Dept. Of Orthopaedic Surgery, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA.
Medical College of Wisconsin, Milwaukee, WI, USA.
Stud Health Technol Inform. 2021 Jun 28;280:155-160. doi: 10.3233/SHTI210457.
Early-onset scoliosis (EOS) can be a progressive and debilitating condition if left untreated. Different casting techniques have fallen in and out of favor over the years for conservative management. Two types of casting, elongation-derotation-flexion (EDF) and body casting (BC) are employed at our institution. Here we compare the radiographic outcomes between these two types of casting in a cohort of patients diagnosed with EOS. Sixteen children with EOS were treated by EDF serial casting while seventeen children with the same diagnosis were treated by BC. Radiographic measurements included Cobb angle, rib-vertebral-angle difference (RVAD) and vertebral rotation (VR) by Nash-Moe method in casting (IC) or out of casting (OOC), thoracic height (TH) and width (TW). All of the patients had x-ray measurements at pre-casting OOC, 1st IC and final post-casting OOC. Casts were changed every 2-4 months. Independent two sample t-test, Wilcoxon rank-sum test, and Chi-square test were performed. There were no significant differences at the initial treatment for age, classification of EOS, OOC, RVAD, VR, kyphosis, TH, and TW between EDF and BC casting. There were no significant differences of changes for OOC, RVAD, VR, kyphosis, TH and TW from pre-casting to the final post-casting status between two casting techniques (P>0.05). However, children with EDF tended to receive 3 to 4 more castings than those with BC (7.5 vs.4 casts) (P=0.007) and achieved better outcomes in success (25% vs.20%) and improvement (50% vs.10%) (P=0.03). EDF has better outcomes with EOS improvement when there is treatment of longer duration.
早发性脊柱侧凸（EOS）如果不治疗可能会逐渐恶化并导致身体残疾。多年来，不同的石膏固定技术在保守治疗中时兴时衰。我们机构采用两种类型的石膏固定，即伸长-旋转-弯曲（EDF）和体部石膏固定（BC）。在这里，我们比较了这两种类型的石膏固定在一组诊断为 EOS 的患者中的放射学结果。16 名 EOS 患儿采用 EDF 连续石膏固定治疗，17 名 EOS 患儿采用 BC 治疗。放射学测量包括 Cobb 角、肋骨-椎体角差（RVAD）和 Nash-Moe 法测量的椎体旋转（VR），在石膏固定（IC）或取出石膏（OOC）时进行，以及胸椎高度（TH）和宽度（TW）。所有患者在预固定 OOC、第 1 次 IC 和最终的 OOC 后都进行了 X 光测量。每 2-4 个月更换一次石膏。进行了独立两样本 t 检验、Wilcoxon 秩和检验和卡方检验。EDF 和 BC 组在初始治疗时的年龄、EOS 分类、OOC、RVAD、VR、后凸、TH 和 TW 均无显著差异。两种固定技术从预固定到最终的 OOC 后，OOC、RVAD、VR、后凸、TH 和 TW 的变化均无显著差异（P>0.05）。然而，EDF 组的患儿比 BC 组需要接受 3-4 次石膏固定（7.5 次 vs.4 次）（P=0.007），并且在成功率（25% vs.20%）和改善率（50% vs.10%）方面有更好的结果（P=0.03）。在 EOS 改善的治疗中，EDF 具有更好的效果，治疗时间更长。
