Shriners Hospitals for Children Salt Lake City, Salt Lake City, Utah.
University of Utah, Salt Lake City, Utah.
J Bone Joint Surg Am. 2019 Sep 4;101(17):1530-1538. doi: 10.2106/JBJS.18.01268.
With the exception of Mehta's 2005 report on her experience treating early-onset scoliosis with serial casting, all subsequent studies have had limited follow-up. This current study sought to assess the results of serial casting at a minimum 5-year follow-up and to identify the predictors of the sustained resolution of scoliosis.
This study is a retrospective review of children treated for idiopathic early-onset scoliosis with serial casting at a children's hospital between 2001 and 2013 with a minimum 5-year follow-up. A Cobb angle of ≤15° and a decrease in the Cobb angle of >20° at the most recent follow-up were separately assessed. The differences between groups based on these criteria were tested with Student t tests with alpha = 0.05.
Fifty-four children were treated during the study period; of these, 38 had at least 5 years of follow-up and comprised the study sample. The mean follow-up (and standard deviation) was 8 ± 2 years (range, 5 to 13 years). The mean patient age at the time of the first cast was 24 ± 15.1 months (range, 9 to 63 months), with a mean Cobb angle of 56.2° ± 20.1° (range, 22° to 109°). Forty-nine percent of children had scoliosis of ≤15° at the time of the most recent follow-up, and 73% of children were improved by at least 20°. Children with ≤15° scoliosis, compared with children with >15° scoliosis, had significantly lower initial Cobb angle (48.2° compared with 63.7°; p = 0.016), supine traction Cobb angle (22.5° compared with 33.2°; p = 0.048), first-in-cast Cobb angle (24.1° compared with 37.6°; p = 0.01), and first-in-cast rib-vertebral angle difference (12.8° compared with 26.2°; p < 0.01). Age at the time of the first cast, initial rib-vertebral angle difference, flexibility, and body mass index were not significantly different (p > 0.05) between the groups. Three children who initially achieved scoliosis of ≤15° after casting substantially relapsed.
At a minimum follow-up of 5 years, the initial Cobb angle, first-cast Cobb angle, rib-vertebral angle difference, and traction Cobb angle were all predictive of sustained scoliosis of ≤15°. However, with continued growth, relapse of scoliosis was seen in 3 patients.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
除了 Mehta 于 2005 年报告的她使用连续矫形器治疗早发性脊柱侧凸的经验外，所有后续研究的随访时间都有限。本研究旨在评估至少 5 年随访时连续矫形器治疗的结果，并确定脊柱侧凸持续缓解的预测因素。
这是一项回顾性研究，对 2001 年至 2013 年期间在一家儿童医院接受连续矫形器治疗的特发性早发性脊柱侧凸儿童进行了研究，随访时间至少为 5 年。分别评估最近随访时 Cobb 角≤15°和 Cobb 角下降>20°的情况。基于这些标准的组间差异用α=0.05 的学生 t 检验进行检验。
研究期间共 54 名儿童接受治疗，其中 38 名至少有 5 年随访，为研究样本。平均随访（标准差）为 8±2 年（范围 5 至 13 年）。第一次佩戴矫形器时患者的平均年龄为 24±15.1 个月（范围 9 至 63 个月），平均 Cobb 角为 56.2°±20.1°（范围 22°至 109°）。49%的儿童在最近一次随访时 Cobb 角≤15°，73%的儿童改善至少 20°。与 Cobb 角>15°的儿童相比，Cobb 角≤15°的儿童初始 Cobb 角显著更低（48.2°比 63.7°；p=0.016）、仰卧位牵引 Cobb 角（22.5°比 33.2°；p=0.048）、第一次佩戴矫形器时的 Cobb 角（24.1°比 37.6°；p=0.01）和第一次佩戴矫形器时的肋骨-椎体角度差（12.8°比 26.2°；p<0.01）。两组之间的首次佩戴矫形器的年龄、初始肋骨-椎体角度差、柔韧性和体重指数无显著差异（p>0.05）。3 名最初 Cobb 角矫正为≤15°的儿童明显复发。
至少 5 年的随访表明，初始 Cobb 角、第一次佩戴矫形器时的 Cobb 角、肋骨-椎体角度差和牵引 Cobb 角都可预测持续的≤15°脊柱侧凸。然而，随着生长的继续，有 3 名患者的脊柱侧凸复发。
治疗性 IV 级。有关证据水平的完整描述，请参见作者说明。
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