Zaina Fabio, Cordani Claudio, Donzelli Sabrina, Lazzarini Stefano Giuseppe, Arienti Chiara, Del Furia Matteo Johann, Negrini Stefano
ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy.
IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy.
Children (Basel). 2022 Oct 31;9(11):1672. doi: 10.3390/children9111672.
There is a common agreement that bracing is appropriate for curves between 20 and 40° for the Cobb angle during growth, but for larger curves, the experts' opinions are not consistent. We designed this systematic review to report the updated evidence about the effectiveness of bracing in scoliosis patients with curves ≥40° and a residual growth period. We included randomized controlled trials, non-randomized controlled trials, prospective and retrospective observational studies, and case series addressing the effect of bracing in patients with idiopathic scoliosis during growth with curves ≥40° for the Cobb angle, published from 2000 onwards. Outcome: The percentage of patients with surgery, curves above 45° or 50°, and a Cobb angle change are all included in the study. Nine papers (563 patients, average worst curve of 44.8°) are included: four are retrospective case series, two are retrospective and two are prospective cohort studies, and one is a prospective controlled study. The overall quality was good, with respect to the type of design. A total of 32% of the patients improved, 26% were stable, and 42% worsened. The rate of improvement ranged from 11% to 78%; the rate of worsening ranged from 4% to 64%. There are some studies suggesting the use of bracing even in the case of severe curves when patients are motivated by trying to avoid surgery. More and better-quality research with coherent outcome criteria is needed.
人们普遍认为，在生长期间，对于Cobb角在20°至40°之间的脊柱侧弯，支具治疗是合适的，但对于较大的侧弯，专家们的意见并不一致。我们设计了这项系统评价，以报告有关支具治疗对Cobb角≥40°且有残余生长发育期的脊柱侧弯患者有效性的最新证据。我们纳入了随机对照试验、非随机对照试验、前瞻性和回顾性观察性研究以及病例系列，这些研究涉及2000年以后发表的关于支具治疗对生长期间Cobb角≥40°的特发性脊柱侧弯患者的影响。结果：研究包括接受手术的患者百分比、45°或50°以上的侧弯以及Cobb角变化。纳入了9篇论文（563例患者，平均最严重侧弯为44.8°）：4篇为回顾性病例系列，2篇为回顾性研究，2篇为前瞻性队列研究，1篇为前瞻性对照研究。就设计类型而言，总体质量良好。共有32%的患者病情改善，26%稳定，42%恶化。改善率在11%至78%之间；恶化率在4%至64%之间。有一些研究表明，即使在严重侧弯的情况下，如果患者出于避免手术的意愿，也可使用支具治疗。需要开展更多具有连贯结果标准的高质量研究。
