青少年特发性脊柱侧凸支具治疗结束后近期矫正丢失及影响因素

目的:观察青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)支具治疗结束后短期内侧凸的矫正丢失情况,并探讨其影响因素。方法:选取2002年10月～2007年12月在我院完成规范化支具治疗后短期随访的AIS患者84例,其中男4例,女80例。初诊时年龄10～15岁,平均12.8岁;Risser征0～3级,平均1.6级;主弯Cobb角20°～43°,平均29.5°。胸腰双主弯36例,单胸弯22例,单胸腰弯或腰弯26例。所有患者在初诊、复查时均摄佩带支具前后站立位全脊柱正位X线片。分别测定不同时期侧凸Cobb角,记录侧凸类型、Risser征、患者的生理年龄及月经初潮时间,分析去除支具后侧凸的矫正丢失情况及影响因素。结果:AIS患者支具治疗后主弯Cobb角的平均矫正率为12.4%,其中14例(16.7%)患者在治疗期间出现脊柱侧凸进展,不同弯型脊柱侧凸的侧凸矫正率、进展率比较差异无显著性(P0.05)。支具治疗结束时主弯Cobb角10°～37°,平均25.5°,明显小于初诊时的29.5°(P0.05),停用支具后6～18个月主弯Cobb角为27.2°,与支具治疗结束时比较无显著性差异(P0.05)。停用支具后,有15例(17.6%)患者出现脊柱侧凸进展,不同弯型脊柱侧凸进展差异无统计学意义(P0.05);侧凸进展的患者在支具治疗时主弯Cobb角的平均矫正率为23.3%,明显高于未出现侧凸进展患者的10.6%,且差异具有统计学意义(P0.05)。停用支具时不同Cobb角组后期出现侧凸进展的概率无显著性差异(P0.05)。结论:支具治疗能够有效控制AIS患者侧凸的进展。在结束支具治疗后短期内随访侧凸矫正基本稳定,但仍有一小部分患者会出现侧凸进展,这种进展与弯型、侧凸的严重程度无关,可能与支具治疗期间侧凸的矫正率较大有关。     

支具治疗女性青少年特发性脊柱侧凸畸形加重的危险因素分析

目的:观察支具治疗女性青少年特发性脊柱侧凸的畸形变化情况并分析侧凸畸形进展的危险因素。方法:对65例接受支具治疗的女性青少年特发性脊柱侧凸患者进行随访。在随访期间连续测量记录患者的Cobb角、侧凸类型、月经初潮与否、坐高、站高、Risser分级、顶椎旋转度等。分析初诊时和末次随访时侧凸变化情况,并从上述多项参数中筛选引起侧凸加重的危险因素。结果:65例获得随访,时间12～60个月,平均24.1个月。初诊年龄10～16岁,平均13.7岁。末次随访时17例(26.15%)患者侧凸进展超过5°,初诊时原发弯Cobb角>35°,顶椎旋转度≥Ⅲ度的患者,侧凸明显进展的百分率较高(P<0.05)。通过Logistic逐步回归分析,发现初诊时原发弯Cobb角>35°,顶椎旋转度≥Ⅲ度,年身高增长>30mm的患者,是侧凸进展到5°以上的危险因素。结论:初诊时原发弯Cobb角值,顶椎旋转度及身高增长速度是预测女性青少年特发性脊柱侧凸进展的重要因素,借助Risser分级预测侧凸进展并不可靠,初始原发弯Cobb角>35°、顶椎旋转度≥Ⅲ度、年身高增长>30mm的患者,侧凸进展的危险性较高。     

青少年特发性脊柱侧凸患者结束支具治疗后侧凸进展的危险因素分析

目的研究青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者结束支具治疗后侧凸进展的危险因素,为AIS的科学、合理使用支具治疗提供理论依据。方法纳入2013-03-2016-03于我院支具治疗的164例青少年特发性脊柱侧凸患者,结束支具治疗后随访24个月,以侧凸Cobb进展≥5°诊断为支具治疗后侧凸进展,设为进展组,侧凸Cobb进展5°设为非进展组。调查两组患者初诊年龄、性别、初诊Cobb角等病历资料,通过Logistic回归分析探究AIS患者结束支具治疗后侧凸进展的独立危险因素。结果 AIS患者结束支具治疗后侧凸进展38例,进展率23.17%,平均侧凸Cobb角(6.84±0.87)°,未进展126例,平均侧凸Cobb角(3.77±0.65)°;两组初发Cobb角、顶椎旋转度、站高增长速度、女性初潮年龄、Risser征的差异有统计学意义(P0.05);Logistic回归分析证实:初发Cobb角≥35°、顶椎旋转度≥Ⅲ度、女性初潮年龄12岁、站高增长速度30 mm/年,均是AIS患者结束支具后侧凸进展的独立危险因素。结论 AIS患者结束支具治疗后侧凸进展发生率较高,初发Cobb角≥35°、顶椎旋转度≥Ⅲ度、站高增长速度30 mm/年、女性初潮年龄12岁均会增加侧凸进展风险。     

