Conry Keegan T, Floccari Lorena V, Morscher Melanie, Brown Miraides F, Ritzman Todd F
Department of Orthopaedic Surgery, Cleveland Clinic Akron General, Akron, OH, USA.
Department of Orthopaedics, Akron Children's Hospital, 215 West Bowery Street, Akron, OH, 44308, USA.
Spine Deform. 2024 Sep;12(5):1459-1466. doi: 10.1007/s43390-024-00868-1. Epub 2024 Apr 13.
The efficacy of traditional Mehta casting in the treatment of early onset scoliosis (EOS) is well-established. However, waterproof casting has not been previously described. Inherent advantages of waterproof casting include clearance for bathing/swimming, avoiding cast holidays, and improved family satisfaction. The purpose of this study was to assess the safety and efficacy of waterproof serial casting at controlling curve progression in EOS.
The current study is an IRB-approved Level IV retrospective consecutive cohort of EOS patients who underwent a serial 75% body weight traction-elongation-flexion Mehta cast protocol with waterproof cast padding. The addition of 3-point apical translation with stockinettes was utilized during casting. Bracing was initiated after correction < 15° or 1 year of serial casting.
Seventeen patients at mean age 21.6 months, with pre-cast Cobb angle 52.3° (R: 35°-82°), underwent serial waterproof casting. In-cast correction index was 64%; for post-cast, Cobb angle was 18.6°. At mean 5.6 years follow-up (R: 2.3-8.9 years), 82% successfully avoided surgical intervention, 53% maintained correction < 25°, and 29% are considered "cured". 3/17 (18%) underwent a 2nd round of casting, and a total of 3/17 (18%) ultimately required surgery at 6.2 years post-casting. No major cast-related complications, decubiti, or cast holidays were encountered.
Serial waterproof casting is safe and efficacious in EOS when compared to published results of traditional Mehta casting. Of 17 patients with mean pre-cast Cobb 52.3°, 82% successfully avoided surgery and 53% maintained mild curves < 25° magnitude at 5.6 years follow-up. No major complications or skin decubiti occurred, and advantages include clearance for bathing and avoidance of need for cast holidays during treatment.
Level IV.
传统梅塔石膏固定法在早发性脊柱侧弯（EOS）治疗中的疗效已得到充分证实。然而，此前尚未有关于防水石膏固定的描述。防水石膏固定的内在优势包括可进行沐浴/游泳、避免石膏拆除期以及提高家庭满意度。本研究的目的是评估防水系列石膏固定在控制EOS曲线进展方面的安全性和有效性。
本研究是一项经机构审查委员会（IRB）批准的IV级回顾性连续队列研究，研究对象为接受了连续75%体重牵引-延长-屈曲梅塔石膏固定方案并使用防水石膏衬垫的EOS患者。在石膏固定过程中采用了加用弹力织物进行三点顶椎平移的方法。在矫正小于15°或连续石膏固定1年后开始使用支具。
17例平均年龄21.6个月、石膏固定前Cobb角为52.3°（范围：35°-82°）的患者接受了连续防水石膏固定。石膏固定期间的矫正指数为64%；石膏固定后，Cobb角为18.6°。平均随访5.6年（范围：2.3-8.9年）时，82%的患者成功避免了手术干预，53%的患者维持矫正小于25°，29%的患者被认为“治愈”。17例中有3例（18%）接受了第二轮石膏固定，17例中共有3例（18%）最终在石膏固定后6.2年需要手术。未遇到与石膏固定相关的重大并发症、褥疮或石膏拆除期。
与传统梅塔石膏固定已发表的结果相比，连续防水石膏固定在EOS治疗中是安全有效的。在17例平均石膏固定前Cobb角为52.3°的患者中，82%成功避免了手术，5.6年随访时53%维持了小于25°的轻度曲线。未发生重大并发症或皮肤褥疮，其优势包括可进行沐浴以及在治疗期间无需石膏拆除期。
IV级。
