Waldron Sean R, Poe-Kochert Connie, Son-Hing Jochen P, Thompson George H
Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH.
J Pediatr Orthop. 2013 Dec;33(8):775-80. doi: 10.1097/BPO.0000000000000072.
Treatment of early onset scoliosis (EOS) is challenging. In many cases, bracing will not be effective and growing rod surgery may be inappropriate. Serial, Risser casts may be an effective intermediate method of treatment.
We studied 20 consecutive patients with EOS who received serial Risser casts under general anesthesia between 1999 and 2011. Analyses included diagnosis, sex, age at initial cast application, major curve severity, initial curve correction, curve magnitude at the time of treatment change or latest follow-up for those still in casts, number of casts per patient, the type of subsequent treatment, and any complications.
There were 8 patients with idiopathic scoliosis, 6 patients with neuromuscular scoliosis, 5 patients with syndromic scoliosis, and 1 patient with skeletal dysplasia. Fifteen patients were female and 5 were male. The mean age at first cast was 3.8±2.3 years (range, 1 to 8 y), and the mean major curve magnitude was 74±18 degrees (range, 40 to 118 degrees). After initial cast application, the major curve measured 46±14 degrees (range, 25 to 79 degrees). At treatment change or latest follow-up for those still in casts, the major curve measured 53±24 degrees (range, 13 to 112 degrees). The mean time in casts was 16.9±9.1 months (range, 4 to 35 mo). The mean number of casts per patient was 4.7±2.2 casts (range, 1 to 9 casts). At the time of this study, 7 patients had undergone growing rod surgery, 6 patients were still undergoing casting, 5 returned to bracing, and 2 have been lost to follow-up. Four patients had minor complications: 2 patients each with superficial skin irritation and cast intolerance.
Serial Risser casting is a safe and effective intermediate treatment for EOS. It can stabilize relatively large curves in young children and allows the child to reach a more suitable age for other forms of treatment, such as growing rods.
Level IV; case series.
早发性脊柱侧弯（EOS）的治疗具有挑战性。在许多情况下，支具治疗无效，而生长棒手术可能并不合适。连续使用Risser石膏背心可能是一种有效的中间治疗方法。
我们研究了1999年至2011年间连续20例接受全身麻醉下连续Risser石膏背心治疗的EOS患者。分析内容包括诊断、性别、首次应用石膏背心时的年龄、主弯严重程度、初始弯度矫正、治疗改变时或仍在使用石膏背心的患者最新随访时的弯度大小、每位患者使用石膏背心的次数、后续治疗类型以及任何并发症。
有8例特发性脊柱侧弯患者，6例神经肌肉型脊柱侧弯患者，5例综合征型脊柱侧弯患者，1例骨骼发育不良患者。15例为女性，5例为男性。首次使用石膏背心时的平均年龄为3.8±2.3岁（范围1至8岁），主弯平均大小为74±18度（范围40至118度）。首次应用石膏背心后，主弯测量值为46±14度（范围25至79度）。在治疗改变时或仍在使用石膏背心的患者最新随访时，主弯测量值为53±24度（范围13至112度）。使用石膏背心的平均时间为16.9±9.1个月（范围4至35个月）。每位患者使用石膏背心的平均次数为4.7±2.2次（范围1至9次）。在本研究时，7例患者已接受生长棒手术，6例患者仍在接受石膏背心治疗，5例恢复使用支具，2例失访。4例患者出现轻微并发症：2例患者分别出现浅表皮肤刺激和石膏不耐受。
连续使用Risser石膏背心是EOS的一种安全有效的中间治疗方法。它可以稳定幼儿相对较大的弯度，并使儿童达到更适合接受其他治疗形式（如生长棒）的年龄。
IV级；病例系列。
