Stasikelis Peter J, Carpenter Ashley M
Shriners Hospitals for Children, Greenville, SC.
J Pediatr Orthop. 2018 Apr;38(4):e186-e189. doi: 10.1097/BPO.0000000000001140.
Previous work has demonstrated best results for casting in infantile scoliosis when the curves are small and the child begins casting under 2 years of age. This study examines if casting can delay the need for growth friendly instrumentation in severe curves (50 to 106 degrees) and how the comorbidities of syrinx or genetic syndromes affected outcomes.
All children undergoing casting for scoliosis at a single institution over an 8-year period were examined. Inclusion criteria included initial curve at first casting of ≥50 degrees, age ≤3 years at the start of casting, and a minimum follow-up of 3 years. Of 148 children undergoing casting during this period, 44 met our inclusion criteria. All children underwent magnetic resonance imaging. Ten children with a syrinx were identified. Ten children had known genetic syndromes (2 who also had a syrinx). The 26 children without these comorbidities were considered idiopathic. Curve magnitude ranged from 50 to 106 degrees.
Nine of the 26 (35%) children in the children with idiopathic curves demonstrated resolution of their curves, while only 3 of the remaining 18 (17%) did. Of the children that did not have resolution of their curves, 14 were maintained over the entire follow-up period to within 15 degrees of their initial curve and 13 were improved 15 degrees or more. Only 5 children had an increase of 15 degrees or more over the follow-up period and 4 of these have undergone growth friendly instrumentation after a mean delay from initial cast of 71 months (range, 18 to 100 mo).
This study demonstrates that even in severe curves, casting was effective in delaying instrumentation in all cases, and led to curve resolution of the curves in 12 of 44 children.
Level III-case control study.
先前的研究表明，对于婴幼儿脊柱侧弯，当侧弯角度较小且患儿在2岁前开始支具治疗时，支具治疗效果最佳。本研究旨在探讨支具治疗能否延缓严重侧弯（50至106度）患儿使用生长友好型器械的需求，以及空洞或遗传综合征等合并症如何影响治疗结果。
对一家机构8年间所有接受脊柱侧弯支具治疗的儿童进行检查。纳入标准包括首次支具治疗时初始侧弯≥50度、支具治疗开始时年龄≤3岁以及至少3年的随访。在此期间接受支具治疗的148名儿童中，44名符合我们的纳入标准。所有儿童均接受了磁共振成像检查。确定了10名有空洞的儿童。10名儿童患有已知的遗传综合征（其中2名也有空洞）。26名无这些合并症的儿童被视为特发性。侧弯角度范围为50至106度。
26名特发性侧弯患儿中有9名（35%）侧弯得到矫正，而其余18名中只有3名（17%）得到矫正。在侧弯未得到矫正的患儿中，14名在整个随访期间侧弯维持在初始侧弯15度以内，13名改善了15度或更多。只有5名儿童在随访期间侧弯增加了15度或更多，其中4名在平均初始支具治疗71个月（范围18至100个月）后接受了生长友好型器械治疗。
本研究表明，即使对于严重侧弯，支具治疗在所有病例中均能有效延缓器械治疗，且44名儿童中有12名侧弯得到矫正。
III级——病例对照研究。
