Department of Orthopaedic Surgery, C.S. Mott Children's Hospital, Michigan Medicine, 1540 E. Hospital Dr., SPC 4241, Ann Arbor, MI, 48109-4241, USA.
Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
Spine Deform. 2021 Mar;9(2):595-602. doi: 10.1007/s43390-020-00213-2. Epub 2020 Sep 28.
Previous reports have demonstrated the effectiveness of casting for EOS. Brace treatment for EOS has not been studied. The purpose of this multicenter retrospective study was to compare radiographic outcomes, complications, and rates of conversion to surgery in children with EOS treated with casting or bracing.
Children aged 2-6 years with idiopathic or neuromuscular EOS treated with casting or bracing with minimum follow-up of 2 years were identified.
68 patients (36 cast, 32 brace) were analyzed. Diagnosis, age at start of treatment, and duration of follow-up were similar. Although the cast patients had a larger pre-treatment major curve magnitude (50° vs 31°, p < 0.001), both groups had a similar major curve magnitude at most recent follow-up (36° vs 32°, p = 0.456). T1-T12 and T1-S1 length increased in both groups. The cast and brace patients had similar complications and conversions to surgery. Sub-analysis showed that while casting resulted in curve improvement regardless of etiology, bracing was able to prevent curve progression in patients with idiopathic EOS but not in patients with non-idiopathic EOS (Δ- 15° vs 27°, p = 0.006). Regression analysis (significance p = 0.10) controlling for baseline age, major curve magnitude, and T1-T12 and T1-S1 length showed that treatment method was associated with difference in major curve magnitude (p = 0.090) and T1-T12 length (p = 0.024).
In our study, serial casting led to curve improvement in children with idiopathic and neuromuscular EOS, whereas brace treatment appeared to prevent curve progression in patients with idiopathic EOS but did not appear to control the curve in neuromuscular EOS.
先前的报告已经证明了铸造治疗 EOS 的有效性。尚未研究过 Brace 治疗 EOS。本多中心回顾性研究的目的是比较接受铸造或 Brace 治疗的 EOS 患儿的放射学结果、并发症和手术转化率。
确定了接受铸造或 Brace 治疗的特发性或神经肌肉性 EOS 患儿，随访时间至少为 2 年。
分析了 68 例患者（36 例接受铸造治疗，32 例接受 Brace 治疗）。诊断、治疗开始时的年龄和随访时间相似。尽管 Cast 组患者的初始主弯度数较大（50° vs 31°，p < 0.001），但两组在最近的随访中主弯度数相似（36° vs 32°，p = 0.456）。T1-T12 和 T1-S1 长度在两组中均增加。Cast 和 Brace 组患者的并发症和手术转化率相似。亚组分析显示，尽管铸造治疗无论病因如何都能改善曲线，但 Brace 治疗仅能预防特发性 EOS 患者的曲线进展，而不能预防非特发性 EOS 患者的曲线进展（Δ-15° vs 27°，p = 0.006）。回归分析（显著性 p = 0.10）控制基线年龄、主弯度数以及 T1-T12 和 T1-S1 长度，表明治疗方法与主弯度数（p = 0.090）和 T1-T12 长度（p = 0.024）的差异相关。
在我们的研究中，连续铸造治疗可改善特发性和神经肌肉性 EOS 患儿的曲线，而 Brace 治疗似乎可预防特发性 EOS 患者的曲线进展，但似乎不能控制神经肌肉性 EOS 患儿的曲线。
