Yoshida Kiyoshi, Kajiura Ichiro, Suzuki Tsunehiko, Kawabata Hidehiko
Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Japan.
Department of Orthopaedic Surgery, Osaka Rehabilitation Hospital for Children, Japan.
J Orthop Sci. 2018 Jul;23(4):649-652. doi: 10.1016/j.jos.2018.03.009. Epub 2018 Apr 26.
Scoliosis in cerebral palsy (CP) often occurs and causes a disturbance in daily life. The purpose of this study was to investigate the natural history of scoliosis in cerebral palsy and determine risk factors for the progression of scoliosis using multivariate analyses.
We revised 113 patients with CP (47 males and 66 females) who had scoliosis with a curve of at least 10° were reviewed and retrospectively investigated these cases of scoliosis and analyzed the risk factors for the progression of this condition.
The mean follow-up period was 16.5 years and the mean age at onset of scoliosis was 6.6 years (range: 1-16 years). In 59 patients (52%), the age at onset of scoliosis was under 6 years. On the final radiographs, the mean Cobb angle was 55.1° (range: 10° to 169°). After the age of 20 years, 13 of 40 patients (32.5%) had a progression of over 10° in scoliosis. Multivariate analyses showed the risk factors for the progression of scoliosis to be hip displacement (p = 0.0038), the onset of scoliosis before the age of 6 years (p = 0.0024), and 30° of the Cobb angle before the age of 10 years (p < 0.001). A subtype of CP (spastic quadriplegia) was identified as a potential risk factor.
After the age of 20 years, 32.5% patients had a progression of over 10° in scoliosis. Risk factors for the progression of scoliosis in CP included hip displacement, early-onset scoliosis, and Cobb angle of 30° before the age of 10 years.
Prognostic level IV - case series.
脑瘫（CP）患者常出现脊柱侧弯，对日常生活造成困扰。本研究旨在调查脑瘫患者脊柱侧弯的自然病史，并通过多因素分析确定脊柱侧弯进展的危险因素。
我们回顾了113例患有脊柱侧弯且侧弯角度至少为10°的脑瘫患者（47例男性和66例女性），对这些脊柱侧弯病例进行回顾性调查，并分析该病症进展的危险因素。
平均随访期为16.5年，脊柱侧弯发病的平均年龄为6.6岁（范围：1至16岁）。59例患者（52%）脊柱侧弯发病年龄在6岁以下。在最后一次X光片上，平均Cobb角为55.1°（范围：10°至169°）。20岁以后，40例患者中有13例（32.5%）脊柱侧弯进展超过10°。多因素分析显示，脊柱侧弯进展的危险因素为髋关节移位（p = 0.0038）、6岁前出现脊柱侧弯（p = 0.0024）以及10岁前Cobb角为30°（p < 0.001）。一种脑瘫亚型（痉挛性四肢瘫）被确定为潜在危险因素。
20岁以后，32.5%的患者脊柱侧弯进展超过10°。脑瘫患者脊柱侧弯进展的危险因素包括髋关节移位、早发性脊柱侧弯以及10岁前Cobb角为30°。
预后IV级——病例系列。
