Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
J Pediatr Orthop. 2023 Sep 1;43(8):475-480. doi: 10.1097/BPO.0000000000002457. Epub 2023 Jun 26.
Early conservative treatment for patients with idiopathic infantile scoliosis (IIS) with elongation derotation flexion (EDF) casting and subsequent serial bracing has become widely utilized. However, the long-term outcomes of patients treated with EDF casting are limited.
We performed a retrospective chart review of all patients who had undergone serial elongation derotation flexion casting and subsequent bracing for scoliosis presenting at a single large tertiary center. All patients were followed for a minimum of 5 years or until surgical intervention.
Our study included 21 patients diagnosed with IIS and treated with EDF casting. At a mean 7-year follow-up, 13 of the 21 patients were considered successfully treated with a mean final major coronal curvature of 9 degrees compared to a pretreatment coronal curve of 36 degrees. These patients, on average, began casting at 1.3 years old and spent 1 year in a cast. Patients that did not have substantial improvement began casting at mean 4 years old and remained in a cast for 0.8 years. Three patients initially had substantial improvement with the correction to <20 degrees at a mean age of 7; however, their curves worsened in adolescence with poor brace compliance. All 3 patients will require surgical intervention. Of the patients not successfully treated with casting, 7 required surgery at a mean 8.2 years of age, 4.3 years after initiation of casting. A significant predictor of treatment failure was older age of cast initiation ( P <0.001).
EDF casting can be an effective cure for IIS patients if initiated at a young age with 15 of 21 patients successfully treated (76%). However, 3 patients had a recurrence in adolescence resulting in an overall success rate of only 62%. Casting should be initiated early to maximize the likelihood of treatment success and periodic monitoring should be continued through skeletal maturity as recurrence during adolescence can occur.
对于特发性婴儿型脊柱侧凸（IIS）患者，采用伸长旋转屈伸（EDF）石膏矫形和随后的连续支具治疗已广泛应用。然而，采用 EDF 石膏矫形治疗的患者的长期疗效有限。
我们对在一家大型三级中心就诊的所有接受连续伸长旋转屈伸石膏矫形和随后支具治疗的脊柱侧凸患者进行了回顾性图表审查。所有患者均至少随访 5 年或直至接受手术干预。
我们的研究纳入了 21 例被诊断为 IIS 并接受 EDF 石膏矫形治疗的患者。在平均 7 年的随访中，21 例患者中有 13 例被认为治疗成功，最终主要冠状面曲率为 9 度，而治疗前冠状面曲率为 36 度。这些患者平均在 1.3 岁开始接受石膏矫形治疗，在石膏中治疗 1 年。那些没有明显改善的患者平均在 4 岁开始接受石膏矫形治疗，在石膏中治疗 0.8 年。3 例患者最初的矫正效果较好，在平均 7 岁时<20 度；然而，他们的脊柱侧凸在青春期时由于支具依从性差而恶化。所有 3 例患者都需要手术干预。在未成功接受石膏矫形治疗的患者中，7 例患者在平均 8.2 岁时需要手术治疗，即在开始石膏矫形治疗后 4.3 年。石膏矫形治疗开始年龄较大是治疗失败的显著预测因素（P<0.001）。
如果在幼年时开始 EDF 石膏矫形治疗，21 例患者中有 15 例（76%）可以获得有效治疗。然而，3 例患者在青春期复发，总体成功率仅为 62%。为了最大限度地提高治疗成功的可能性，应尽早开始石膏矫形治疗，并在骨骼成熟后继续定期监测，因为青春期可能会出现复发。
