Division of Rehabilitation Services, Hospital for Sick Children, Toronto, ON, Canada.
Division of Orthopaedic Surgery, Hospital for Sick Children, Toronto, ON, Canada.
Spine Deform. 2021 Jan;9(1):75-84. doi: 10.1007/s43390-020-00182-6. Epub 2020 Aug 11.
Retrospective cross-sectional study.
To analyze the patient demographic referred for scoliosis to the Hospital for Sick Children to determine the proportion of patients suitable for brace treatment, as per the Scoliosis Research Society guidelines. There is level 1 evidence that bracing in adolescent idiopathic scoliosis (AIS) decreases the risk of curve progression and need for surgery, but optimal brace treatment requires early curve detection.
We performed a retrospective review of 618 consecutive patients who underwent initial assessment in our Spine Clinic between Jan. 1 and Dec. 31, 2014. We included children 10-18 years, with scoliosis greater than 10°, excluding those diagnosed with non-idiopathic curves. Primary outcomes were Cobb angle, menarchal status, and Risser score. We analyzed the effect of specific referral variables (family history, the person who first noticed the curve, and geographic location of residence) on presenting curve magnitude.
During the study period, 335 children met the inclusion criteria, with an average age of 14.1 ± 1.8 years and a mean Cobb angle of 36.8 ± 14.5°. Brace treatment was indicated in 17% of patients; 18% had curves beyond optimal curve range for bracing (> 40°), and 55% were skeletally mature, therefore not brace candidates. The majority of curves (54%) were first detected by the patient or family member and averaged 7° more than curves first detected by a physician. A family history of scoliosis made no difference to curve magnitude, nor did geographic location of residence.
The majority of AIS patients present too late for effective management with bracing.
III.
回顾性横断面研究。
分析因脊柱侧弯到 SickKids 儿童医院就诊的患者人口统计学资料，以确定符合 Scoliosis Research Society 指南的适合支具治疗的患者比例。有 1 级证据表明，在青少年特发性脊柱侧弯（AIS）中使用支具可降低曲线进展和手术需求的风险，但最佳支具治疗需要早期发现曲线。
我们对 2014 年 1 月 1 日至 12 月 31 日期间在我们的脊柱诊所接受初次评估的 618 例连续患者进行了回顾性审查。我们纳入了 10-18 岁、脊柱侧弯大于 10°的儿童，但不包括诊断为非特发性曲线的患者。主要结局是 Cobb 角、初潮状态和 Risser 评分。我们分析了特定转诊变量（家族史、首次发现曲线的人以及居住地的地理位置）对表现出的曲线幅度的影响。
在研究期间，335 名儿童符合纳入标准，平均年龄为 14.1±1.8 岁，平均 Cobb 角为 36.8±14.5°。17%的患者需要支具治疗；18%的患者曲线超过支具最佳治疗范围（>40°），55%的患者骨骼成熟，因此不适合支具治疗。大多数曲线（54%）是由患者或家庭成员首次发现的，比医生首次发现的曲线平均大 7°。脊柱侧弯家族史对曲线幅度没有影响，居住地的地理位置也没有影响。
大多数 AIS 患者就诊时已经太晚，无法有效管理支具治疗。
III。
