Welborn Michelle Cameron, D'Astous Jacques, Bratton Susan, Heflin John
Department of Orthopaedic Surgery, Shriner's Hospital for Children Portland, 3101 SW Sam Jackson Park Road, Portland OR 97239, USA.
Department of Orthopaedic Surgery, Shriner's Hospital for Children Salt Lake City, Fairfax Road & Virginia Street, Salt Lake City, UT 84103, USA.
Spine Deform. 2018 Sep-Oct;6(5):614-620. doi: 10.1016/j.jspd.2018.01.007.
IRB-approved retrospective single cohort study.
To review our ten-year history with EDF (Elongation Derotation Flexion) casting in patients with infantile idiopathic scoliosis (IIS) to better understand which factors predict successful outcomes.
Numerous studies have demonstrated the efficacy of EDF casting in the treatment of progressive infantile idiopathic scoliosis. But none have reproduced the success of Mehta's even with early intervention.
Patients with IIS treated with EDF casting with a minimum 24-month follow-up were included. Radiographs and clinical records were reviewed. Age, sex, and curve type were documented. Precast, traction, in cast, in brace, and final Cobb angles were measured and recorded. Outcomes were defined by Cobb angle at final follow-up out of cast or brace. Patients were considered cured if the final Cobb angle was <10°, palliated at 10°-45°, and failed if they required surgical treatment.
Sixty-three patients with IIS were reviewed. Thirty-two were excluded for incomplete records or insufficient follow-up, leaving 31 patients. No patients progressed to surgical intervention during the study. Patients with a Cobb angle >10° in the final cast were 7.3 times more likely to fall into the palliative range at the most recent follow-up than if their Cobb angle was 10° or less even when adjusted for age. Earlier age at onset of casting (14.9 vs. 21.1 months) was not statistically significant (p=.073). Magnitude of initial curvature, flexibility, initial correction, sex, and curve type were also not found to be significant.
EDF casting is a valid treatment option for IIS with a high cure rate. Major Cobb angle at the end of casting is most predictive of outcome. Cobb angles >10° at the end of casting had a 7.3 times greater risk of falling into the palliated category versus Cobb angles less than or equal to 10° even when adjusted for age. Initial curve magnitude, curve flexibility, sex, and curve type were not predictive.
Level IV.
经机构审查委员会批准的回顾性单队列研究。
回顾我们对婴儿特发性脊柱侧凸（IIS）患者采用EDF（伸展 - 旋转 - 屈曲）支具治疗的十年历史，以更好地了解哪些因素可预测成功的治疗结果。
众多研究已证实EDF支具在治疗进展性婴儿特发性脊柱侧凸方面的有效性。但即便进行早期干预，也没有研究能重现Mehta治疗方法的成功效果。
纳入接受EDF支具治疗且随访至少24个月的IIS患者。回顾X光片和临床记录。记录年龄、性别和侧弯类型。测量并记录支具治疗前、牵引、佩戴支具期间、佩戴矫形器期间以及最后的Cobb角。结局根据去除支具或矫形器后的最终随访时的Cobb角来定义。如果最终Cobb角<10°，则认为患者治愈；10° - 45°为病情缓解；如果需要手术治疗，则认为治疗失败。
对63例IIS患者进行了回顾。32例因记录不完整或随访不足被排除，最终纳入31例患者。研究期间没有患者进展到需要手术干预。即使在对年龄进行校正后，最终支具治疗时Cobb角>10°的患者在最近一次随访时进入病情缓解范围的可能性比Cobb角为10°或更小的患者高7.3倍。开始支具治疗的年龄较早（14.9个月对21.1个月）无统计学意义（p = 0.073）。初始弯曲程度、柔韧性、初始矫正、性别和侧弯类型也未发现具有统计学意义。
EDF支具是一种治疗IIS的有效方法，治愈率高。支具治疗结束时的主要Cobb角最能预测治疗结果。即使在对年龄进行校正后，支具治疗结束时Cobb角>10°的患者进入病情缓解类别的风险比Cobb角小于或等于10°的患者高7.3倍。初始弯曲程度、弯曲柔韧性、性别和侧弯类型无法预测治疗结果。
四级。
