初诊骨密度对女性青少年特发性脊柱侧凸患者早期支具治疗效果的预测价值  

The role of initial bone mineral status in predicting the early outcome of brace treatment in girls with adolescent idiopathic scoliosis

作　　者：孙旭[1] 朱泽章[1] 邱勇[1] 王斌[1] 李卫国[1] 朱锋[1] 俞杨[1] 钱邦平[1] 马薇薇[1] 

机构地区：[1]南京大学医学院附属鼓楼医院脊柱外科,210008

出　　处：《中华外科杂志》2008年第14期1066-1069,共4页Chinese Journal of Surgery

基　　金：国家自然科学基金资助项目（30672131）

摘　　要：目的探讨青少年特发性脊柱侧凸女性患者初诊时骨密度对短期支具治疗期间侧凸畸形进展的预测价值。方法对接受规范化支具治疗1年以上的77例10—15岁龄的AIS女性患者，采用Logistic回归分析鉴定初诊骨密度与侧凸进展之间的关联，并运用多元回归分析探讨初诊骨密度状态是否是影响支具治疗期间侧凸进展的因素。结果侧凸进展组16例（21％），非进展组61例（79％）。进展组患者中以初潮未至、低Risser征、主胸弯、初诊大Cobb角者以及骨密度减低者居多。多元Logistic逐步回归分析表明，除了初潮未至（OR=4．606，P=0．020）、Cobb角31°-45°（OR=3．408，P=0．097）和主胸弯类型（OR=3．414，P=0．090）等因素外，骨密度减低（OR=5．362，P=0．022）也是支具治疗期间侧凸进展的危险因素。结论初诊时较低的骨密度是独立影响特发性脊柱侧凸女性患者短期支具疗效的风险因素。分析支具治疗前患者的骨量状态有助于预测支具治疗效果。Objective To investigate whether initial bone mineral status acts as a predictor factor in evaluating the early outcome of brace treatment in adolescent idiopathic scoliosis （ AIS ） girls. Methods Seventy-sevengirls with AIS, aged 10-15 years old, were included in this study. A standardized bracing protocol was performed in these girls, and the early outcomes of brace treatment were evaluated at over-1year follow-up. Girls with a progressed scoliosis and those with a non-progressed scoliosis were identified. The associations between the outcome and the indices before bracing, including age, menstrual status, Risser grade, bone mineral density （BMD） status, curve magnitude and curve pattern were assessed using univariate analysis. A multiple Logistic stepwise regression was used to determine the risk factors in curve progression in AIS girls treated with brace treatment. Results There were 16 girls （21%） with a progressed scoliosis and 61 girls （79%） with a non-progressed scoliosis, respectively. In the girls with a progressed scoliosis, higher ratios of subjects were found with premenarchal status （ X^2 = 9. 628, P = 0. 004）, lower Risser grade （X^2 =4. 565 ,P =0. 037） ,main thoracic scoliosis （X^2 =4. 009 ,P =0. 045）, a larger curve （X^2 = 1. 685 ,P = 0. 194）, as well as osteopenia （X^2 = 3. 828, P = 0. 050）, as compared with those with a non- progressed scoliosis. During brace treatment, besides premenarchal status, a larger Cobb angle, and a main thoracic scoliosis, osteopenia （ OR = 5. 362, P = 0. 022） was identified as the risk factor in curve progression in AIS girls, as revealed by the multiple Logistic regression analysis. Conclusions Osteopenia might be an independent risk factor in the curve progression during brace treatment. The analysis of initial BMD status before bracing may help to predict the outcome of brace treatment.

关 键 词：脊柱侧凸 骨密度 青少年 

分 类 号：R682[医药卫生—骨科学]