摘要
目的探讨青少年特发性脊柱侧凸支具治疗的适应证,并评价其临床疗效。方法77例骨骼发育未成熟的青少年特发性脊柱侧凸患者接受Milwaukee支具或Boston支具矫正,男15例,女62例;年龄10～15岁,平均12.7岁。胸腰双主弯26例、单胸弯37例、单胸腰弯或腰弯14例。原发弯Cobb角22°～62°,平均35.9°;20°～35°者37例,>35°者40例。Risser征0度38例、Ⅰ度19例、Ⅱ度13例、Ⅲ度7例。每3～6个月定期复查,复查时均摄佩带支具前、后的站立位全脊柱正位X线片,测量初次就诊及末次随访时的Cobb角、顶椎旋转度及Risser征。结果全部病例随访24～60个月,平均30个月。29.9%的病例出现脊柱侧凸进展,不同类型脊柱侧凸中胸腰双主弯进展率最低,但与其他类型比较差异无显著性。Risser征越小,初诊支具矫正率越大、侧凸进展率越高,且Risser征Ⅰ度组(包括0度)与Ⅱ度组之间、Ⅰ度组与Ⅲ度组之间初诊支具矫正率的差异有显著性(P<0.05)。原发弯Cobb角20°～35°组的初诊支具矫正率大于Cobb角>35°组(P<0.05);而侧凸进展率低于Cobb角>35°组,但差异无显著性。21例因出现侧凸进展而采用手术矫形,支具治疗使其中13例的手术时间推迟了12～20个月。结论Risser征可作为预测青少年特发性脊柱侧凸支具矫正成功率的一个指标。
Objective To investigate the indications of bracing for adolescent idiopathic scoliosis, and evaluate its clinical outcomes. Methods 77 immatured skeleton patients suffered from adolescent idiopathic scoliosis with no history of prior management. They were treated with Milwaukee or Boston brace, including 15 males and 62 females. The age of the patients at the time of bracing ranged from 10 to 15 years (mean, 12.7 years). 26 patients had double major curve, 37 had single thoracic curve, and 14 had either single thoracolumbar or single lumbar curve. The mean primary curve was 35.9°(range, 22°-62°), including curves between 20° and 35° in 37 cases and >35° in 40. Risser sign was 0 in 38,Ⅰin 19,Ⅱin 13, and Ⅲ in 7. The standing AP X-ray films were obtained at intervals of 3 to 6 months. The Cobb's angle, the apical vertebral rotation and the Risser sign were measured at initial brace application and at the latest follow-up. Results With a follow-up of 24 to 60 months (mean, 30 months), 23 patients (29.9%) were judged as curve progression. Patients with double major curve were found to have the lowest percentage of curve progression, but there was no significant difference compared with other patterns of curves. The lower the Risser sign, the higher the initial brace correction rate and the percentage of curve progression. The difference of the initial brace correction rate was significant(P<0.05) between RisserⅠ(included 0) group and RisserⅡgroup, and between RisserⅠgroup and Risser Ⅲ group respectively. The initial brace correction rate in patienrts with a Cobb's angle between 20° and 35° were higher than those with a Cobb's angle >35°(P<0.05), the percentage of curve progression was lower than those with a Cobb's angle >35°. 21 patients required surgical correction before completing bracing treatment because of curve progression, but in 13 of them, the surgical intervention was postponed about 12-20 months. Conclusion The Risser sign is a good predictor of bracing effect. Patients with double major curve have the lowest rate of treatment failure. The greater the amount of the Cobb's angle, the higher the percentage of curve progression. Bracing should be considered as successful if it can effectively reduce curve progression and postpone surgery.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2004年第5期276-280,共5页
Chinese Journal of Orthopaedics
