仰卧位侧弯X线片可预测青少年特发性脊柱侧弯患者使用普罗维登斯支具的初始支具内矫正情况。
Supine Lateral Bending Radiographs Predict the Initial In-brace Correction of the Providence Brace in Patients With Adolescent Idiopathic Scoliosis.
作者信息
Ohrt-Nissen Søren, Hallager Dennis W, Gehrchen Martin, Dahl Benny
机构信息
From the Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Denmark.
出版信息
Spine (Phila Pa 1976). 2016 May;41(9):798-802. doi: 10.1097/BRS.0000000000001519.
STUDY DESIGN
Retrospective, cross-sectional.
OBJECTIVE
To determine the initial curve correction of the providence brace (PB) and to determine to what extend the in-brace Cobb angle corresponds to the curve seen on supine lateral bending radiographs (SLBR).
SUMMARY OF BACKGROUND DATA
SLBR are used to assess curve flexibility in patients undergoing surgical treatment for adolescent idiopathic scoliosis (AIS). A low rate of in-brace correction (IBC) has been associated with a higher risk of curve progression, but to what extent SLBR can be used to predict IBC before initiating bracing treatment is unknown.
METHODS
All patients with AIS treated with the PB from January 1, 2006 to December 31, 2013 with a major curve of 25 to 45 degrees° were included. Cobb angle on SLBR before treatment and on initial standing, in-brace radiograph (IBR) were measured twice for each patient by one observer 30 days apart. Using a repeated measure mixed effect model, mean difference and 95% limits of agreement (LOA) between Cobb angles on each type of radiograph were estimated. Correction index (CI) was calculated as: curve flexibility (%)/curve correction (%).
RESULTS
A total of 127 patients were included. Mean long-standing Cobb angle was 35° (SD: 6°), which was reduced to mean 13° (SD: 8) on IBR (P < 0.05). No difference in curve correction between curve types was found when adjusting for flexibility using correction index (P = 0.77). Overall mean difference between SLBR and IBR was 0.2° (LOA ± 10°). Mean difference for thoracic curves was 0.2° (LOA ± 8°), for thoracolumbar/lumbar curves 0.9° (LOA ± 10°) and for double major curves 0.4° (LOA ± 16).
CONCLUSION
SLBR provide a close estimation to the expected in-brace correction with a mean difference of less than one degree. SLRB could potentially serve as prognostic parameter for curve progression before initiating brace treatment.
LEVEL OF EVIDENCE
研究设计
回顾性横断面研究。
目的
确定普罗维登斯支具（PB）的初始曲线矫正情况，并确定支具内Cobb角与仰卧位侧弯X线片（SLBR）上所见曲线的对应程度。
背景数据总结
SLBR用于评估接受青少年特发性脊柱侧凸（AIS）手术治疗患者的曲线柔韧性。支具内矫正率（IBC）低与曲线进展风险较高相关，但在开始支具治疗前，SLBR能在多大程度上用于预测IBC尚不清楚。
方法
纳入2006年1月1日至2013年12月31日期间接受PB治疗、主弯角度为25至45度的所有AIS患者。由一名观察者在相隔30天的时间里，对每位患者治疗前的SLBR以及初始站立位、支具内X线片（IBR）上的Cobb角各测量两次。使用重复测量混合效应模型，估计每种类型X线片上Cobb角之间的平均差异和95%一致性界限（LOA）。矫正指数（CI）计算如下：曲线柔韧性（%）/曲线矫正（%）。
结果
共纳入127例患者。平均长期Cobb角为35°（标准差：6°），在IBR上降至平均13°（标准差：8°）（P<0.05）。使用矫正指数调整柔韧性后，各曲线类型之间的曲线矫正无差异（P = 0.77）。SLBR和IBR之间的总体平均差异为0.2°（LOA±10°）。胸段曲线的平均差异为0.2°（LOA±8°），胸腰段/腰段曲线为0.9°（LOA±10°），双主弯曲线为0.4°（LOA±16°）。
结论
SLBR能对预期的支具内矫正提供接近的估计，平均差异小于1度。在开始支具治疗前，SLRB可能作为曲线进展的预后参数。
证据级别
3级。
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