柔韧性可预测青少年特发性脊柱侧凸患者使用普罗维登斯夜间支具时的曲线进展。
Flexibility Predicts Curve Progression in Providence Nighttime Bracing of Patients With Adolescent Idiopathic Scoliosis.
作者信息
Ohrt-Nissen Søren, Hallager Dennis W, Gehrchen Martin, Dahl Benny
机构信息
Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
出版信息
Spine (Phila Pa 1976). 2016 Nov 15;41(22):1724-1730. doi: 10.1097/BRS.0000000000001634.
STUDY DESIGN
Retrospective cohort study.
OBJECTIVE
To determine treatment outcome with providence brace (PB) and to assess the ability of pretreatment supine lateral bending radiographs (SLBR) in predicting curve progression.
SUMMARY OF BACKGROUND DATA
Results from treatment with the PB for adolescent idiopathic ccoliosis (AIS) have been inconsistent and further research is needed. The association between flexibility, as determined by pretreatment SLBR, and curve progression has not previously been examined.
METHODS
All patients treated with the PB from 2006 to 2011 who met Scoliosis Research Society (SRS) bracing criteria were included. Flexibility of the curve was determined based on SLBR and radiographic variables were registered at beginning of treatment and at skeletal maturity (SM) or before surgery. An increase in standing Cobb angle by more than 5 degrees was considered progression. Follow-up SRS-22 scores were compared with a control group with minor AIS. Analysis included multiple linear and logistic regression.
RESULTS
A total of 63 patients were included. Mean age was 13.3 years (SD: 1.5) and mean standing Cobb angle was 34° (SD: 5°). Radiographic progression was observed in 43% of patients at SM and surgical rate was 27% and 37% at SM and 2-year follow up, respectively. SRS-22 total scores were similar but the mental health score was significantly better in the control group (P = 0.042). Multiple linear regression analysis showed that decreased flexibility adjusted for age, Cobb angle, and menarchal status was significantly associated with curve progression (P < 0.001). Multiple logistic regression analysis showed that a one percent increase in flexibility was associated with a decrease in risk of curve progression ≥6° (odds ratio = 0.95; 95% confidence interval 0.90-0.98; P = 0.013).
CONCLUSION
Progression was seen in 43% of AIS patients treated with the PB. Increase in flexibility was independently associated with a decreased risk of progression.
LEVEL OF EVIDENCE
研究设计
回顾性队列研究。
目的
确定普罗维登斯支具（PB）的治疗效果，并评估治疗前仰卧位侧弯X线片（SLBR）预测侧弯进展的能力。
背景数据总结
PB治疗青少年特发性脊柱侧凸（AIS）的结果并不一致，需要进一步研究。此前尚未研究过由治疗前SLBR确定的柔韧性与侧弯进展之间的关联。
方法
纳入2006年至2011年期间接受PB治疗且符合脊柱侧凸研究学会（SRS）支具治疗标准的所有患者。根据SLBR确定侧弯的柔韧性，并在治疗开始时以及骨骼成熟（SM）时或手术前记录X线变量。站立位Cobb角增加超过5度被视为进展。将随访的SRS-22评分与轻度AIS对照组进行比较。分析包括多元线性回归和逻辑回归。
结果
共纳入63例患者。平均年龄为13.3岁（标准差：1.5），平均站立位Cobb角为34°（标准差：5°）。在SM时，43%的患者出现X线进展，在SM时手术率为27%，在2年随访时为37%。SRS-22总分相似，但对照组的心理健康评分明显更好（P = 0.042）。多元线性回归分析表明，在调整年龄、Cobb角和月经初潮状态后，柔韧性降低与侧弯进展显著相关（P < 0.001）。多元逻辑回归分析表明，柔韧性每增加1%，侧弯进展≥6°的风险降低（优势比 = 0.95；95%置信区间0.90 - 0.98；P = 0.013）。
结论
接受PB治疗的AIS患者中43%出现进展。柔韧性增加与进展风险降低独立相关。
证据级别
3级。
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