Davies Evan, Norvell Daniel, Hermsmeyer Jeffrey
Southampton University Hospitals Trust, Southampton, UK.
Evid Based Spine Care J. 2011 May;2(2):25-34. doi: 10.1055/s-0030-1267102.
Systematic review.
(1) Does brace treatment compared with observation of curves lead to lower rates of surgery and failure for patients with idiopathic scoliosis? (2) Does brace treatment compared with observation of curves lead to better quality of life outcomes for patients with idiopathic scoliosis? (3) Does brace treatment compared with observation of curves lead to improved curve angle for patients with idiopathic scoliosis?
A systematic review of the English-language literature was undertaken for articles published between 1970 and December 2010. Electronic databases and reference lists of key articles were searched to identify studies comparing brace treatment with observation of curves in patients with idiopathic scoliosis. Two independent reviewers assessed the strength of evidence using the GRADE criteria assessing quality, quantity, and consistency of results. Disagreements were resolved by consensus.
We identified eight studies meeting our inclusion criteria. The pooled studies comparing surgical rates between observation and brace treatment showed no statistical significance (P = .65). One study showed a statistically significant difference in failure rate between observation (45%) and brace (15%) treatment (P < .001). Findings with respect to posttreatment quality of life at 2 years were inconsistent. Two studies favored the brace group, and one the observation group using the SRS-22 and Quality of Life Profile for Spine Deformities (QLPSD) measures. Two of three studies reporting pretreatment and posttreatment curve angles demonstrated a treatment effect favoring bracing; however, statistical significance for these treatment effects could not be calculated. One study described a treatment effect favoring observation but the differences were not statistically significant (P = .26).
This systematic review identified and summarized only the highest level of evidence by limiting to comparison studies. Case-series were not included. This allowed for comparisons among the same patient populations. Findings with respect to surgical rates, quality of life, and change in curve angle demonstrate either no significant differences or inconsistent findings favoring one treatment or the other. If bracing does not cause a positive treatment effect, then its rejection will lead to significant savings for healthcare providers and purchasers. Given the very low to low level of evidence and inconsistent findings, a randomized trial is necessary to determine if bracing should be recommended.
系统评价。
（1）对于特发性脊柱侧凸患者，与观察脊柱侧弯相比，支具治疗是否能降低手术率和失败率？（2）对于特发性脊柱侧凸患者，与观察脊柱侧弯相比，支具治疗是否能带来更好的生活质量结果？（3）对于特发性脊柱侧凸患者，与观察脊柱侧弯相比，支具治疗是否能改善脊柱侧弯角度？
对1970年至2010年12月发表的英文文献进行系统评价。检索电子数据库和关键文章的参考文献列表，以识别比较特发性脊柱侧凸患者支具治疗与观察脊柱侧弯的研究。两名独立评审员使用GRADE标准评估证据强度，该标准评估结果的质量、数量和一致性。分歧通过共识解决。
我们确定了八项符合纳入标准的研究。汇总比较观察治疗和支具治疗手术率的研究显示无统计学意义（P = 0.65）。一项研究显示观察治疗（45%）和支具治疗（15%）的失败率存在统计学显著差异（P < 0.001）。关于2年后治疗后生活质量的研究结果不一致。两项研究支持支具组，一项研究支持观察组，采用脊柱侧凸研究学会-22（SRS-22）和脊柱畸形生活质量量表（QLPSD）进行测量。报告治疗前和治疗后脊柱侧弯角度的三项研究中有两项显示出有利于支具治疗的治疗效果；然而，这些治疗效果的统计学意义无法计算。一项研究描述了有利于观察治疗的治疗效果，但差异无统计学意义（P = 0.26）。
本系统评价通过仅限于比较研究来识别和总结最高水平的证据。未纳入病例系列研究。这使得能够在相同患者群体之间进行比较。关于手术率、生活质量和脊柱侧弯角度变化的研究结果表明，两种治疗方法之间要么没有显著差异，要么支持一种治疗方法或另一种治疗方法的研究结果不一致。如果支具治疗没有产生积极的治疗效果，那么拒绝使用支具将为医疗服务提供者和购买者节省大量费用。鉴于证据水平非常低到低且研究结果不一致，有必要进行一项随机试验来确定是否应推荐使用支具。
