目的：2010年评估了早发性脊柱侧凸（EOS）治疗的共识和不确定性。目前尚不清楚治疗偏好在过去十年中如何演变。这项研究的目的是重新评估EOS患者治疗方案的共识和不确定性，以了解他们与10年前的比较。
方法：邀请了11名儿科脊柱外科医师（与2010年的参与者相似）完成了对315例特发性和神经肌肉EOS病例（与2010年相同）的调查。治疗方案包括：保守管理，基于分散注意力的方法，生长指导/调制，和关节固定术。共识被定义为≥70%的协议，不确定度<70%。通过卡方和多元回归分析评估病例特征与治疗共识之间的关联。描述了与不确定性相关的案例特征。
结果：2010年原始队列中的11名外科医生[31.7±7.8年的经验]完成了调查。在年龄≤3岁的特发性患者中发现了保守治疗的共识，而在2010年，其中一些病例被选择进行手术。目前，对于1岁或2岁具有中等曲线的特发性患者，而在2010年，铸造和支撑之间存在不确定性。在手术共识的神经肌肉病例中，选择9岁曲线较大的患者进行关节固定术。
结论：目前，与2010年相比，保守管理的偏好有所增加，在某些婴儿病例中，铸造似乎比支撑更受欢迎。未来具有更高水平证据的研究工作应致力于阐明不确定性领域，以改善EOS人群的护理。
Consensus and uncertainty in early onset scoliosis (EOS) treatment were evaluated in 2010. It is currently unknown how treatment preferences have evolved over the past decade. The purpose of this study was to re-evaluate
consensus and uncertainty among treatment options for EOS patients to understand how they compare to 10 years ago.
11 pediatric spinal surgeons (similar participants as in 2010) were invited to complete a survey of 315 idiopathic and neuromuscular EOS cases (same cases as in 2010). Treatment options included the following: conservative management, distraction-based methods, growth guidance/modulation, and arthrodesis.
Consensus was defined as ≥ 70% agreement, and uncertainty was < 70%. Associations between case characteristics and
consensus for treatments were assessed via chi-squared and multiple regression analyses. Case characteristics associated with uncertainty were described.
Eleven surgeons [31.7 ± 7.8 years of experience] in the original 2010 cohort completed the survey. Consensus for conservative management was found in idiopathic patients aged ≤ 3, whereas in 2010, some of these cases were selected for surgery. There is currently consensus for casting idiopathic patients aged 1 or 2 with moderate curves, whereas in 2010, there was uncertainty between casting and bracing. Among neuromuscular cases with
consensus for surgery, arthrodesis was chosen for patients aged 9 with larger curves.
Presently, preferences for conservative management have increased in comparison to 2010, and casting appears to be preferred over bracing in select infantile cases. Future research efforts with higher levels-of-evidence should be devoted to elucidate the areas of uncertainty to improve care in the EOS population.
Level V.
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