性别对青少年特发性脊柱侧凸患者支具治疗效果的影响

目的:比较男、女性青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者支具治疗的效果,探讨性别因素对支具治疗效果的影响。方法:2003年7月~2009年7月在我院完成支具治疗的男性AIS患者19例(A组),初诊时平均年龄14.0±2.0岁,平均主弯Cobb角28.8°±5.7°,初始Boston支具治疗6例,Milwaukee支具治疗13例;随机抽取同时期完成支具治疗的女性AIS患者57例(B组),初诊时平均年龄13.0±1.4岁,平均主弯Cobb角29.4°±6.1°,初始Boston支具治疗17例,Milwaukee支具治疗40例。定义末次随访时Cobb角大于初诊6°或治疗期间建议行矫形手术者为侧凸进展。结果:两组初诊时Risser征(P=0.786)、Cobb角(P=0.790)、弯型分布(P=0.350)和应用支具类型分布(P=0.350)等无显著性差异。A组和B组平均支具治疗时长分别为2.1±0.7年和2.5±0.9年,平均依从性分别为84.4%±7.6%和87.1%±5.7%。A组患者中发生侧凸进展8例(42%),其中需手术治疗者6例(32%);B组中侧凸进展12例(21%),其中需手术治疗者10例(18%)。男性患者侧凸进展比例高于女性,但统计学差异不明显(P=0.071)。两组中,生长发育状态低下、侧凸Cobb角大及主胸弯型患者侧凸进展比例高。结论:支具治疗可有效控制多数AIS患者的侧凸进展,女性患者支具治疗效果可能好于男性患者。     

女性青少年特发性脊柱侧凸支具治疗效果和影响因素评估

目的 评估女性青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者支具治疗效果及影响因素.方法 2003年7月至2009年7月,完成支具治疗或因侧凸进展而行手术治疗的女性AIS患者142例,初诊时平均年龄为(13.1±1.5)岁,平均主弯Cobb角29.6°±5.4°,平均Risser征为(2.0±1.5)级.定义侧凸畸形进展为末次随访Cobb角大于初诊6°以上或治疗期间建议行矫形手术(Cobb 角＞45°),其余为非进展.根据侧凸进展或需手术治疗的比率来评估支具治疗效果.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 平均支具治疗时间为(2.5±1.0)年.按照侧凸进展的定义,进展组为27例(19%),非进展组115例(81%);手术组病例18例(13%),因支具治疗而避免手术病例124例(87%).卡方检验发现侧凸进展组和手术组中以初诊年龄10.0～12.9岁、月经初潮未至、Risser征0～1级、初诊Cobb角＞30°以及胸弯型居多.Logistic回归分析发现月经初潮未至(P=0.000)和胸弯型(P=0.012)是支具治疗后侧凸进展的独立预测因素,而初诊Cobb角＞30°(P=0.022)是支具治疗期间因侧凸进展而需手术治疗的另一独立预测因素.结论 支具治疗可有效控制多数AIS患者的侧凸进展,而生长发育状态、侧凸严重程度和侧凸类型是影响支具疗效的重要因素.

Abstract：

Objective To analyze the outcomes of bracing treatment for girls with adolescent idiopathic scoliosis (AIS), and to investigate the predictive factors of the protocol. Methods This study included 142 girls with AIS who finished standardized bracing treatment from July 2003 to July 2009. These patients had a mean age of 13.1±1.5 years, a mean main curve of 29.6°±5.4°, and a mean Risser grade of 2.0±1.5 before bracing treatment. Curve progression was defined that Cobb angle was greater than 6° compared to bracing initiation or was aggravated to more than 45° (indicative for surgery). The outcomes of bracing treatment were assessed based on the ratio of curves of progression or indicative for surgery. Chi-square and Logistic regression Analyses were performed to investigate the predictive factors of bracing treatment. Results The duration of bracing treatment averaged 2.5±1.0 years. Twenty-seven girls with curve progression (19%)and 115 girls (81%) with non-progression were found. Final curve which was greater than 45° was found in 18 girls (13%) who need a correction surgery, the remaining 124 girls (87%) had completed bracing treatment and avoided surgery. Chi-square analyses revealed that curve progression were more common in younger girls with lower Risser grade, with initial larger Cobb angle and with a main thoracic curve pattern.Logistic regression analyses found that premenarchal status and a main thoracic curve pattern were the independent risk factors of curve progression despite bracing. While initial Cobb angle which was greater than 30° was the additional independent risk factor of progression requiring surgery. Conclusion Bracing treatment could effectively prevent curve progression in most girls with AIS. The degree of growth maturity, the pattern and grade of curve are the influencing factor for bracing treatment.     

