Song Jun, Rui Hong-Xin, Xie Ya-Chun, Wang Yan, Li Ting, Chi Xia, Tong Mei-Lin, Lin Feng
Women's Hospital of Nanjing Medical University (Nanjing Women and Children's Healthcare Hospital) Nanjing Jiangsu China.
Department of Rehabilitation Medicine The First Affiliated Hospital of Nanjing Medical University Nanjing Jiangsu China.
Health Care Sci. 2024 Aug 18;3(4):274-285. doi: 10.1002/hcs2.111. eCollection 2024 Aug.
This study aimed to investigate the potential variance in the prevalence of early-onset scoliosis among children aged 4-7 years and analyze the influencing factors. The goal was to establish a crucial reference point for monitoring and evaluating spinal curvature development in preschoolers, ultimately to reduce the occurrence of adverse health outcomes.
Children aged 4-7 years within the main urban area of Nanjing were selected using a stratified random sampling method. A team of four senior therapists conducted screenings for spinal curvature among children using visual inspection, the Adams forward bending test, and an electronic scoliometer to measure the angle of trunk rotation (ATR) and identify children displaying signs of scoliosis. Children with suspected scoliosis in the initial screening underwent X-ray Cobb angle assessment for confirmation. The prevalence of early-onset scoliosis was then determined from the screening results. R version 4.2.0 software was used to analyze the factors associated with scoliosis among children using partial least squares structural equation modeling.
A total of 2281 children were included in this study, consisting of 1211 boys and 1070 girls, with a mean age of 5.44 ± 0.81 years (ranging from 4 to 7 years). Among them, 7.58% exhibited positive signs of scoliosis, 5.87% had early-onset scoliosis, and the positive predictive value was 77.5%. Significant differences in ATR were observed among children in different age groups (Kruskal-Wallis = 15, = 0.0104) and by sex ( = 3.17, = 0.00153). Significant variations in ATR were noted in children with scoliosis ( = -22.7, < 0.001), with a cutoff at ATR = 4.5°, and auxiliary values of 0.947 and 0.990. Children diagnosed with early-onset scoliosis generally exhibited lower body mass index values, with a statistically significant difference ( = 2.99, = 0.003).
Using visual inspection, the Adams test, and an electronic scoliometer to measure the ATR, the present triad method is more sensitive for early scoliosis screening in children with abnormal posture aged 4-7 years. A full spine X-ray is advised in children with an ATR over 4.5° and poor posture.
本研究旨在调查4至7岁儿童早发性脊柱侧弯患病率的潜在差异，并分析影响因素。目的是为监测和评估学龄前儿童脊柱弯曲发育建立关键参考点，最终减少不良健康结果的发生。
采用分层随机抽样方法选取南京市主城区4至7岁儿童。由四名资深治疗师组成的团队对儿童进行脊柱弯曲筛查，采用目视检查、亚当斯前屈试验和电子脊柱侧凸测量仪测量躯干旋转角度（ATR），以识别有脊柱侧弯迹象的儿童。初筛中疑似脊柱侧弯的儿童接受X线Cobb角评估以确诊。然后根据筛查结果确定早发性脊柱侧弯的患病率。使用R版本4.2.0软件，采用偏最小二乘结构方程模型分析儿童脊柱侧弯的相关因素。
本研究共纳入2281名儿童，其中男孩1211名，女孩1070名，平均年龄5.44±0.81岁（4至7岁）。其中，7.58%表现出脊柱侧弯阳性体征，5.87%患有早发性脊柱侧弯，阳性预测值为77.5%。不同年龄组儿童（Kruskal-Wallis检验=15，P=0.0104）和不同性别儿童（P=3.17，P=0.00153）的ATR存在显著差异。脊柱侧弯儿童的ATR有显著变化（P=-22.7，P<0.001），截断值为ATR=4.5°，辅助值为0.947和0.990。被诊断为早发性脊柱侧弯的儿童一般体重指数值较低，差异有统计学意义（P=2.99，P=0.003）。
采用目视检查、亚当斯试验和电子脊柱侧凸测量仪测量ATR，目前的三联法对4至7岁姿势异常儿童的早期脊柱侧弯筛查更敏感。对于ATR超过4.5°且姿势不良的儿童，建议进行全脊柱X线检查。
