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一大群接受保守治疗结束的特发性脊柱侧弯青少年中,支具治疗获得具有临床意义结果的预测因素。

Predictors of Clinically Meaningful Results of Bracing in a Large Cohort of Adolescents with Idiopathic Scoliosis Reaching the End of Conservative Treatment.

作者信息

Donzelli Sabrina, Fregna Giulia, Zaina Fabio, Livetti Giulia, Reitano Maria Chiara, Negrini Stefano

机构信息

ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy.

Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, 44121 Ferrara, Italy.

出版信息

Children (Basel). 2023 Apr 13;10(4):719. doi: 10.3390/children10040719.

Abstract

BACKGROUND

We need good outcome predictors to maximize the treatment efficiency of adolescents with idiopathic scoliosis (AIS). The in-brace correction has shown an important predictive effect on brace failure, while the influence of other variables is still debated. We aimed to identify new outcome predictors from a big prospective database of AIS.

METHODS

Design: Retrospective analysis of prospectively collected data.

INCLUSION CRITERIA

AIS between 21 and 45°, Risser 0-2, brace prescription during the observation, treatment conclusion. All of the participants followed a personalized conservative approach according to the SOSORT Guidelines.

OUTCOMES

End of growth below 30°-40°-50°. The regression model included age, BMI, Cobb angle, ATR, TRACE score, real brace wear (RBW), and in-brace correction (IBC).

RESULTS

A total of 1050 patients, 84% females, ages 12.1 ± 1.1, 28.2 ± 7.9° Cobb. IBC increased by 30%, 24%, and 23% the odds of ending treatment below 30°, 40°, and 50°, respectively. The OR did not change after the covariate adjustment. Cobb angle and ATR at the start also showed a predictive effect.

CONCLUSIONS

The systematic evaluation of IBC in clinics is useful for individuating the patient response to brace treatment more accurately, even in relation to the Cobb angle and ATR degrees at the start. Further studies are needed to increase the knowledge on predictors of AIS treatment results.

摘要

背景

我们需要良好的预后预测指标,以最大限度地提高青少年特发性脊柱侧凸(AIS)的治疗效率。支具内矫正已显示出对支具治疗失败具有重要的预测作用,而其他变量的影响仍存在争议。我们旨在从一个大型的AIS前瞻性数据库中识别新的预后预测指标。

方法

设计:对前瞻性收集的数据进行回顾性分析。

纳入标准

21至45°的AIS,Risser 0 - 2,观察期间开具支具处方,治疗结束。所有参与者均遵循SOSORT指南采用个性化保守治疗方法。

结果

生长结束时角度低于30° - 40° - 50°。回归模型包括年龄、体重指数、Cobb角、ATR、TRACE评分、实际支具佩戴时间(RBW)和支具内矫正(IBC)。

结果

共1050例患者,84%为女性,年龄12.1±1.1岁,Cobb角28.2±7.9°。IBC分别使治疗结束时角度低于30°、40°和50°的几率增加30%、24%和二十三岁。协变量调整后,OR未改变。起始时的Cobb角和ATR也显示出预测作用。

结论

在临床中对IBC进行系统评估有助于更准确地确定患者对支具治疗的反应,即使与起始时的Cobb角和ATR度数相关。需要进一步研究以增加对AIS治疗结果预测指标的认识。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1bf/10136690/292e3a34b19b/children-10-00719-g001.jpg

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