支具治疗后初始Cobb角进展速率对青少年特发性脊柱侧凸患者支具疗效的预测价值

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(P0.05)。非进展组IAV显著小于进展组(-9.9°±13.8°/年VS 5.2°±12.5°/年,P0.001),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)%,P0.001]。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。     

支具治疗青少年特发性脊柱侧凸的临床随访

目的评价支具治疗青少年特发性脊柱侧凸的临床疗效,分析影响疗效的相关因素,并探讨支具治疗的适应证。方法对79例接受支具治疗的青少年特发性脊柱侧凸患者进行随访,记录患者的Cobb角,侧凸类型,女性患者初潮与否,坐高,站高,Risser征,顶椎旋转度等。结果随访12～60个月,平均23．9个月。末次随访时21例（26．6％）畸形明显进展,40例（50．6％）畸形维持或稍进展,18例（22．8％）畸形改善。初诊时原发弯Cobb角〉45°组侧凸进展率较Cobb角≤35°组高,侧凸改善率较Cobb角≤35°组低（P〈0．05）;顶椎旋转度Ⅲ°以上组侧凸进展率较0～Ⅱ°组高,侧凸改善率较0～Ⅱ°组低（P〈0．05）。侧凸类型、Risser征等参数不同的患者畸形进展和改善的比率均存在不同程度的差别,但差异不具有显著性（P〉0．05）。结论矫形支具能够有效控制或改善轻、中度特发性脊柱侧凸畸形。单独借助Risser征预测侧凸畸形变化趋势并不可靠。初始Cobb角〉45°,顶椎旋转度在Ⅲ°以上的患者,如果支具治疗的效果不佳,应考虑尽早手术矫形。     

Matrilin-1基因多态性与青少年特发性脊柱侧凸支具疗效的相关性

目的 探讨matrilin-1基因多态性与青少年特发性脊柱侧凸(AIS)患者支具治疗效果的相关性.方法 自2005年1月至2008年12月,对门诊行规范化支具治疗的AIS患者进行前瞻性研究.入选对象要求:女性患者;骨骼发育为未成熟状态(Risser征0～3级);月经初潮未至或来潮1.5年以内;标准站立位全脊柱X线片上侧凸Cobb角为20°～40°;排除了先天性和神经肌源性以及其他原因引起的侧凸;无已知的可影响骨塑型和钙代谢的病史和药物使用史;初诊前无支具治疗史;接受支具治疗(Boston支具或Milwaukee支具)期间每3个月复诊1次,随访时间超过2年.符合下述条件之一者,则予以剔除:最终随访不足2年;支具治疗过程中依从性(每日实际佩戴时间与建议佩戴时间的比值)较差(<75%);支具治疗期间未按照医嘱自行更换支具.根据患者侧凸类型选择相应的支具进行治疗.记录初次就诊及末次随访的原发弯的Cobb角.支具治疗失败的标准为原发弯增加>5°.选取matrilin-1基因启动子区域位点rs1149048进行PCR-RFLP基因分型.按支具疗效分为治疗失败和治疗成功两组,比较两组之间的初诊年龄、Risser征、侧凸类型、初诊Cobb角及基因型分布的差异并进行统计学分析.结果 共有77例AIS女孩入选并完成本研究.初诊时平均年龄为(13.0±1.5)年,平均主弯Cobb角为29.5°±7.8°.在平均(2.6±0.3)年随访后,平均主弯Cobb角为30.3°±11.9°.支具治疗失败总共19例(24.7%),支具治疗成功58例(75.3%).支具治疗失败组的初诊Cobb角较大(P>0.05).在不同的侧凸类型中,胸腰双主弯的支具治疗失败率最低(19.4%).基因型GG个体支具治疗失败率(66.7%)明显高于基因型为从或AG的个体.结论 通过早期规范化支具治疗,大部分脊柱侧凸进展可得到控制.初诊Cobb角较大及基因型GG的AIS患者支具疗效较差.     

