Aulisa Angelo G, Guzzanti Vincenzo, Falciglia Francesco, Galli Marco, Pizzetti Paolo, Aulisa Lorenzo
U.O.C. of Orthopedics and Traumatology, Children's Hospital Bambino Gesù, Institute of Scientific Research, P.zza S. Onofrio 4, 00165 Rome, Italy.
University of Cassino, 03043 Cassino, FR Italy.
Scoliosis Spinal Disord. 2017 Oct 30;12:36. doi: 10.1186/s13013-017-0142-y. eCollection 2017.
The factors influencing curve behavior following bracing are incompletely understood and there is no agreement if scoliotic curves stop progressing with skeletal maturity. The aim of this study was to evaluate the loss of the scoliotic curve correction in patients treated with bracing during adolescence and to compare patient outcomes of under and over 30 Cobb degrees, 10 years after brace removal.
We reviewed 93 (87 female) of 200 and nine patients with adolescent idiopathic scoliosis (AIS) who were treated with the Lyon or PASB brace at a mean of 15 years (range 10-35). All patients answered a simple questionnaire (including work status, pregnancy, and pain) and underwent clinical and radiological examination. The population was divided into two groups based on Cobb degrees (< 30° and > 30°). Statistical analysis was performed to test the efficacy of our hypothesis.
The patients underwent a long-term follow-up at a mean age of 184.1 months (±72.60) after brace removal. The pre-brace scoliotic mean curve was 32.28° (± 9.4°); after treatment, the mean was 19.35° and increased to a minimum of 22.12° in the 10 years following brace removal. However, there was no significant difference in the mean Cobb angle between the end of weaning and long term follow-up period ( = 0.105). The curve angle of patients who were treated with a brace from the beginning was reduced by 13° during the treatment, but the curve size lost 3° at the follow-up period.The groups over 30° showed a pre-brace scoliotic mean curve of 41.15°; at the end of weaning, the mean curve angle was 25.85° and increased to a mean of 29.73° at follow-up; instead, the groups measuring ≤ 30° showed a pre-brace scoliotic mean curve of 25.58°; at the end of weaning, it was reduced to a mean of 14.24° and it increased to 16.38° at follow-up.There was no significant difference in the mean progression of curve magnitude between the ≤ 30° and > 30° groups at the long-term follow-up.
Scoliotic curves did not deteriorate beyond their original curve size after bracing in both groups at the 15-year follow-ups. These results are in contrast with the history of this pathology that normally shows a progressive and lowly increment of the curve at skeletal maturity. Bracing is an effective treatment method characterized by positive long-term outcomes, including for patients demonstrating moderate curves.
影响支具治疗后脊柱侧凸曲线变化的因素尚未完全明确，对于脊柱侧凸曲线是否会随着骨骼成熟而停止进展也尚无定论。本研究旨在评估青春期接受支具治疗的患者脊柱侧凸曲线矫正的丢失情况，并比较去除支具10年后Cobb角小于30度和大于30度患者的治疗效果。
我们回顾了209例青少年特发性脊柱侧凸（AIS）患者中的93例（87例女性），这些患者平均在15岁（范围10 - 35岁）时接受了Lyon或PASB支具治疗。所有患者均回答了一份简单问卷（包括工作状态、妊娠和疼痛情况），并接受了临床和影像学检查。根据Cobb角（<30°和>30°）将患者分为两组。进行统计分析以检验我们假设的有效性。
患者在去除支具后平均184.1个月（±72.60）进行了长期随访。支具治疗前脊柱侧凸平均曲线为32.28°（±9.4°）；治疗后平均为19.35°，在去除支具后的10年中增加到最小值22.12°。然而，在断奶结束时和长期随访期之间的平均Cobb角没有显著差异（P = 0.105）。从一开始就接受支具治疗的患者的曲线角度在治疗期间减少了13°，但在随访期间曲线大小丢失了3°。Cobb角大于30°的组支具治疗前脊柱侧凸平均曲线为41.15°；断奶结束时，平均曲线角度为25.85°，随访时增加到平均29.73°；相反，测量值≤30°的组支具治疗前脊柱侧凸平均曲线为25.58°；断奶结束时，降至平均14.24°，随访时增加到16.38°。在长期随访中，≤30°组和>30°组之间曲线大小的平均进展没有显著差异。
在15年的随访中，两组接受支具治疗后的脊柱侧凸曲线均未恶化超过其原始曲线大小。这些结果与该疾病的历史情况相反，该疾病通常在骨骼成熟时显示出曲线的渐进性和缓慢增加。支具治疗是一种有效的治疗方法，具有积极的长期效果，包括对表现为中度曲线的患者。
