Henstenburg Jeffrey, Heard Jeremy, Sturm Peter, Blakemore Laurel, Li Ying, Ihnow Stephanie B, Shah Suken A
Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH.
J Pediatr Orthop. 2023 Mar 1;43(3):151-155. doi: 10.1097/BPO.0000000000002347. Epub 2023 Jan 9.
Serial casting is favored for the initial treatment of early onset scoliosis (EOS), but there is concern about significant morbidity and caregiver burden. Studies have examined the utility of bracing as an alternative to casting, but little is known about differences in health-related quality of life (HRQoL) between treatments. We hypothesized that patients with a diagnosis of idiopathic EOS experience an improvement in HRQoL when transitioning from serial casting to bracing as measured by the 24-Item Early Onset Scoliosis Questionnaire (EOSQ).
Subjects with idiopathic EOS were retrospectively identified from a multicenter database. EOSQ scores were compared before treatment, after index casting, after transition out of cast to brace, and at the most recent follow-up. Available major curve magnitudes were also compared during these time points. Data were compared using repeated-measures ANOVA with post hoc Bonferroni correction.
Sixty-six subjects met the inclusion criteria. Thirty-seven (56%) subjects were male and the average age at the time of index treatment was 1.9 (0.37-6.4) years. The average follow-up was 3.2 (0.90-6.8) years. In 57 subjects, the major curve magnitude improved from a mean of 33 (CI 28-37) degrees before treatment initiation to 27 (CI 23-30) degrees after casting and to 24 (CI 20-29) degrees at the most recent follow-up. The HRQoL subdomain showed a significant decrease in HRQoL during casting treatment 75.7 (CI 72.9-78.5) from pre-index treatment 84.9 (CI 81.4-88.5), during brace treatment 84.8 (CI 81.8-88.0) and at most recent follow-up 87.0 (CI 83.6-90.3) ( P <0.001). The parental impact subdomain improved from the beginning to the end of treatment (77.7 to 87.7, P =0.001) (n=64). Satisfaction improved from casting to bracing (73.4 to 86.7, P <0.001) (n=63) and to the most recent follow-up (73.4 to 87.9, P <0.001).
Patients treated with casting for EOS experience reversible declines in HRQoL. After patients transition from casting to bracing, EOSQ scores recover to pretreatment baseline levels and are maintained at follow-up. This information must be balanced with the effectiveness of treatment for EOS with either method and customized for each patient.
Level III-retrospective comparative study.
连续石膏矫形是早发性脊柱侧弯（EOS）初始治疗的常用方法，但人们担心其会带来较高的发病率和护理负担。已有研究探讨了支具作为石膏矫形替代方法的效用，但对于两种治疗方法在健康相关生活质量（HRQoL）方面的差异了解甚少。我们假设，根据24项早发性脊柱侧弯问卷（EOSQ）测量，诊断为特发性EOS的患者从连续石膏矫形过渡到支具治疗后，HRQoL会有所改善。
从多中心数据库中回顾性识别出患有特发性EOS的受试者。比较治疗前、初次石膏矫形后、从石膏矫形过渡到支具治疗后以及最近一次随访时的EOSQ评分。同时比较这些时间点的主弯角度。采用重复测量方差分析及事后Bonferroni校正进行数据比较。
66名受试者符合纳入标准。37名（56%）受试者为男性，初次治疗时的平均年龄为1.9（0.37 - 6.4）岁。平均随访时间为3.2（0.90 - 6.8）年。在57名受试者中，主弯角度从治疗开始前的平均33（可信区间28 - 37）度改善至石膏矫形后的27（可信区间23 - 30）度以及最近一次随访时的24（可信区间20 - 29）度。HRQoL子领域显示，在石膏矫形治疗期间HRQoL显著下降，从指数治疗前的84.9（可信区间81.4 - 88.5）降至75.7（可信区间72.9 - 78.5），在支具治疗期间为84.8（可信区间81.8 - 88.0），在最近一次随访时为87.0（可信区间83.6 - 90.3）（P <0.001）。家长影响子领域从治疗开始到结束有所改善（77.7至87.7，P =0.001）（n = 64）。满意度从石膏矫形到支具治疗有所提高（73.4至86.7，P <0.001）（n = 63），到最近一次随访时进一步提高（73.4至87.9，P <0.001）。
接受石膏矫形治疗的EOS患者的HRQoL出现可逆性下降。患者从石膏矫形过渡到支具治疗后，EOSQ评分恢复到治疗前基线水平，并在随访时保持稳定。这一信息必须与两种方法治疗EOS的有效性相权衡，并为每位患者量身定制。
III级——回顾性比较研究。
