这不仅仅关乎额状面：矢状面参数会影响接受支具治疗的青少年特发性脊柱侧弯（AIS）患者的侧弯进展。
It is not just about the frontal plane: sagittal parameters impact curve progression in AIS patients undergoing brace treatment.
作者信息
Matsumoto Hiroko, Warren Shay, Simhon Matthew E, Konigsberg Matthew W, Fields Michael W, Roye Benjamin D, Roye David P, Vitale Michael G
机构信息
Department of Pediatric Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA.
Department of Pediatric Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, ATTN: Hiroko Matsumoto, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA.
出版信息
Spine Deform. 2020 Oct;8(5):921-929. doi: 10.1007/s43390-020-00122-4. Epub 2020 Apr 27.
STUDY DESIGN
Retrospective cohort study.
OBJECTIVES
The purpose of this study was to explore the association between pre-brace and in-brace sagittal parameters and curve progression. To date, there has been no published research focused on spinopelvic sagittal parameters and bracing outcomes in AIS. We hypothesize that sagittal spinopelvic parameters are associated with curve progression at 2 years.
METHODS
This study included AIS patients with a pre-brace (PB) major curve between 20° and 45°. The outcome was defined as > 10° curve progression or surgery within 2 years of brace initiation. Spinopelvic parameters included C7-Central Sacral Vertebral Line shift (C7-CSVL), thoracic trunk shift, lumbar lordosis (LL), pelvic incidence (PI), T2-T12 thoracic kyphosis (TK) pelvic incidence-lumbar lordosis (PI-LL) mismatch, sagittal vertical axis (SVA), and pelvic tilt (PT).
RESULTS
Of 50 patients included in this review, [70% Rigo (RCSO) and 30% Boston (BSO)], 16 (32%) patients demonstrated progression (23% of patients with RCSO vs 53% with BSO; p = 0.034). In patients with more than 30% major coronal curve correction (CCC), 23% had progression. 45% of patients progressed when they achieved ≤ 30% correction (p = 0.108). Among PB sagittal parameters and adjusting for coronal curve, patients with an abnormal PB SVA had 3.1 times increased risk of treatment failure compared with patients who had a normal PB SVA. Patients with PB hypo-LL had a 2.8 times increased risk of treatment failure compared with patients who had normal or hyper-LL. Among IB sagittal parameters, patients who had a normal PB PI-LL had a 3.9 times increased risk of treatment failure when they became mismatched in-brace (IB). Patients who had normal pre-brace kyphosis who became hypo-kyphotic IB had an 8.4 times increased risk of treatment failure compared with patients who maintained normal TK or became hyper-kyphotic.
CONCLUSION
These data suggest that we should pay careful attention to sagittal parameters prior to and during brace treatment as braces can control these parameters.
LEVEL OF EVIDENCE
Level III.
研究设计
回顾性队列研究。
目的
本研究旨在探讨支具治疗前和支具治疗期间矢状面参数与侧弯进展之间的关联。迄今为止，尚无已发表的研究聚焦于青少年特发性脊柱侧弯（AIS）的脊柱骨盆矢状面参数和支具治疗效果。我们假设矢状面脊柱骨盆参数与2年时的侧弯进展相关。
方法
本研究纳入了支具治疗前（PB）主弯在20°至45°之间的AIS患者。结局定义为支具治疗开始后2年内侧弯进展>10°或接受手术。脊柱骨盆参数包括C7 - 骶骨中心垂直线偏移（C7 - CSVL）、胸段躯干偏移、腰椎前凸（LL）、骨盆入射角（PI）、T2 - T12胸段后凸（TK）、骨盆入射角 - 腰椎前凸（PI - LL）不匹配、矢状垂直轴（SVA）和骨盆倾斜度（PT）。
结果
本综述纳入的50例患者中，[70%使用里戈支具（RCSO），30%使用波士顿支具（BSO）]，16例（32%）患者出现进展（RCSO支具患者中23%，BSO支具患者中53%；p = 0.034）。在主冠状面侧弯矫正（CCC）超过30%的患者中，23%出现进展。当矫正≤30%时，45%的患者出现进展（p = 0.108）。在PB矢状面参数并校正冠状面侧弯后，PB SVA异常的患者治疗失败风险比PB SVA正常的患者增加3.1倍。PB低LL的患者治疗失败风险比LL正常或高LL的患者增加2.8倍。在支具治疗期间（IB）矢状面参数方面，PB时PI - LL正常的患者在支具治疗期间（IB）出现不匹配时治疗失败风险增加3.9倍。支具治疗前后凸正常但在支具治疗期间变为低后凸的患者治疗失败风险比维持正常TK或变为高后凸的患者增加8.4倍。
结论
这些数据表明，在支具治疗前和治疗期间我们应密切关注矢状面参数，因为支具可以控制这些参数。
证据级别
三级。
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