PDF(Pubmed)
Abstract：
Background: The progression of scoliosis has been observed in skeletally mature patients with cerebral palsy (CP). The aims of this systematic review were to determine the incidence of curve progression of untreated scoliosis after skeletal maturity, to estimate the average annual increase and to identify factors that influence the progression. Methods: A systematic literature search was performed in PubMed, Embase and the Cochrane Library for original research articles published between 1968 and May 2024 with a retrospective, prospective or cross-sectional design, investigating CP patients that were followed up beyond the age of 15 years. The search was limited to articles in English, French, German and Dutch. Articles were excluded if the study population concerned neuromuscular diseases other than CP. After an assessment of the methodological quality of each study, estimates of annual curve progression and the effect of the investigated risk factors for progression were recorded systematically and synthetized. Results: Fifteen studies met the inclusion criteria, resulting in a total sample size of 2569 participants. The study populations of the included original research articles were small and heterogeneous in terms of patient age and the type and severity of CP. Curve progression after skeletal maturity occurred in all included studies. A greater curve magnitude at the end of adolescence and a severe motor deficit (an inability to walk or GMFCS IV-V) were identified as significant risk factors for the progression of scoliosis after skeletal maturity. If at least one of these risk factors was present, scoliotic curves progressed after skeletal maturity in up to 74% of patients, with an average annual increase of 1.4 to 3.5 degrees per year. No significant association was found between curve progression and the physiologic type of CP, the type of scoliotic curve, previous hip surgery, positioning and gravity, weight and length, sex, epilepsy, or pelvic obliquity. Findings on the effect of hip instability were inconsistent: a positive correlation was found with the progression of scoliosis overall, but not after skeletal maturity in particular. A significant selection bias should be considered in the calculation of average annual curve progression, as patients that received interventions to halt curve progression were excluded from follow-up. Conclusions: The identification of risk factors in patients with CP and scoliosis can aid in predicting curve progression and managing follow-ups in clinical practice. Based on the findings in this review a radiographic follow-up once every 3 years is recommended for skeletally mature CP patients with at least one risk factor, and once every 5 years if no risk factors are present.
摘要：
背景：已在骨骼成熟的脑瘫（CP）患者中观察到脊柱侧凸的进展。这项系统评价的目的是确定骨骼成熟后未经治疗的脊柱侧凸的曲线进展的发生率。估计年平均增幅，并确定影响进展的因素。方法：在PubMed进行系统的文献检索，Embase和Cochrane图书馆在1968年至2024年5月之间发表的原始研究文章，并进行了回顾性研究，前瞻性或横截面设计，调查年龄超过15岁的CP患者。搜索仅限于英文文章，法语,德国和荷兰。如果研究人群涉及除CP以外的神经肌肉疾病，则排除文章。在评估了每项研究的方法学质量后，系统并综合记录了年度曲线进展的估计值以及所调查的进展风险因素的影响.结果：15项研究符合纳入标准，总样本量为2569名参与者。纳入的原始研究文章的研究人群在患者年龄以及CP的类型和严重程度方面是小且异质的。在所有纳入的研究中，骨骼成熟后出现曲线进展。青春期结束时更大的曲线幅度和严重的运动缺陷（无法行走或GMFCSIV-V）被确定为骨骼成熟后脊柱侧凸进展的重要危险因素。如果这些危险因素中至少有一个存在，脊柱侧凸曲线在骨骼成熟后进展高达74%的患者，每年平均增加1.4至3.5度。曲线进展与CP的生理类型之间没有发现显着关联，脊柱侧弯的类型,以前做过髋关节手术,定位和重力，重量和长度,性别,癫痫,或骨盆倾斜。对髋关节不稳定的影响的研究结果不一致：发现与脊柱侧凸的总体进展呈正相关，但特别是在骨骼成熟之后。在计算年平均曲线级数时应考虑显著的选择偏差，因为接受干预以停止曲线进展的患者被排除在随访之外.结论：确定CP和脊柱侧凸患者的危险因素有助于预测曲线进展和管理临床实践中的随访。根据本综述的发现，建议对至少有一个危险因素的骨骼成熟CP患者进行每3年一次的影像学随访。如果没有危险因素，每5年一次。