青少年特发性脊柱侧凸的支具治疗

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。不同类型脊柱侧凸中胸     

女性青少年特发性脊柱侧凸患者停止支具治疗后的侧凸进展及其相关因素

目的 :分析发育成熟的女性青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患儿在停止支具治疗后长期随访中的侧凸进展情况,并探讨其相关因素。方法:回顾性分析于我院门诊就诊符合SRS(scoliosis research society)支具治疗标准的女性AIS患儿130例,初诊年龄11.8±1.4岁(10~14岁)。所有患儿均随访至支具治疗结束后至少2年,且至少具有佩戴支具后初次随访、停止支具治疗时、停止支具治疗后6个月、1年、2年及末次随访时的资料。在每次随访时的全脊柱正位X线片上测量主弯侧凸Cobb角,并评估侧凸进展超过5°的患儿及比例、侧凸进展度数和进展速率。末次随访时侧凸进展超过5°定义为侧凸进展,采用独立样本t检验比较侧凸进展组和非进展组患儿的初诊年龄、月经初潮年龄、初诊Cobb角、初始矫正率、停止支具治疗年龄。结果:与停止支具治疗时相比,停止支具治疗后6个月、1年、2年及末次随访时的侧凸进展超过5°的患儿分别为33例(25.4%)、42例(32.3%)、61例(46.9%)和63例(48.5%);侧凸进展度数分别为2.0°±4.4°、3.2°±5.0°、4.9°±5.5°和5.1°±6.9°;侧凸进展速率分别为0.33°±0.71°/月、0.20°±0.41°/月、0.14°±0.29°/月和0.01°±0.19°/月。停止支具治疗后侧凸非进展组和进展组患儿的初诊年龄、月经初潮年龄、初诊Cobb角、初始矫正率、停止支具治疗时年龄等无显著性差异(P0.05),而停止支具治疗时的Cobb角有统计学差异(P0.05)。结论:行支具治疗的AIS患儿停止支具治疗后仍有较高的侧凸进展风险,停止支具治疗后的6个月内为侧凸进展高风险和高速率期;停止支具治疗时的侧凸Cobb角越大发生侧凸进展的风险越高。     

Outcomes and predictors of brace treatment for girls with adolescent idiopathic scoliosis

Objective: To evaluate the effectiveness and to identify the predictive factors of standardized brace treatment for girls with adolescent idiopathic scoliosis (AIS). Methods: From July 2003 to July 2009, 142 girls with AIS completed standardized brace treatment. These patients had a mean age of (13.1 ± 1.5) years (range, 10.1–15.9 years), a mean main curve of 29.6°± 5.4° (range, 20°–40°), and a mean Risser grade of 2.0 ± 1.5 (range, 0–4) before brace treatment. Based on whether their scoliosis progressed or not, patients were divided into two groups: progressed (Group Pr, n = 27, 19%) and non‐progressed (Group NP, n = 115, 81%), and were then divided into a further two groups: surgery (Group Su, n = 18, 13%) and non‐surgery (Group NS, n = 124, 87%). χ² and logistic regression analyses were performed to investigate factors predicting outcomes of brace treatment. Results: The duration of brace treatment in all patients averaged 2.5 ± 1.0 years (range, 0.6–5.9). χ² analysis revealed that patients with progressive curves tended to be younger, with lower Risser grade, initial larger curve magnitude and a main thoracic curve pattern. Using stepwise logistic regression, pre‐menarche status (P= 0.00028) and a main thoracic curve pattern (P= 0.012) were found to be independent risk factors of curve progression despite brace treatment, while an initial Cobb angle >30° (P= 0.022) was an additional independent risk factor of curve requiring surgery due to progression. Conclusion: Brace treatment can prevent curve progression in most girls with AIS. The outcomes of brace treatment in these girls are influenced by growth status, curve pattern and curve magnitude. Less mature patients, and those with larger curves and thoracic curves are at risk of scoliosis progression despite brace treatment.     

