The Children's Hospital of Philadelphia, Philadelphia, PA.
J Pediatr Orthop. 2021 Oct 1;41(9):543-548. doi: 10.1097/BPO.0000000000001929.
Hand radiographs for skeletal maturity staging are now frequently used to evaluate remaining growth potential for patients with adolescent idiopathic scoliosis (AIS). Our objective was to create a model predicting a patient's risk of curve progression based on modern treatment standards.
We retrospectively reviewed all AIS patients presenting with a major curve <50 degrees, available hand radiographs, and complete follow up through skeletal maturity at our institution over a 3-year period. Patients with growth remaining underwent rigid bracing of curves >25 degrees, whereas patients between 10 and 25 degrees were observed. Treatment success was defined as reaching skeletal maturity with a major curve <50 degrees. Four risk categories were identified based on likelihood of curve progression.
Of 609 AIS patients (75.4% female) presenting with curves over 10 degrees and reaching skeletal maturity at most recent follow up, 503 (82.6%) had major thoracic curves. 16.3% (82/503) of thoracic curves progressed into surgical treatment range. The highest risk group (Sanders 1 to 6 and curve 40 to 49 degrees, Sanders 1 to 2 and curve 30 to 39) demonstrate a 30% success rate with nonoperative treatment. This constitutes an 111.1 times (95% confidence interval: 47.6 to 250.0, P<0.001) higher risk of progression to surgical range than patients in the lowest risk categories (Sanders 1 to 8 and curve 10 to 19 degrees, Sanders 3 to 8 and curve 20 to 29 degrees, Sanders 5 to 8 and curve 30 to 39 degrees).
Skeletal maturity and curve magnitude have strong predictive value for future curve progression. The results presented here represent a valuable resource for orthopaedic providers regarding a patient's risk of progression and ultimate surgical risk.
Level III-retrospective cohort study.
手部 X 光片常用于评估青少年特发性脊柱侧凸（AIS）患者的骨骼成熟度和剩余生长潜力。我们的目标是根据现代治疗标准，建立一个预测患者曲线进展风险的模型。
我们回顾性分析了在我们机构就诊的 3 年内，所有存在主弯<50°、可获得手部 X 光片且骨骼成熟度完整的 AIS 患者。有生长潜力的患者接受了>25°的支具固定，而 10°至 25°之间的患者则接受观察。治疗成功定义为在骨骼成熟时，主弯<50°。根据曲线进展的可能性，我们确定了四个风险类别。
在 609 名存在>10°的 AIS 患者中（75.4%为女性），有 503 名（82.6%）患者的主胸弯到达最近随访时的骨骼成熟度。82/503（16.3%）例胸弯进展至手术治疗范围。风险最高的组（Sanders 1 至 6 级，弯曲度 40 至 49°；Sanders 1 至 2 级，弯曲度 30 至 39°）采用非手术治疗的成功率为 30%。与风险最低的组（Sanders 1 至 8 级，弯曲度 10 至 19°；Sanders 3 至 8 级，弯曲度 20 至 29°；Sanders 5 至 8 级，弯曲度 30 至 39°）相比，进展到手术范围的风险高 111.1 倍（95%置信区间：47.6 至 250.0，P<0.001）。
骨骼成熟度和弯曲程度对未来的曲线进展具有很强的预测价值。这里的结果为骨科医生提供了一个有价值的资源，了解患者的进展风险和最终手术风险。
III 级-回顾性队列研究。
