Abstract：
Risser stage is widely used as a marker for skeletal maturity (SM) and thereby an indirect measure for the risk of progression of adolescent idiopathic scoliosis (AIS). The Scoliosis Research Society recommends bracing for Risser stages 0-2 as Risser stage 3 or above is considered low risk. Very few studies have assessed the risk of progression during bracing in Risser stages 3-4. The objective of the current study is to determine if Risser stages 3-4 provide a meaningful cutoff in terms of progression risk in patients with AIS treated with night-time bracing.
AIS patients treated with night-time brace from 2005 to 2018 with a Cobb angle between 25 and 40 degrees and Risser stages 0-4 were retrospectively included. Curve progression (> 5 degrees increase) was monitored until surgery or SM. Skeletal maturity was defined as either 2 years postmenarchal, no height development or closed ulnar epiphyseal plates on radiographs.
One hundred and thirty-five patients were included (Risser stages 0-2: n = 86 and 3-4: n = 49). Overall, radiographic curve progression occurred in 52% while progression beyond 45 degrees was seen in 35%. The progression rate in the Risser 0-2 group was 60% and 37% in the Risser 3-4 group (p = 0.012). In multivariate logistic regression analysis, adjusted for Risser stages and age, only premenarchal status showed a statistically significant association with progression (OR: 2.68, 95%CI 1.08-6.67).
Risser stage does not provide a clinically meaningful differentiation of progression risk in AIS patients treated with a night-time brace. Risk assessment should include other more reliable measures of skeletal growth potential.
AIS patients treated with night-time brace from 2005 to 2018 with a Cobb angle between 25 and 40 degrees and Risser stages 0-4 were retrospectively included. Curve progression (> 5 degrees increase) was monitored until surgery or SM. Skeletal maturity was defined as either 2 years postmenarchal, no height development or closed ulnar epiphyseal plates on radiographs.
One hundred and thirty-five patients were included (Risser stages 0-2: n = 86 and 3-4: n = 49). Overall, radiographic curve progression occurred in 52% while progression beyond 45 degrees was seen in 35%. The progression rate in the Risser 0-2 group was 60% and 37% in the Risser 3-4 group (p = 0.012). In multivariate logistic regression analysis, adjusted for Risser stages and age, only premenarchal status showed a statistically significant association with progression (OR: 2.68, 95%CI 1.08-6.67).
Risser stage does not provide a clinically meaningful differentiation of progression risk in AIS patients treated with a night-time brace. Risk assessment should include other more reliable measures of skeletal growth potential.
摘要：
目的：Risser分期被广泛用作骨骼成熟度（SM）的标志，从而间接衡量青少年特发性脊柱侧凸（AIS）的进展风险。脊柱侧弯研究协会建议支持Risser0-2期，因为Risser3期或以上被认为是低风险的。很少有研究评估Risser3-4期支撑过程中的进展风险。当前研究的目的是确定Risser3-4阶段是否在夜间支撑治疗的AIS患者的进展风险方面提供有意义的界限。
方法：回顾性纳入2005年至2018年接受夜间支具治疗的AIS患者，Cobb角在25至40度之间，Riser0-4期。监测曲线进展(>5度增加)直至手术或SM。骨骼成熟度定义为初潮后2年，X线片上无高度发育或尺骨骨phy板封闭。
结果：纳入了130例患者（Risser阶段0-2：n=86和3-4：n=49）。总的来说,52%的患者出现影像学曲线进展,35%的患者出现超过45度的进展.Risser0-2组的进展率为60％，Risser3-4组为37％（p=0.012）。在多变量逻辑回归分析中，针对Risser阶段和年龄进行了调整，只有初潮前状态与疾病进展有统计学显著关联(OR:2.68,95CI1.08-6.67).
结论：Risser分期并不提供夜间支架治疗的AIS患者的进展风险的临床意义。风险评估应包括其他更可靠的骨骼生长潜力指标。
方法：回顾性纳入2005年至2018年接受夜间支具治疗的AIS患者，Cobb角在25至40度之间，Riser0-4期。监测曲线进展(>5度增加)直至手术或SM。骨骼成熟度定义为初潮后2年，X线片上无高度发育或尺骨骨phy板封闭。
结果：纳入了130例患者（Risser阶段0-2：n=86和3-4：n=49）。总的来说,52%的患者出现影像学曲线进展,35%的患者出现超过45度的进展.Risser0-2组的进展率为60％，Risser3-4组为37％（p=0.012）。在多变量逻辑回归分析中，针对Risser阶段和年龄进行了调整，只有初潮前状态与疾病进展有统计学显著关联(OR:2.68,95CI1.08-6.67).
结论：Risser分期并不提供夜间支架治疗的AIS患者的进展风险的临床意义。风险评估应包括其他更可靠的骨骼生长潜力指标。