Osteopenia: a new prognostic factor of curve progression in adolescent idiopathic scoliosis

BACKGROUND: Studies have shown that 27% to 38% of girls with adolescent idiopathic scoliosis have systemic osteopenia. The aim of this study was to investigate whether osteopenia could serve as one of the important prognostic factors in predicting curve progression. METHODS: A prospective study was performed in 324 adolescent girls with adolescent idiopathic scoliosis who had a mean age of thirteen and a half years. Bone mineral density of the spine and both hips was measured at the time of the clinical diagnosis of scoliosis. All patients were followed longitudinally until skeletal maturity or until the curve had progressed > or =6 degrees . The univariate chi-square test and stepwise logistic regression were used to predict the prevalence of curve progression, and a receiver operating characteristic curve was plotted. RESULTS: The overall prevalence of curve progression was 50%. The prevalence of osteopenia at the spine and hips was 27.5% and 23.1%, respectively. A larger initial Cobb angle (odds ratio = 4.6), a lower Risser grade (odds ratio = 4.7), premenarchal status (odds ratio = 2.5), osteopenia in the femoral neck of the hip on the side of the concavity (odds ratio = 2.3), and a younger age at the time of diagnosis (odds ratio = 2.1) were identified as risk factors in predicting curve progression. A predictive model was established, and the area under the receiver operating characteristic curve of the model was 0.80 (p < 0.01). CONCLUSION: Osteopenia may be an important risk factor in curve progression. The measurement of bone mineral density at the time of diagnosis may serve as an additional objective measurement in predicting curve progression in adolescent idiopathic scoliosis. The bone mineral density-inclusive predictive model may be used in treatment planning for patients with adolescent idiopathic scoliosis who are at high risk of curve progression.     

Results of brace treatment of adolescent idiopathic scoliosis in boys compared with girls: a retrospective study of 102 patients treated with the Boston brace

The aim of the study was to compare the results of brace treatment of adolescent idiopathic scoliosis (AIS) in male patients with matched female patients and to assess the effectiveness of bracing of boys in AIS and to discuss the results with published data. Between 1987 and 1995, 51 consecutive male patients with AIS were treated with the Boston brace. The patients were advised to wear the brace 23 h/day. The medical records of all patients were reviewed. Cobb angles and Risser signs were measured before bracing, in brace, at brace discontinuation and at final follow-up. Everyone of 51 male patients was compared with a female patient who was treated by the same method and matched by Risser sign, curve pattern, curve magnitude and duration of treatment and follow-up time. Compliance with brace was noted at every visit. Fourteen boys had worn the brace only during nighttime or occasionally and were considered non-compliant. Only compliant patients with treatment period > 1 year and follow-up > 1 year after treatment were accepted for the analyses of effectiveness of brace treatment and its prognostic factors. Thirty-three boys met these inclusion criteria. Bracing was considered to have a failure if > 5° progression occurred or if surgery was performed. At the final follow-up study progression > 5° was found in 16/51 (31.4%) of male patients. Corresponding figures of female patients were 11/51 (21.6%), respectively. In compliant boys progression > 5° occurred in 6/33 boys compared with 9/33 girls. The association between risk of progression and correction% in brace was statistically significant. The overall results of brace treatment of idiopathic scoliosis in male patients were inferior compared with matched females. One reason for inferior overall results in boys was poor compliance with brace wear. However, brace treatment in AIS may be recommended with the same principles in both genders.     

Role of the triradiate cartilage in predicting curve progression in adolescent idiopathic scoliosis

Braces are commonly used to treat progressive adolescent idiopathic scoliosis. Several previous studies have reported a correlation between the success of brace treatment and skeletal maturity markers. These studies have not focused on the status of the triradiate cartilage (TRC) as it relates to successful brace treatment for adolescent idiopathic scoliosis. The authors retrospectively evaluated all patients at their institution from 1990 to 1997 with a diagnosis of adolescent idiopathic scoliosis who were treated in a Boston brace. Sixty-two patients met inclusion criteria. At presentation, the average age was 12.87 years, the average Risser sign was 0.56, and 45% of patients had an open TRC. The average follow-up was 2.92 years. Greater than 5 degrees of progression at discontinuation of bracing was considered a failure. Curves with a closed TRC failed bracing 21% of the time, whereas those with an open TRC failed 54% of the time (P = 0.0069). Those curves with a closed TRC progressed 3.12 degrees on average, whereas curves with an open TRC progressed 6.86 degrees. Curves associated with a closed TRC at initiation of bracing progressed less frequently and to a lesser degree than those associated with an open TRC (P = 0.027). Although the TRC is not an independent predictor of curve stability, it is an additional indicator of skeletal maturity and may prove most useful in patients with otherwise borderline indications for brace treatment.     

