Thompson Tiffany, O'Sullivan Michael, Monroig-Rivera Carlos, Johnston Charles E
Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA.
Spine Deform. 2025 Jan;13(1):293-297. doi: 10.1007/s43390-024-00957-1. Epub 2024 Sep 25.
Patients with idiopathic EOS treated by Mehta casting followed by bracing or observation from a single institution.
To determine casting protocol parameters leading to successful management; to determine efficacy of bracing vs. observation after cast discontinuance.
Previous studies have not precisely defined parameters for cast discontinuance (amount of correction, number of casts), nor have documented the efficacy of brace treatment.
73 patients undergoing Mehta casting were braced (n = 56) or observed (n = 17) after casting with follow-up for a mean of 51-58 months. 57 patients had ≥ 4 casts applied; 39 had ≥ 5 casts. Success was defined as no further treatment required. Curve magnitude was measured at time points pre-casting, at cast discontinuance, and last follow up.
There was no difference in success rate between braced patients (79% success) and observed (71%). Curve correction to < 30° at cast discontinuance was crucial parameter for success, as 95% (45/47) of patients with this correction achieved success, braced or not, while only 42% (11/26) with residual curves ≥ 30° achieved success (p < .001) and 14 of these required surgery compared to 0/47 successful patients. The number of casts (over/under 4 or 5) made no difference in achieving success. 10/26 patients who had residual curves ≥ 30° and were braced achieved success due to further curve diminution during bracing.
Cast correction to < 30° followed by bracing achieved 100% success in 34 patients compared to 85% (13 patients) who were observed (p = .07). For residual curves ≥ 30° bracing can produce some correction and succeed in delaying further treatment.
对来自单一机构的特发性脊柱侧凸患者采用梅塔石膏固定法进行治疗，随后进行支具治疗或观察。
确定导致成功治疗的石膏固定方案参数；确定拆除石膏后支具治疗与观察的疗效。
既往研究尚未精确界定拆除石膏的参数（矫正量、石膏数量），也未记录支具治疗的疗效。
73例行梅塔石膏固定的患者在拆除石膏后接受支具治疗（n = 56）或观察（n = 17），平均随访51 - 58个月。57例患者接受了≥4次石膏固定；39例接受了≥5次石膏固定。成功定义为无需进一步治疗。在石膏固定前、拆除石膏时及末次随访时测量侧弯度数。
接受支具治疗的患者成功率（79%成功）与接受观察的患者（71%）之间无差异。拆除石膏时侧弯矫正至<30°是成功的关键参数，因为95%（45/47）达到此矫正程度的患者无论是否接受支具治疗均取得成功，而残留侧弯≥30°的患者只有42%（11/26）取得成功（p <.001），其中14例需要手术，而47例成功患者中0例需要手术。石膏固定次数（超过/低于4次或5次）对成功与否无影响。10/26例残留侧弯≥30°且接受支具治疗的患者因在支具治疗期间侧弯进一步减小而取得成功。
石膏矫正至<30°后进行支具治疗的34例患者中100%取得成功，相比之下，接受观察的患者成功率为85%（13例患者）（p = 0.07）。对于残留侧弯≥30°，支具治疗可产生一定矫正效果，并成功延迟进一步治疗。
