青少年特发性脊柱侧弯早期的夜间支具治疗与观察比较
Nighttime bracing versus observation for early adolescent idiopathic scoliosis.
作者信息
Wiemann John M, Shah Suken A, Price Charles T
机构信息
*Orthopaedic Center for Spinal and Pediatric Care, Dayton Children's Hospital, Dayton, OH †Alfred I. DuPont Hospital for Children, Wilmington, DE ‡Arnold Palmer Hospital for Children, Orlando, FL.
出版信息
J Pediatr Orthop. 2014 Sep;34(6):603-6. doi: 10.1097/BPO.0000000000000221.
BACKGROUND
Spinal bracing is widely utilized in patients with moderate severity adolescent idiopathic scoliosis with the goal of preventing curve progression and therefore preventing the need for surgical correction. Bracing is typically initiated in patients with a primary curve angle between 25 and 40 degrees, who are Risser sign 0 to 2 and <1-year postmenarchal. The purpose of this study is to determine whether nighttime bracing using a Charleston bending brace is effective in preventing progression of smaller curves (15 to 25 degrees) in skeletally immature, premenarchal female patients relative to current standard of care (observation for curves <25 degrees).
METHODS
Premenarchal, Risser 0 female patients presenting to 2 pediatric orthopaedic specialty practices for evaluation of idiopathic scoliosis with Cobb angle measurements between 15 and 25 degrees were selected. They were randomized by location to receive nighttime bending brace treatment or observation. Patients in the observation group were converted to fulltime TLSO wear if they progressed to >25 degrees primary curve Cobb angle. Curve progression was monitored with minimum 2-year follow-up.
RESULTS
Sixteen patients in the observation group and 21 patients in the bracing group completed 2-year follow-up. All patients in the observation group progressed to fulltime bracing threshold. In the nighttime bracing group, 29% of the patients did not progress to 25 degrees primary curve magnitude. Rate of progression to surgical magnitude was similar in the 2 groups.
CONCLUSIONS
Risser 0 patients presenting with mild idiopathic scoliosis are at high risk for progression to >25 degrees primary curve magnitude. Treatment with the Charleston nighttime bending brace may reduce progression to full-time bracing threshold. No difference in progression to surgical intervention was shown between nighttime bracing and observation for small curves.
LEVEL OF EVIDENCE
Level II--therapeutic study (prospective comparative study).
背景
脊柱支具广泛应用于中度严重程度的青少年特发性脊柱侧凸患者，目的是防止侧弯进展，从而避免手术矫正的需要。支具治疗通常适用于主弯角度在25至40度之间、Risser征为0至2且初潮后<1年的患者。本研究的目的是确定相对于当前的标准治疗方法（对<25度的侧弯进行观察），使用查尔斯顿弯曲支具进行夜间支具治疗在预防骨骼未成熟、初潮前女性患者较小侧弯（15至25度）进展方面是否有效。
方法
选择初潮前、Risser 0级的女性患者，她们因特发性脊柱侧凸到2家小儿骨科专科诊所就诊，Cobb角测量值在15至25度之间。根据就诊地点将她们随机分为接受夜间弯曲支具治疗组或观察组。观察组患者如果主弯Cobb角进展到>25度，则改为全天佩戴胸腰骶椎矫形器（TLSO）。对侧弯进展进行至少2年的随访监测。
结果
观察组16例患者和支具治疗组21例患者完成了2年随访。观察组所有患者均进展到全天支具治疗阈值。在夜间支具治疗组中，29%的患者主弯未进展到25度。两组进展到手术程度的比例相似。
结论
患有轻度特发性脊柱侧凸的Risser 0级患者进展到主弯>25度的风险很高。使用查尔斯顿夜间弯曲支具治疗可能会减少进展到全天支具治疗阈值的情况。对于小侧弯，夜间支具治疗和观察在进展到手术干预方面没有差异。
证据水平
II级——治疗性研究（前瞻性比较研究）。
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