女性青少年特发性胸椎侧弯的胸椎矢状面形态对支具治疗效果的影响  

The effect of thoracic sagittal profile on bracing effectiveness in girls with thoracic adolescent idiopathic scoliosis

作　　者：吕峰[1] 邱勇[1] 邱旭升[1] 王斌[1] 孙旭[1] 张兴[1] 丁旗[1] 季明亮[1] 

机构地区：[1]南京医科大学鼓楼临床医学院脊柱外科,210008

出　　处：《中华小儿外科杂志》2011年第12期911-915,共5页Chinese Journal of Pediatric Surgery

基　　金：江苏省创新学者攀登项目（编号：BK2009001）

摘　　要：目的探讨女性青少年特发性胸椎侧弯患儿初诊时胸椎矢状面形态对支具治疗期间侧弯进展的预测价值。方法回顾性分析2002年1月至2008年12月70例接受规范化支具治疗的女性青少年特发性胸椎侧弯患儿资料。测量初诊和末次随访时的Cobb角、初诊胸椎后凸角，并记录初诊时的年龄、Risser征、月经状态等参数。分析末次随访时的侧弯变化情况，末次随访Cobb角大于初诊5。以上或治疗期间接受矫形手术者定义为支具治疗失败，其余为治疗成功。运用卡方检验和Logistic回归分析探讨影响支具治疗效果的因素。结果患儿初诊时年龄平均为（12．6±1．2）岁，主弯Cobb角平均为30．2°±5．5°，随访时间平均为（2．7±1．1）年，末次随访主弯Cobb角平均为29．6°±8．0°。支具治疗失败患儿19例（27．1％），成功51例（72．9％0）。卡方检验发现支具治疗失败组以月经初潮未至、低Risser征（0～1级）以及低初诊年龄（10-13岁）居多。Logistic回归分析表明月经初潮未至（OR=21．162，P=0．007）是支具治疗后侧弯进展的独立预测因素，而胸椎后凸形态与侧弯进展无明显相关性。结论通过早期规范化支具治疗，大部分脊柱侧弯进展可得到控制。患儿的生长发育状态是影响支具疗效的重要因素，而初诊时胸椎矢状面形态与支具治疗期间侧弯的进展无明显相关性。Objective To investigate the effect of thoracic sagittal profile on bracing effective ness in girls with thoracic adolescent idiopathic scoliosis （AIS）, and its clinical diagnostic sigfinicances. Methods The clinical data from 70 cases of female patients with AIS girls treated with a standardized bracing protocol was retrospectively reviewed. Cobb angle of the thoracic curve was re corded before the bracing initiation and at the end of follow-up; furthermore, the age, menstrual status, Risser sign, and thoracic kyphosis were recorded before bracing initiation. Bracing failure was identified and confirmed once the primary curve increased more than 5 compared with the initial recorded data or surgical intervention was necessary. Chi-square and logistic regression analyses were employed to statistic the predictive factors of bracing treatment. Results The average age was 12. 6 years in patients undertaking bracing initiation with a mean Cobb angle of 30. 2 ± 5.5. After an average duration of 2. 7 years follow up, the mean Cobb angle was changed to 29. 6 ± 8. 0. The procedure failed in 19 patients of all （27. 1%） and 51 cases （72. 9%） had a successful outcome. Chi-square analyses revealed that the population in failure group is those with sign of higher ratios of premenarchal status, lower Risser grade, and lower age before bracing initiation in contrast to successful group. The logistic regression revealed that premenarchal status was an independent risk factor for curve progression during brace treatment, while thoracic kyphosis was not associated with the curve progression. Conclusions Most of the curve progression can be controlled by early stage of standard bracing treatment in thoracic AIS patients. The individual state of growth and development will have effect on therapeutic outcome, while the initial thoracic sagittal profile is not correlated with the treatment.

关 键 词：脊柱侧弯 青少年 胸椎 支具 治疗结果 

分 类 号：R682[医药卫生—骨科学]