规范化支具治疗对青少年特发性脊柱侧凸女孩骨密度的影响  

Accumulation of bone mineral density in adolescent idiopathic scoliosis girls treated with a standard-ized bracing protocol:a prospective study

作　　者：孙旭[1] 邱勇[1,2] 郑振耀[2,3] 朱泽章[1] 朱锋[1] 李卫国[1] 俞杨[1] 王斌[1] 

机构地区：[1]南京大学医学院附属鼓楼医院脊柱外科,江苏南京市210008 [2]南京大学-香港中文大学脊柱侧凸联合研究中心 [3]香港中文大学威尔斯亲王医院矫形外科及创伤学系

出　　处：《中国脊柱脊髓杂志》2009年第3期198-203,共6页Chinese Journal of Spine and Spinal Cord

基　　金：江苏省科技厅国际合作项目(编号:BZ2007024)

摘　　要：目的:评估规范化支具治疗对青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)女孩骨密度(bone mineral density,BMD)积累的影响,分析治疗期间影响BMD积累的可能因素。方法:2005年1月至2006年12月,49例骨骼发育未成熟的AIS女孩,年龄为13.2±1.5岁,主弯Cobb角为27.8°±5.8°,均接受规范化支具治疗,平均随访1.1年。治疗前及支具治疗1年时测定患者腰椎(LS)和非优势侧股骨颈(FN)BMD,分析其积累速率与患者初诊时骨量状态、生长发育等指标和支具佩戴时间之间的关系。结果:在支具治疗1年时,有46例(94%)和47例(96%)患者分别表现为LSBMD和FNBMD的正性积累,LSBMD和FNBMD均值均显著高于初诊时(P<0.001)。LSBMD和FNBMD的平均年积累速率分别为0.054g/(cm2·y)和0.076g/(cm2·y)。LSBMD和FNBMD的年积累速率与初诊时骨量状态和支具佩戴时间均无显著相关性,而LSBMD年积累速率与初诊时年龄、月经状态、Risser征、身高和体重等呈负相关(分别为:r=-0.467,P=0.001;r=-0.295,P=0.032;r=-0.261,P=0.038;r=-0.276,P=0.039;r=-0.293,P=0.041),并与身高和体重的变化量存在显著正相关(分别为:r=0.511,P<0.001;r=0.380,P=0.007)。结论:在支具治疗期间绝大多数AIS女孩表现为BMD的正性积累,支具佩戴和初诊时骨量状态对AIS女孩支具治疗后的BMD积累均无显著影响,而患者的生长潜能可能是影响BMD积累的重要因素。Objective：To evaluate the effect of standardized bracing treatment on bone mineral density（BMD） accumulation of girls with adolescent idiopathic scoliosis （AIS）,and to analyze the possible impact factors of BMD accumulation during bracing treatment.Method：The current prospective study consisted of 49 AIS girls with skeletal immaturity who received standardized bracing treatment.At the beginning of bracing treatment, these girls aged 13.2±1.5 year with a mean curve magnitude 27.8°±5.8°.After a mean follow-up of 1.1 year, the changes in BMD in lumbar spine（LS） and BMD in femoral neck（FN） of the non-dominant side as well as the annual accumulation rates of BMD at both sites were calculated,and the relationships of the annual BMD accumulation rates with initial bone mineral status ,the anthropometric data and the duration of bracing were analyzed.Result：After 1 year＇s brace treatment,46（94%） and 47（96%） of AIS girls had a positive accrual in LS BMD and FN BMD respectively.The mean values of LS BMD and FN BMD at the follow-up were significantly higher than those at entry （P〈0.001）.The annual accumulation rates of LS BMD and FN BMD were 0.054g/（cm^2·Y） and 0.076g/（cm^2·Y） respectively.The annual accumulation rates of LS BMD and FN BMD were not significantly correlated with either initial bone mineral status or the duration of bracing treatment.However,LS BMD accumulation rates were found to be negatively correlated with age （r=-0.467,P=0.001）, menstrual status （r=-0.295, P=0.032 ）, Risser sign （r=-0.261, P=0.038 ）, height （r=-0.276, P=0.039 ） and weight（r=-0.293,P=0.041） ,while positively correlated with changes in height（r=0.511,P〈0.001） and those in weight（r=0.380,P=0.007）. Conclusion：Nearly all of AIS female patients had positive accumulations of BMD and BMC at both sites after over-1-year bracing treatment.Neither brace treatment nor the initial bone mineral status may play an important role in the BMD accumulation,while growth pote

关 键 词：特发性脊柱侧凸 骨密度 支具治疗 女孩 

分 类 号：R682.3[医药卫生—骨科学] R454[医药卫生—外科学]