Sasao Shinji, Oba Hiroki, Ikegami Shota, Uehara Masashi, Hatakenaka Terue, Kurogochi Daisuke, Fukuzawa Takuma, Shigenobu Keisuke, Makiyama Fumiaki, Koseki Michihiko, Takahashi Jun
Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
Faculty of Textile Science and Technology, Shinshu University, 3-15-1 Tokida, Ueda, Nagano, 386-8567, Japan.
Spine Deform. 2025 Sep 13. doi: 10.1007/s43390-025-01163-3.
This study aimed to identify independent risk factors for brace treatment failure, examine the correlation between initial in-brace Cobb angle and curve progression, and assess the relationships among age, curve type, initial in-brace Cobb angle, and treatment success.
Eighty consecutive patients (76 girls and 4 boys; mean age: 12.0 ± 1.2 years) commenced treatment with an underarm brace and were followed for a minimum of 2 years after brace initiation. Brace treatment failure was defined as a final Cobb angle of ≥ 50°, surgery, or curve progression ≥ 6°. A spinal surgeon evaluated standing long-cassette antero-posterior radiographs the pre-treatment, initial in-brace, and final follow-up time points. Multivariate analysis was conducted to classify patients into the bracing success and failure groups. We employed receiving operator characteristic analysis to determine cut-off values based on age and initial in-brace Cobb angle.
The cohort of 80 patients were followed for a mean of 3.1 ± 1.2 years. Overall success rate was 62%, with 19 patients requiring surgery and 30 experiencing bracing failure. Bracing success cases exhibited significantly lower pre-treatment Cobb angle (29.1° vs. 31.7°; P = 0.038), lower initial in-brace Cobb angle (15.5° vs. 21.0°; P < 0.001), and higher in-brace correction rate (48.6% vs. 32.9%; P < 0.001). Multivariate analysis identified younger age (+ 1 year, odds ratio 0.44; P = 0.006) and higher initial in-brace Cobb angle (+ 10°, odds ratio 5.0; P = 0.009) as independent predictors of treatment failure, with cut-off values of 12 years and 16°, respectively.
For patients aged ≥ 12 years, controlling Cobb angle to < 16° at the initial underarm brace fitting may prevent significant curve progression and reduce the likelihood of surgery.
本研究旨在确定支具治疗失败的独立危险因素，研究初始支具内Cobb角与侧弯进展之间的相关性，并评估年龄、侧弯类型、初始支具内Cobb角与治疗成功之间的关系。
连续80例患者（76名女孩和4名男孩；平均年龄：12.0±1.2岁）开始使用腋下支具治疗，并在开始使用支具后至少随访2年。支具治疗失败定义为最终Cobb角≥50°、手术或侧弯进展≥6°。脊柱外科医生在治疗前、初始支具内和最终随访时间点评估站立位长片前后位X线片。进行多变量分析以将患者分为支具治疗成功和失败组。我们采用接受者操作特征分析来确定基于年龄和初始支具内Cobb角的截断值。
80例患者队列平均随访3.1±1.2年。总体成功率为62%，19例患者需要手术，30例出现支具治疗失败。支具治疗成功的病例治疗前Cobb角显著更低（29.1°对31.7°；P = 0.038），初始支具内Cobb角更低（15.5°对21.0°；P < 0.001），支具内矫正率更高（48.6%对32.9%；P < 0.001）。多变量分析确定年龄较小（增加1岁，比值比0.44；P = 0.006）和初始支具内Cobb角较高（增加10°，比值比5.0；P = 0.009）是治疗失败的独立预测因素，截断值分别为12岁和16°。
对于年龄≥12岁的患者，在初次腋下支具佩戴时将Cobb角控制在<16°可能会防止侧弯显著进展并降低手术可能性。
