Fletcher Nicholas D, McClung Anna, Rathjen Karl E, Denning Jaime R, Browne Richard, Johnston Charles E
Emory Orthopaedics Spine Center, Atlanta, GA 30329, USA.
J Pediatr Orthop. 2012 Oct-Nov;32(7):664-71. doi: 10.1097/BPO.0b013e31824bdb55.
Serial casting can cure mild infantile idiopathic scoliosis. Its use in delaying surgery in older children and those with larger curves or syndromes is poorly defined.
A review of a single center's experience with casting was performed. Patients were included if they had a syndromic, neuromuscular, or congenital scoliosis or were older than 2.5 years with an idiopathic scoliosis measuring >50 degrees.
A retrospective review was performed on 29 patients meeting all inclusion criteria. Of these, 12 were idiopathic and 17 were nonidiopathic curves. Average age at first cast was 4.4 ± 2.1 years, and 3.0 ± 1.8 cast changes were performed over 1.4 ± 1.1 years. Patients were transitioned to a brace and followed up for 5.5 years (range, 2.2 to 11.4 y). The main thoracic Cobb angle before casting was 68.8 ± 12.3 degrees, which corrected to 39.1 ± 16.4 degrees in a cast. Cobb angle after cast removal was 60.9 ± 18.4 degrees, which increased to 76.3 ± 24.0 degrees at final follow-up. T1-T12 height increased to 1.1 ± 2.6 cm during the treatment period (P=0.05). There were 5 minor complications. Fifteen patients (51.7%) required surgical treatment for their scoliosis at most recent follow-up and an additional 7 patients (24.1%) were delayed until a definitive anterior/posterior spinal fusion could be performed. Surgery was delayed 39 ± 25 months from the first cast. Growing rods were required in 8 patients (27.6%). The patients who ultimately underwent surgical intervention (SG) were more likely to have a larger postcasting residual main thoracic Cobb angle than those who did not require surgery [NS; 69.5 ± 14.6 degrees (SG) vs. 51.6 ± 17.9 degrees (NS), P=0.007] and had a greater progression of their curves after cast removal [20.9 ± 13.5 degrees (SG) vs. 9.4 ± 11.0 degrees (NS), P=0.02].
Serial casting is a viable alternative to surgical growth sparing techniques in moderate-to-severe early-onset scoliosis and may help delay eventual surgical intervention. Although a cure cannot be expected, an average of 39 months of delay was achieved in this patient cohort and 72.4% have avoided growing spine surgery.
Level IV, case series.
连续石膏固定可治愈轻度婴儿特发性脊柱侧凸。其在大龄儿童以及侧弯角度较大或患有综合征的儿童中延迟手术方面的应用尚不清楚。
回顾了单一中心使用石膏固定的经验。纳入标准为患有综合征性、神经肌肉性或先天性脊柱侧凸，或年龄超过2.5岁且特发性脊柱侧凸角度大于50度的患者。
对符合所有纳入标准的29例患者进行了回顾性研究。其中，12例为特发性脊柱侧凸，17例为非特发性脊柱侧凸。首次石膏固定的平均年龄为4.4±2.1岁，在1.4±1.1年期间平均更换3.0±1.8次石膏。患者改用支具并随访5.5年（范围为2.2至11.4年）。石膏固定前主胸弯Cobb角为68.8±12.3度，在石膏固定后矫正至39.1±16.4度。去除石膏后的Cobb角为60.9±18.4度，在最终随访时增加至76.3±24.0度。治疗期间T1-T12高度增加至1.1±2.6厘米（P=0.05）。有5例轻微并发症。在最近一次随访中，15例患者（51.7%）因脊柱侧凸需要手术治疗，另外有7例患者（24.1%）推迟到可以进行确定性前后路脊柱融合手术时。从首次石膏固定起手术推迟了39±25个月。8例患者（27.6%）需要使用生长棒。最终接受手术干预的患者（SG组）与不需要手术的患者相比，石膏固定后残留的主胸弯Cobb角更大[无统计学差异；69.5±14.6度（SG组）对51.6±17.9度（非手术组），P=0.007]，且去除石膏后侧弯进展更大[20.9±13.5度（SG组）对9.4±11.0度（非手术组），P=0.02]。
对于中重度早发性脊柱侧凸，连续石膏固定是一种可行的保留生长手术技术的替代方法，可能有助于延迟最终的手术干预。虽然无法预期治愈，但该队列患者平均延迟了39个月，72.4%的患者避免了脊柱生长手术。
IV级，病例系列。
