倍；年龄<12岁、先天性或青少年脊柱侧弯患者，相对风险增加3倍。在曾进行过锻炼、女性、胸腰段侧弯或脊柱侧弯、接受ISICO治疗以及年龄<12岁的患者中，20度改善的相对风险在统计学上增加超过3倍。
并非我们所有的结果都与大量病例系列中通常报道的预后因素相符，但必须考虑到这里仅考虑了较大的度数变化（20度或以上）。在这一人群中，有1.9%的患者通过保守治疗至少改善了20度，这一点也值得注意。最后，由于这些结果与已知自然史预期的不同，保守治疗似乎能够改变自然史。