Rib-vertebral angle measurements predict brace treatment outcome in Risser grade 0 and premenarchal girls with adolescent idiopathic scoliosis

Purpose

To investigate the predictive role of rib-vertebral angle (RVA) measurements in early adolescent idiopathic scoliosis (AIS) girls with right thoracic curve during brace treatment.

Methods

Early AIS (premenarchal and Risser 0) girls who had undergone brace treatment and had been followed regularly were recruited to this study. According to the bracing outcome, they were divided into Group A (non-progressed) and Group B (curve worsened over six degrees or indicated for surgery).

Results

Totally 48 girls were included. There were 30 and 18 patients in Groups A and B, respectively. Ratio of curve progression was significantly higher in patients with initial RVA difference (RVAD) ≥20° versus <20°, or convex RVA (CRVA) ≤68° versus >68°. From brace initiation to the latest follow-up, CRVA was found to be significantly higher in Group A versus Group B (P < 0.05), while RVAD was higher in Group B versus Group A (P < 0.05). Serial measurements revealed an increasing trend for RVAD (from 19 ± 10° to 29 ± 8°) yet a decreasing trend for CRVA (from 68 ± 6° to 60 ± 7°) in Group B, but both RVAD and CRVA were found to remain stable in Group A during the follow-up period. Association analyses showed that both RVAD ≥20° and CRVA ≤68° at brace initiation and at each follow-up were significantly associated with curve progression.

Conclusions

The initial RVAD ≥20° and CRVA ≤68° serve as valid factors in predicting the risk of curve progression during bracing in early AIS. Constant watch on RVAD and CRVA can help to more accurately predict the effectiveness of bracing in these patients.

     

Nighttime bracing with the Providence brace in adolescent girls with idiopathic scoliosis

STUDY DESIGN: A prospective study was conducted of 102 consecutive female patients with adolescent idiopathic scoliosis. Those patients with Risser 0, 1, and 2 met the criteria for inclusion and were treated only with the Providence brace. OBJECTIVES: To report the authors' experience with a hypercorrective nighttime brace and to evaluate the results with respect to risk factors for progression. Second, the study compares results with expectations from the natural history as reported by others. SUMMARY OF BACKGROUND DATA: Compliance with full-time brace treatment for adolescent idiopathic scoliosis has been a problem. Since the introduction of the Milwaukee brace, alternatives such as low-profile braces, reduced wearing schedules, and nighttime only bracing have been tried. However, many factors influence the success or failure besides compliance. These include in-brace correction, brace design, and the orthotist's skills. This is the first report of the results of treatment with a new nighttime brace that is made with CAD/CAM technology that can achieve higher initial in-brace corrections than other reported methods. METHODS: Results were analyzed with respect to curve size, curve pattern, maturity, and level of the primary curve apex. Both compliant and noncompliant patients were included in the analysis. A univariate analysis was done on those factors thought to influence success with bracing using the Pearson chi2 test. RESULTS: The average initial in-brace correction with a supine radiograph was 96% for major curves and 98% for minor curves. Seventy-five patients (74%) did not progress >5 degrees and 27 patients (26%) progressed > or =6 degrees or went on to surgery. Twenty-nine percent of Risser 0 or 1 patients progressed and 17% of patients Risser 2 progressed. The risk of progression anticipated by natural history data, which included all curve patterns, was 68% for Risser 0 and 1 and 23% for Risser 2. Risser 3 and 4 patients were excluded from the study. Seventy-six percent of patients with curve apexes between T8 and L1 had successful outcomes using the Providence brace. This is compared with a 74% success rate in the prospective Scoliosis Research Society study of patients wearing a thoraco lumbar sacral orthosis for 16 hours per day with curve apexes between T8 and L1. With the Providence brace, 63% of thoracic curves and 65% of double curves were successful. Ninety-four percent of lumbar curves and 93% of thoracolumbar curves were successful. CONCLUSION: Excellent initial in-brace correction of adolescent idiopathic scoliosis was observed with this computer-designed and manufactured recumbent brace. Patients with high apex curves cephalad to T8 (n = 31) had a success rate of 61% compared with a success rate of 79% (n = 71) if the apex was at or below T9. Compared with previous natural history and the prospective study data, the Providence brace is effective in preventing progression of adolescent idiopathic scoliosis for curves <35 degrees. It was effective for larger curves with a low apex. The authors' experience with patients with curves >35 degrees (n = 8) is too small to validate its effectiveness for larger curves with a higher apex.