Department of Orthopaedics, Yongchuan Hospital of Chongqing Medical University, 439# Xuanhua Road, Yongchuan District, Chongqing, 402160, China.
Department of Health Services, Fourth Military Medical University, 169# Changle Western Rd., Xi'an, 710032, Shaanxi Province, China.
Eur Spine J. 2020 Dec;29(12):3123-3134. doi: 10.1007/s00586-020-06573-7. Epub 2020 Aug 27.
The study aimed for unraveling the long-term health impact of cumulative radiation exposure from full-spine radiographs on children/adolescents with scoliosis.
All cohort, case-control or cross-sectional studies about radiation exposure to scoliosis patients with follow-up period as 20 years or more were included. Meta-analyses were performed for outcomes reported in two or more studies.
A total of 9 eligible studies involving 35,641 participants between 1912 and 1990 fulfilled the inclusion criteria, including 18,873 patients with scoliosis and 16,768 controls as regional matched general population. The average number of full-spine radiographs was 23.13 (range: 0-618) according to 14,512 patients between 1912 and 1990 in five studies. The estimated mean cumulated radiation dose of breast was 11.35 cGy. In comparison with controls, pooled incidence rates of cancer, breast cancer and cancer mortality of patients with scoliosis were statistically significant higher [rate of cancer, odds risk (OR) = 1.46, p < 0.00001; breast cancer, OR = 1.20, p = 0.02; cancer mortality, OR = 1.50, p < 0.00001]. No statistically significant differences were found in terms of reproductive events for scoliosis patients, pulmonary function and physical activity for adolescent idiopathic scoliosis patients.
Based on 35,641 participants with over 20 years' observations from 1912 to 1990, repeated radiographs and pertaining cumulative radiation dose resulted in elevated rates of cancer, breast cancer and cancer mortality for children/adolescents with scoliosis in comparison with matched general population. It is recommended that low-radiation or radiation-free and efficient methods should be used to monitor the evolution of children/adolescents with scoliosis.
本研究旨在揭示全脊柱 X 射线摄影术对脊柱侧弯患儿/青少年累积辐射暴露的长期健康影响。
纳入所有关于脊柱侧弯患者接受 X 射线照射且随访时间超过 20 年的队列研究、病例对照研究或横断面研究。对 2 项或以上研究报告的结果进行荟萃分析。
共有 9 项符合纳入标准的研究，共纳入 1912 年至 1990 年期间的 35641 名参与者，包括 18873 例脊柱侧弯患者和 16768 例作为区域性匹配的一般人群对照。根据 5 项研究中 1912 年至 1990 年期间的 14512 例患者的数据，全脊柱 X 射线摄片的平均次数为 23.13（范围：0-618）。估计乳房的累积平均辐射剂量为 11.35cGy。与对照组相比，脊柱侧弯患者的癌症、乳腺癌和癌症死亡率的合并发病率有统计学意义上的升高[癌症，比值比（OR）=1.46，p<0.00001；乳腺癌，OR=1.20，p=0.02；癌症死亡率，OR=1.50，p<0.00001]。脊柱侧弯患者的生殖事件、青少年特发性脊柱侧弯患者的肺功能和体力活动方面无统计学差异。
基于 1912 年至 1990 年期间 35641 名参与者超过 20 年的观察结果，与匹配的一般人群相比，重复 X 射线摄片和相应的累积辐射剂量导致脊柱侧弯患儿/青少年的癌症、乳腺癌和癌症死亡率升高。建议使用低辐射或无辐射且高效的方法来监测脊柱侧弯患儿/青少年的病情演变。
