PDF(Pubmed)
Abstract：
Juvenile idiopathic scoliosis (JIS) outcomes with brace treatment are limited with poorly described bracing protocols. Between 49 and 100% of children with JIS will progress to surgery, however, young age, long follow-up, and varying treatment methods make studying this population difficult. The purpose of this study is to report the outcomes of bracing in JIS treated with a Boston brace™ and identify risk factors for progression and surgical intervention.
This is a single-center retrospective review of 175 patients with JIS who initiated brace treatment between the age of 4 and 9 years. A cohort of 140 children reached skeletal maturity; 91 children had surgery or at least 2 year follow-up after brace completion. Standard in-brace protocol for scoliosis 320° was a Boston brace for 18-20 h/day after MRI (n = 82). Family history, MRI abnormalities, comorbidities, curve type, curve magnitude, bracing duration, number of braces, compliance by report, and surgical interventions were recorded.
Children were average 7.9 years old (range 4.1-9.8) at the initiation of bracing. The Boston brace™ was prescribed in 82 patients and nine used night bending brace. Mid-thoracic curves (53%) was the most frequent deformity. Maximum curve at presentation was on average 30 ± 9 degrees, in-brace curve angle was 16 ± 8 degrees, and in-brace correction was 58 ± 24 percent. Patients were braced an average of 4.6 ± 1.9 years. 61/91 (67%) went on to posterior spinal fusion at 13.3 ± 2.1 (range 9.3-20.9) years and curve magnitude of 61 ± 12 degrees. Of those that underwent surgery, 49/55 (86%) progressed > 10°, 6/55 (11%) stabilized within 10°, and 0/55 (0%) improved > 10° with brace wear. No children underwent growth-friendly posterior instrumentation. Of the 28 who did not have surgical correction, 3 (11%) progressed > 10°, 13/28 (46%) stabilized within 10°, and 12/28 (43%) improved > 10° with brace wear.
This large series of JIS patients with bracing followed to skeletal maturity with long-term follow-up. Surgery was avoided in 33% of children with minimal to no progression, and no child underwent posterior growth-friendly constructs. Risk factors of needing surgery were noncompliance and larger curves at presentation.
This is a single-center retrospective review of 175 patients with JIS who initiated brace treatment between the age of 4 and 9 years. A cohort of 140 children reached skeletal maturity; 91 children had surgery or at least 2 year follow-up after brace completion. Standard in-brace protocol for scoliosis 320° was a Boston brace for 18-20 h/day after MRI (n = 82). Family history, MRI abnormalities, comorbidities, curve type, curve magnitude, bracing duration, number of braces, compliance by report, and surgical interventions were recorded.
Children were average 7.9 years old (range 4.1-9.8) at the initiation of bracing. The Boston brace™ was prescribed in 82 patients and nine used night bending brace. Mid-thoracic curves (53%) was the most frequent deformity. Maximum curve at presentation was on average 30 ± 9 degrees, in-brace curve angle was 16 ± 8 degrees, and in-brace correction was 58 ± 24 percent. Patients were braced an average of 4.6 ± 1.9 years. 61/91 (67%) went on to posterior spinal fusion at 13.3 ± 2.1 (range 9.3-20.9) years and curve magnitude of 61 ± 12 degrees. Of those that underwent surgery, 49/55 (86%) progressed > 10°, 6/55 (11%) stabilized within 10°, and 0/55 (0%) improved > 10° with brace wear. No children underwent growth-friendly posterior instrumentation. Of the 28 who did not have surgical correction, 3 (11%) progressed > 10°, 13/28 (46%) stabilized within 10°, and 12/28 (43%) improved > 10° with brace wear.
This large series of JIS patients with bracing followed to skeletal maturity with long-term follow-up. Surgery was avoided in 33% of children with minimal to no progression, and no child underwent posterior growth-friendly constructs. Risk factors of needing surgery were noncompliance and larger curves at presentation.
摘要：
背景：支架治疗的幼年特发性脊柱侧凸（JIS）结局有限，支架治疗方案描述不佳。49％至100％的JIS儿童将接受手术治疗，然而,年轻的年龄,长期随访,不同的治疗方法使得研究这个人群变得困难。这项研究的目的是报告使用波士顿支架治疗的JIS支架的结果，并确定进展和手术干预的风险因素。
方法：这是对175例JIS患者的单中心回顾性研究，这些患者在4至9岁之间开始了支具治疗。140名儿童达到骨骼成熟；91名儿童在支架完成后接受了手术或至少2年的随访。320°脊柱侧弯的标准支架方案是MRI后18-20小时/天的波士顿支架（n=82）。家族史,MRI异常,合并症,曲线类型,曲线幅度,支撑持续时间,大括号的数量，通过报告遵守，并记录手术干预。
结果：在支撑开始时，儿童的平均年龄为7.9岁（范围为4.1-9.8）。在82名患者和9名使用的夜间弯曲支架中规定了波士顿支架™。胸中曲线（53％）是最常见的畸形。演示时的最大曲线平均为30±9度，内支撑曲线角度为16±8度，支架内矫正为58±24%。患者平均支撑4.6±1.9年。61/91（67％）在13.3±2.1（范围9.3-20.9）年进行后路脊柱融合，曲线幅度为61±12度。在那些接受手术的人中，49/55（86%）进展>10°，6/55(11%)稳定在10°内,0/55(0%)在支架磨损时改善>10°。没有儿童接受了对生长友好的后部器械。在没有手术矫正的28人中，3（11%）进展>10°，13/28（46%）稳定在10°内，和12/28（43％）的支架磨损改善>10°。
结论：这一大系列的JIS患者在长期随访后，骨骼成熟。33%的儿童避免了手术，进展轻微到没有进展，没有孩子接受后路生长友好型结构。需要手术的危险因素是不依从性和表现曲线较大。
方法：这是对175例JIS患者的单中心回顾性研究，这些患者在4至9岁之间开始了支具治疗。140名儿童达到骨骼成熟；91名儿童在支架完成后接受了手术或至少2年的随访。320°脊柱侧弯的标准支架方案是MRI后18-20小时/天的波士顿支架（n=82）。家族史,MRI异常,合并症,曲线类型,曲线幅度,支撑持续时间,大括号的数量，通过报告遵守，并记录手术干预。
结果：在支撑开始时，儿童的平均年龄为7.9岁（范围为4.1-9.8）。在82名患者和9名使用的夜间弯曲支架中规定了波士顿支架™。胸中曲线（53％）是最常见的畸形。演示时的最大曲线平均为30±9度，内支撑曲线角度为16±8度，支架内矫正为58±24%。患者平均支撑4.6±1.9年。61/91（67％）在13.3±2.1（范围9.3-20.9）年进行后路脊柱融合，曲线幅度为61±12度。在那些接受手术的人中，49/55（86%）进展>10°，6/55(11%)稳定在10°内,0/55(0%)在支架磨损时改善>10°。没有儿童接受了对生长友好的后部器械。在没有手术矫正的28人中，3（11%）进展>10°，13/28（46%）稳定在10°内，和12/28（43％）的支架磨损改善>10°。
结论：这一大系列的JIS患者在长期随访后，骨骼成熟。33%的儿童避免了手术，进展轻微到没有进展，没有孩子接受后路生长友好型结构。需要手术的危险因素是不依从性和表现曲线较大。
