Department of Pediatric Orthopaedic Surgery, Children's Hospital Hamburg-Altona, Hamburg, Germany.
Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistr, 52, 20246, Hamburg, Germany.
BMC Musculoskelet Disord. 2019 Nov 20;20(1):554. doi: 10.1186/s12891-019-2938-9.
Serial casting is a treatment for early onset scoliosis (EOS) in young children to achieve curve correction before bracing or to postpone initial surgical treatment until the patient is older. Good results have been reported for patients with idiopathic early onset scoliosis (IS). However, there are few reports of results in non-idiopathic cases, and the benefits of non-surgical methods in the syndromic-associated early onset scoliosis subgroup are unknown.
Retrospective single-institution study of patient charts and X-rays of all cases of sustained serial casting for EOS. Staged correction was obtained by applying three consecutive casts under general anaesthesia. These were changed every 4 weeks, followed by the implementation of a custom-made full-time Chêneau brace. Correction was measured by Cobb angle (CA) and rib-vertebra angle difference (RVAD) on whole spine anterior-posterior radiographs. Statistical analysis was performed via ANOVA.
The study group consisted of 6 patiens with IS and 10 with non-idiopathic scoliosis (NIS) - exclusively syndromic-associated. The mean age at onset of treatment was 35 months (±15). The mean follow up was 21 months (±15). In IS patients average CA/RVAD before treatment was 46°(±8)/20°(±12). In NIS patients average CA/RVAD before treatment was 55°(±15)/24°(±14). After application of the third cast, the CA/RVAD was reduced to 20°(±11)/11°(±10) in IS patients. Whereas in NIS patients average CA/RVAD after the thrid cast was 28°(±12)/18°(±13). At latest follow-up the CA/RVAD was 16°(±7)/9°(±8) in IS patients and 31°(±11)/17° (±15) in NIS patients.
Syndromic etiology is not a contraindication for serial casting in EOS. Our results show a curve correction, measured in CA, of 65% in IS patients and 44% in NIS patients. Significant reduction in the morphologic deformity, measured in RVAD, was achieved in the IS cohort, but not in the NIS cohort. In all cases surgical treatment could be delayed.
序列矫形器固定术是一种治疗儿童早期特发性脊柱侧凸（EOS）的方法，旨在进行支具治疗或推迟初始手术治疗之前，使脊柱弯曲得到矫正。这种方法在特发性早发性脊柱侧凸（IS）患者中取得了良好的效果。然而，在非特发性病例中，其结果报告较少，且在综合征相关早发性脊柱侧凸亚组中，非手术方法的益处尚不清楚。
对所有接受持续序列矫形器固定术治疗的 EOS 患者的病历和 X 线片进行回顾性单中心研究。在全身麻醉下，通过连续应用三个矫形器来获得阶段性矫正。每 4 周更换一次矫形器，然后使用定制的全天佩戴的 Cheneau 支具。通过全脊柱前后位 X 线片测量 Cobb 角（CA）和肋骨-椎体角度差异（RVAD）来评估矫正效果。通过方差分析进行统计学分析。
该研究组包括 6 名特发性脊柱侧凸患者和 10 名非特发性脊柱侧凸患者（均为综合征相关）。治疗开始时的平均年龄为 35 个月（±15）。平均随访时间为 21 个月（±15）。在特发性脊柱侧凸患者中，治疗前的平均 CA/RVAD 为 46°（±8）/20°（±12）。在非特发性脊柱侧凸患者中，治疗前的平均 CA/RVAD 为 55°（±15）/24°（±14）。应用第三个矫形器后，特发性脊柱侧凸患者的 CA/RVAD 降低至 20°（±11）/11°（±10）。而非特发性脊柱侧凸患者应用第三个矫形器后的 CA/RVAD 为 28°（±12）/18°（±13）。在末次随访时，特发性脊柱侧凸患者的 CA/RVAD 为 16°（±7）/9°（±8），而非特发性脊柱侧凸患者的 CA/RVAD 为 31°（±11）/17°（±15）。
综合征病因并不是 EOS 患者接受序列矫形器固定术的禁忌症。我们的结果显示，特发性脊柱侧凸患者的 CA 测量的曲线矫正率为 65%，而非特发性脊柱侧凸患者为 44%。特发性脊柱侧凸患者的形态畸形 RVAD 显著降低，但非特发性脊柱侧凸患者未观察到 RVAD 降低。所有患者的手术治疗都可以推迟。
