阶梯疗法干预下中、小学生脊柱侧凸患病率调查情况

目的总结阶梯疗法干预下持续1-12年观察中、小学生脊柱侧凸发病率的情况。方法 1997年10月-2009年10月应用脊柱侧凸三检法（体检、波纹照相、X线摄片）对中山市44 058名中、小学生进行普查后,建立了由医院、学校、家庭组成的脊柱侧凸防治网络体系。对发生脊柱侧凸的学生按照Cobb角大小进行分组,采用阶梯式疗法分别对不同程度脊柱侧凸进行干预。A组：5°≤Cobb角〈10°,对其实施宣教工作;B组：10°≤Cobb角〈20,°采用体操锻炼疗法;C组：20°≤Cobb角〈40°,采用体操锻炼联合牵引、支具治疗;D组：Cobb角≥40°或脊柱侧凸有较快发展趋势的患者行手术矫形。结果跟踪随访1~12年。按照Cobb角≥10°为诊断标准,共有134例确诊为脊柱侧凸,在阶梯疗法干预下脊柱侧凸发病率为3‰。按照Cobb角程度所分的A、B、C 3组中,分别有4、5、2个患者病情进展、畸形加重进入下一组继续治疗,3组患者中病情进展率分别为2.90%、6.02%、4.65%。D组患者实施手术矫形,手术顺利,患者术后外观改善满意。结论开展青少年儿童脊柱侧凸普查并进行适时、阶梯性干预对早期防治脊柱侧凸有着积极的意义。

A survey on adolescent scoliosis under the step intervention

Objective To investigate the incidence of the scoliosis and the development of deformity among adolescent population under the step intervention.Methods 44 058 students were examined for scoliosis by physical examination,moire topography and X-ray examination from Oct,1997 to Oct,2009.The Cobb′s angle was measured for the suspected subjects.The children whose Cobb′s angle ≥5° were separated into four groups: A: 5°≤Cobb′s angle<10°,B: 10°≤Cobb′s angle<20°,C: 20°≤Cobb′s angle<40°,D: Cobb′s angle≥40°,and then were treated with missionary,gymnastics,traction,braces or surgery respectively.This management strategy was named to step intervention.Results All cases were followed up from 1 to 12 years.According to the diagnositic standand of Cobb′s angle≥10°,134 students were definitely diagnosed to scoliosis,with a prevalence of 3‰.There were 4 patients in group A,5 in group B and 2 in group C whose Cobb′s angle had gotten worse and went into next group continued the corresponding treatment respectively.Therefore,the rates of the worse of disease were 2.90%,6.02% and 4.65% in group A,B and C respectively.Group D were undergone surgical correction.All operations were done without accidents.The appearance recovery was satisfactory.Conclusions The survey on adolescent scoliosis among adolescent population is of great importance for early diagnosis.And the management of adolescent scoliosis with step treatments according to Cobb′s angle could be an effective method to prevent the progressing of deformity.