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目的 :比较行支具治疗的青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者的支具治疗后初始Cobb角进展速率(initial angle velocity,IAV)和初始矫正率与支具疗效的相关性,探讨IAV对AIS患者支具疗效的预测价值。方法:回顾性分析于我院门诊行正规支具治疗的女性AIS患者126例,其中胸主弯74例,胸腰弯52例。于患者每次随访拍摄的站立位全脊柱正位片上测量主弯的Cobb角和Risser征。另外记录患者每次随访时的实足年龄、月经状态及身高等资料。根据患者末次随访时Cobb角进展程度分为两组:进展组55例Cobb角进展≥6°;非进展组71例Cobb进展<6°。IAV定义为患者支具治疗后第一次随访时的Cobb角进展速率,初始矫正率定义为支具治疗后第一次随访时的Cobb角矫正率。采用独立样本t检验比较两组之间的差异,逻辑回归分析不同支具疗效的预测因素。结果:本组所有患者平均初诊年龄12.4±1.6岁;月经年龄12.3±1.2岁;平均初诊身高154.4±9.7cm;初诊Risser征2.1±1.7;平均初诊Cobb角24.4°±6.1°。初诊至第一次随访平均时间间隔4.1±0.6个月;初诊至末次随访平均时间间隔35.9±13.7个月(24~60个月)。末次随访时平均Cobb角29.2°±8.4°。独立样本t检验示进展组和非进展组患者初诊年龄、月经年龄、初诊身高、初诊Risser征及初诊Cobb角均无显著差异(P>0.05)。非进展组IAV显著小于进展组(-9.9°±13.8°/年VS 5.2°±12.5°/年,P<0.001),而非进展组初始Cobb角矫正率显著大于进展组[(11.6±16.9)%VS(-5.3±16.4)%,P<0.001]。逻辑回归分析示支具疗效与IAV(OR=8.451,P=0.004)呈显著相关,而与初始矫正率(OR=2.192,P=0.139)无显著相关。结论:支具治疗后初始Cobb角进展速率与AIS患者支具疗效呈显著相关,较高的支具治疗后初始Cobb角进展速率预示较差的支具治疗效果。
PURPOSE: To compare the association between initial initial Cobb angle (IAV) and initial correction and brace efficacy in the treatment of adolescent idiopathic scoliosis (AIS) To investigate the predictive value of IAV in the treatment of patients with AIS. Methods: A retrospective analysis of 126 cases of female AIS patients undergoing regular brace treatment in our hospital, including 74 cases of thoracolumbar curvature and 52 cases of thoracolumbar curve. The Cobb angle and Risser sign of the main bend were measured on the full orthopaedic spine taken at each follow-up. In addition, records of each patient’s full-time follow-up age, menstrual status and height and other information. According to the degree of progression of Cobb angle at the final follow-up, the patients were divided into two groups: progressing group 55 cases of Cobb angle progressing≥6 °; non-progressing group 71 cases Cobb progressing <6 °. IAV was defined as the Cobb angle progression rate at the first follow-up after patient brace treatment, and the initial correction rate was defined as the Cobb angle correction at the first follow-up after brace treatment. Independent sample t-test was used to compare the differences between the two groups, and logistic regression was used to analyze predictors of efficacy of different braces. Results: All patients in this group had a mean age at diagnosis of 12.4 ± 1.6 years and a mean age of 12.3 ± 1.2 years. The average newly diagnosed height was 154.4 ± 9.7 cm. The initial diagnosis of Risser sign was 2.1 ± 1.7. The mean Cobb angle was 24.4 ° ± 6.1 °. The average time between first visit and the first follow-up was 4.1 ± 0.6 months. The average interval between the first visit and the last follow-up was 35.9 ± 13.7 months (24-60 months). The average follow-up Cobb angle 29.2 ° ± 8.4 °. Independent sample t test showed no significant difference (P> 0.05) between the newly diagnosed group and non-advanced group in the age, menstrual age, height of newly diagnosed, newly diagnosed Risser sign and newly diagnosed Cobb angle. The IAV in non-progression group was significantly lower than that in progression group (-9.9 ° ± 13.8 ° / year vs 5.2 ° ± 12.5 ° / year, P <0.001), while the initial Cobb angle correction rate in non-progression group was significantly higher than that in progression group [(11.6 ± 16.9) % VS (-5.3 ± 16.4)%, P <0.001]. Logistic regression analysis showed that the curative effect was significantly correlated with IAV (OR = 8.451, P = 0.004), but not with the initial correction rate (OR = 2.192, P = 0.139). CONCLUSION: The initial rate of Cobb angle is significantly correlated with the outcome of patients with AIS. The initial rate of progression of Cobb angle after higher braches indicates the poor outcome.