Rowe D E, Bernstein S M, Riddick M F, Adler F, Emans J B, Gardner-Bonneau D
Kalamazoo Center for Medical Studies, Michigan 49008, USA.
J Bone Joint Surg Am. 1997 May;79(5):664-74. doi: 10.2106/00004623-199705000-00005.
With use of data culled from twenty studies, members of the Prevalence and Natural History Committee of the Scoliosis Research Society conducted a meta-analysis of 1910 patients who had been managed with bracing (1459 patients), lateral electrical surface stimulation (322 patients), or observation (129 patients) because of idiopathic scoliosis. Three variables - the type of treatment, the level of maturity, and the criterion for failure - were analyzed to determine which had the greatest impact on the outcome. We also examined the effect of the type of brace that was used and the duration of bracing on the success of treatment. The number of failures of treatment in each study was determined by calculating the total number of patients who had unacceptable progression of the curve (as defined in the study), who could not comply with or tolerate treatment, or who had an operation. The percentage of patients who completed a given course of treatment without failure, adjusted for the sample sizes of the studies in which that treatment was used, yielded the weighted mean proportion of success for that treatment. The weighted mean proportion of success was 0.39 for lateral electrical surface stimulation, 0.49 for observation only, 0.60 for bracing for eight hours per day, 0.62 for bracing for sixteen hours per day, and 0.93 for bracing for twenty-three hours per day. The twenty-three-hour regimens were significantly more successful than any other treatment (p < 0.0001). The difference between the eight and sixteen-hour regimens was not significant, with the numbers available. Although lateral electrical surface stimulation was associated with a lower weighted mean proportion of success than observation only, the difference was not significant, with the numbers available. This meta-analysis demonstrates the effectiveness of bracing for the treatment of idiopathic scoliosis. The weighted mean proportion of success for the six types of braces included in this review was 0.92, with the highest proportion (0.99) achieved with the Milwaukee brace. We found that use of the Milwaukee brace or another thoracolumbosacral orthosis for twenty-three hours per day effectively halted progression of the curve. Bracing for eight or sixteen hours per day was found to be significantly less effective than bracing for twenty-three hours per day (p < 0.0001).
脊柱侧弯研究协会患病率与自然史委员会的成员利用从二十项研究中挑选出的数据，对1910例因特发性脊柱侧弯接受支具治疗（1459例患者）、横向体表电刺激治疗（322例患者）或观察处理（129例患者）的患者进行了荟萃分析。分析了三个变量——治疗类型、成熟度水平和失败标准，以确定哪个变量对结果影响最大。我们还研究了所使用的支具类型和支具佩戴时长对治疗成功的影响。通过计算曲线进展不可接受（如研究中所定义）、无法依从或耐受治疗或接受手术的患者总数，确定每项研究中的治疗失败数量。针对使用该治疗方法的研究样本量进行调整后，完成给定疗程且未失败的患者百分比得出该治疗方法成功的加权平均比例。横向体表电刺激治疗成功的加权平均比例为0.39，仅观察处理为0.49，每天佩戴支具八小时为0.60，每天佩戴支具十六小时为0.62，每天佩戴支具二十三小时为0.93。每天佩戴二十三小时的治疗方案明显比其他任何治疗方法更成功（p < 0.0001）。就现有数据而言，八小时和十六小时治疗方案之间的差异不显著。虽然横向体表电刺激治疗成功的加权平均比例低于仅观察处理，但就现有数据而言，差异不显著。这项荟萃分析证明了支具治疗特发性脊柱侧弯的有效性。本综述纳入的六种支具治疗成功的加权平均比例为0.92，其中密尔沃基支具的比例最高（0.99）。我们发现，每天使用密尔沃基支具或其他胸腰骶矫形器二十三小时可有效阻止曲线进展。发现每天佩戴支具八小时或十六小时明显不如每天佩戴二十三小时有效（p < 0.0001）。
