From the Division of Orthopaedic Surgery and Sports Medicine, Children's National Hospital, Washington, DC (Oetgen, Kelly), and the Orthopaedic Surgery Department, George Washington University Hospital, Washington, DC (Heyer).
J Am Acad Orthop Surg. 2021 May 1;29(9):370-379. doi: 10.5435/JAAOS-D-20-00356.
The national recommendations for school screening programs for scoliosis in the United States have undergone a shift in perspective over the past two decades. In 2004, the United States Preventive Services Task Force recommended against screening programs but changed its recommendation to be inconclusive in 2018. Early diagnosis of scoliosis can allow for close monitoring of the deformity and early initiation of bracing treatment when appropriate, with the goal of preventing costly and invasive surgical intervention. Several different diagnostic tools are available, including Adam's forward bending test alone, Adam's forward bending test with scoliometry, the humpometer, and Moiré topography, each with varying degrees of sensitivity and specificity. Controversy prevails over the cost efficacy of screening programs and possible unnecessary exposure of adolescents to radiation for confirmatory radiographs after a positive screening test. However, the recent definitive evidence of bracing treatment efficacy in slowing the progression of scoliotic curves and preventing the need for surgery indicates that school screening programs may still have a role in allowing early diagnosis.
过去二十年来，美国全国范围内针对脊柱侧凸的学校筛查项目的建议已经发生了转变。2004 年，美国预防服务工作组建议反对筛查项目，但在 2018 年将其建议改为不确定。早期诊断脊柱侧凸可以密切监测畸形，并在适当的时候早期开始支具治疗，以预防昂贵和侵入性的手术干预。有几种不同的诊断工具，包括单独的亚当前屈试验、带脊柱测角计的亚当前屈试验、驼峰计和云纹地形测量仪，每种方法的敏感性和特异性都不同。对于筛查项目的成本效益以及在阳性筛查测试后为确认性射线照相术可能对青少年进行不必要的辐射暴露，存在争议。然而，最近关于支具治疗在减缓脊柱侧凸曲线进展和预防手术需求方面的疗效的明确证据表明，学校筛查项目可能仍然在早期诊断中发挥作用。
