早期脊柱侧凸的矫正支具治疗的临床结果：延长至儿童上学期间的长期支具治疗的有效性。

Clinical Results of Corrective Cast and Brace Treatment for Early-onset Scoliosis: The Effectiveness of Long-term Cast Treatment That Extends into Children's Schooldays.

机构信息

Department of Orthopedic Surgery, Jichi Medical University.

Department of Pediatric Orthopedics, Jichi Children's Medical Center Tochigi, Shimotsuke, Tochigi, Japan.

出版信息

J Pediatr Orthop. 2021 Sep 1;41(8):e635-e640. doi: 10.1097/BPO.0000000000001888.

DOI:10.1097/BPO.0000000000001888

PMID:34183617

Abstract

BACKGROUND

Cast and brace treatment is a conservative treatment for early-onset scoliosis (EOS). We analyzed the clinical results of this treatment when extended into patients' schooldays.

METHODS

Twenty-two children with EOS underwent alternatively repetitive cast and brace treatment (ARCBT). Cast was applied under general anesthesia and remained for some weeks, and the brace was continuously worn, which was repeatedly applied when scoliosis progressed. The change in the major curve angle, requirement for surgical intervention, and complications of ARCBT were analyzed.

RESULTS

Six patients had idiopathic scoliosis (IS), 9 had syndromic scoliosis (SS), and 7 had neuromuscular scoliosis. Cast treatment started at 4.9±2.1 years of age, and the patients were followed up for 8.3 years. The average total number of cast applications was 5.5 per patient. The mean major scoliosis angle was 45.4±12.5 degrees at the first visit; this was corrected to 26.5±8.7 degrees at the first cast application and progressed to 75.4±22.1 degrees at the final visit. Nine patients whose scoliosis progressed finally underwent surgery. The mean age at surgery was 11.0 years (range, 8.8 to 13.1 y), and the mean period from first cast application to surgery was 6.1 years (range, 5.0 to 8.9 y). Four patients' IS rapidly progressed after 9 years of age, and all of them underwent final fusion surgery with a correction rate of 56.9%. Among patients with SS, 1 final fusion, and 2 growth-friendly surgeries were performed at a mean age of 9.2 years; the correction rate was 21.5%. Among patients with neuromuscular scoliosis, 2 final fusion surgeries were performed at a mean age of 11.3 years; the correction rate was 30.7%. The cast-related complication rate was 5.0%, and most complications were skin problems.

CONCLUSIONS

Long-term ARCBT extended into schooldays might be effective for IS. This should be considered as a time-saving treatment option for EOS.

LEVEL OF EVIDENCE

Level IV-case series.

摘要

背景

支具和石膏固定治疗是治疗早发性脊柱侧凸（EOS）的保守治疗方法。我们分析了将这种治疗方法扩展到患者上学期间的临床结果。

方法

22 例 EOS 患儿接受了交替重复支具和石膏固定治疗（ARCBT）。患儿在全身麻醉下进行石膏固定，持续数周，支具持续佩戴，当脊柱侧凸进展时反复应用。分析 ARCBT 的主要曲度角度变化、手术干预需求和并发症。

结果

6 例为特发性脊柱侧凸（IS），9 例为综合征型脊柱侧凸（SS），7 例为神经肌肉型脊柱侧凸。患儿的石膏治疗开始于 4.9±2.1 岁，平均随访 8.3 年。每位患儿平均应用 5.5 次石膏。初诊时的平均主弯角度为 45.4±12.5 度，首次石膏应用时矫正至 26.5±8.7 度，末次随访时进展至 75.4±22.1 度。9 例脊柱侧凸进展的患儿最终接受了手术。手术时的平均年龄为 11.0 岁（8.8~~13.1 岁），从首次石膏应用到手术的平均时间为 6.1 年（5.0~~8.9 岁）。4 例 IS 患儿在 9 岁后迅速进展，均行最终融合术，矫正率为 56.9%。SS 患儿中，1 例行最终融合术，2 例行生长棒手术，平均年龄为 9.2 岁，矫正率为 21.5%。神经肌肉型脊柱侧凸患儿中，2 例行最终融合术，平均年龄为 11.3 岁，矫正率为 30.7%。石膏相关并发症发生率为 5.0%，多数并发症为皮肤问题。