Iorio Justin, Orlando Giuseppe, Diefenbach Chris, Gaughan John P, Samdani Amer F, Pahys Joshua M, Betz Randal R, Cahill Patrick J
*Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY †School of Orthopedics, University of Messina, Messina, Italy ‡Department of Orthopedic Surgery, University of Pittsburgh Medical Center-Hamot, Erie §Biostatistics Consulting Center, Temple University School of Medicine ∥Shriners Hospitals for Children-Philadelphia #Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA ¶Institute for Spine & Scoliosis, Lawrenceville, NJ.
J Pediatr Orthop. 2017 Jul/Aug;37(5):311-316. doi: 10.1097/BPO.0000000000000654.
Serial casting for early-onset scoliosis has been shown to improve curve deformity. Our goal was to define clinical and radiographic features that determine response to treatment.
We retrospectively reviewed patients with idiopathic infantile scoliosis with a minimum of 2-year follow-up. Inclusion criteria were: progressive idiopathic infantile scoliosis and initial casting before 6 years of age. Two groups were analyzed and compared: group 1 (≥10-degree improvement in Cobb angle from baseline) and group 2 (no improvement).
Twenty-one patients with an average Cobb angle of 48 degrees (range, 24 to 72 degrees) underwent initial casting at an average age of 2.1 years (range, 0.7 to 5.4 y). Average follow-up was 3.5 years (range, 2 to 6.9 y). Sex, age at initial casting, magnitude of spinal deformity, and curve flexibility (defined as change in Cobb angle from pretreatment to first in-cast radiograph) were not significantly different between groups (P>0.05). Group 1 had a significantly higher body mass index (BMI) than group 2 at the onset of treatment (17.6 vs. 14.8, P<0.05). Univariate analysis of demographic, radiographic, and treatment factors revealed that only BMI was predictive of Cobb improvement (P=0.04; odds ratio=2.38). Group 1 (n=15) had a significantly lower Cobb angle (21 vs. 56 degrees) and rib vertebral angle difference (13 vs. 25 degrees) compared with group 2 at latest follow-up (P<0.05). A significantly larger proportion of children who were casted at less than 1.8 years of age had a Cobb angle <20 degrees at latest follow-up (P=0.03). Group 2 maintained stable clinical and radiograph parameters from pretreatment to most recent follow-up.
To maintain a homogeneous cohort, we excluded patients with syndromes and developmental delays. We believe that analyzing a homogeneous group provides more meaningful results than if we studied a heterogeneous sample. BMI was significantly associated with outcome such that for each unit increase in BMI, there is a 2.38× increase in the chance of improvement. Curve flexibility was similar between groups, which suggest that the amount of correction obtained at initial casting does not confirm treatment success. Key aspects of treatment that may determine success include age of less than 1.8 years at initiation of casting and derotation of the spine to correct rib vertebral angle difference of <20 degrees.
Level IV-Therapeutic.
已证明对早发性脊柱侧弯进行系列石膏固定可改善侧弯畸形。我们的目标是确定决定治疗反应的临床和影像学特征。
我们回顾性分析了至少随访2年的特发性婴儿型脊柱侧弯患者。纳入标准为：进行性特发性婴儿型脊柱侧弯且6岁前开始石膏固定。分析并比较了两组：第1组（Cobb角较基线改善≥10度）和第2组（无改善）。
21例平均Cobb角为48度（范围24至72度）的患者平均在2.1岁（范围0.7至5.4岁）时接受了初次石膏固定。平均随访3.5年（范围2至6.9年）。两组之间的性别、初次石膏固定时的年龄、脊柱畸形程度和侧弯柔韧性（定义为从治疗前到首次石膏固定时X线片Cobb角的变化）无显著差异（P>0.05）。治疗开始时，第1组的体重指数（BMI）显著高于第2组（17.6对14.8，P<0.05）。对人口统计学、影像学和治疗因素进行单因素分析显示，只有BMI可预测Cobb角改善情况（P=0.04；优势比=2.38）。在最近一次随访时，第1组（n=15）的Cobb角（21度对56度）和肋骨椎骨角差（13度对25度）显著低于第2组（P<0.05）。在1.8岁之前接受石膏固定的儿童中，在最近一次随访时Cobb角<20度的比例显著更高（P=0.03）。从治疗前到最近一次随访，第2组的临床和影像学参数保持稳定。
为保持队列的同质性，我们排除了患有综合征和发育迟缓的患者。我们认为，分析同质组比研究异质样本能提供更有意义的结果。BMI与治疗结果显著相关，即BMI每增加一个单位，改善的机会增加2.38倍。两组之间的侧弯柔韧性相似，这表明初次石膏固定时获得的矫正量并不能确定治疗是否成功。可能决定治疗成功的关键因素包括开始石膏固定时年龄小于1.8岁以及脊柱去旋转以纠正肋骨椎骨角差<20度。
四级——治疗性。
Zotero 插件