目的:在特发性脊柱侧凸(IS)患者中经常观察到下肢差异(LLD),可能与病因有关。尽管已提议将唯一的升降机作为IS的保守治疗方法,支持其疗效的证据有限.本研究旨在评估单举干预对轻度IS患儿的影响。特别关注胸腰椎/腰椎(TL/L)曲率。
方法:20名患者,平均年龄12.3±3.1岁,呈轻度TL/L曲线(15.6°±6.2°),从2023年2月至2023年8月在我们脊柱中心门诊的267名儿科IS患者中选择。纳入标准包括一条介于10°和40°之间的主要TL/L曲线,位于主曲线凸面的下肢,LLD小于2cm;排除需要支撑或手术干预的个体。定制的鞋底提升用于解决下肢较短的问题,目的是使骨盆平整。在干预之前和之后,都使用站立的全脊柱后前X线照片和全腿部X线照片进行了X线照相评估。进行统计分析以评估曲线校正及其与其他影响因素的关系。
结果:平均结构和功能LLD分别为7.1±4.5mm和7.1±4.1mm,分别。在20名患者中,四个显示结构LLD大于10毫米。随访3~8个月,平均6.4±1.9个月。单独提升干预后(7.0±3.0mm),与鞋底前抬起测量相比,TL/L曲线显着降低(15.6°±6.2°与12.1°±7.2°,p<0.001),以及胸曲线的显着降低(12.2°±4.0°与8.6°±6.3°,p=0.064)。9例患者曲线显著降低≥5°,而八个显示在0°和5°之间的减小;然而,2例患者曲线大小无变化.此外,TL/L曲线的校正率与功能LLD(r=-0.484,p=0.030)和骨盆倾斜度(r=-0.556,p=0.011)显着相关。强调积极的骨盆补偿在维持脊柱和下肢之间的平衡。相反,曲线校正与结构LLD无显著相关性(p>0.05)。此外,即使在调整了其他影响因素后,TL/LCobb角在鞋底提升前和后之间仍然存在显着差异(p=0.037)。
结论:这项研究证实了单举干预在纠正具有主要TL/L曲线的轻度IS患儿中的TL/L和胸曲线的有效性。为下肢在主曲线凸度的患者提供补充保守治疗选择。此外,我们的发现强调了下肢和骨盆在IS病因中的积极补偿,强调在治疗策略中考虑其影响的重要性。
OBJECTIVE: Lower limb discrepancy (LLD) was frequently observed in patients with idiopathic scoliosis (IS), potentially associated with etiopathogenesis. Although sole lifts had been proposed as a conservative treatment for IS, evidence supporting their efficacy was limited. This study aimed to assess the effects of sole lift intervention on pediatric patients with mild IS, specifically focusing on thoracolumbar/lumbar (TL/L) curvature.
METHODS: Twenty patients, with an average age of 12.3 ± 3.1 years and presenting mild TL/L curve (15.6° ± 6.2°), were selected from a pool of 267 pediatric IS patients in the outpatient of our spine center from February 2023 to August 2023. Inclusion criteria comprised a main TL/L curve ranging between 10° and 40°, the lower limb positioned at the convexity of the main curve, and LLD of less than 2 cm; individuals requiring bracing or surgical intervention were excluded. Custom sole lifts were used to address the shorter lower limb with the objective of leveling the pelvis. Radiographic evaluations were conducted both before and after intervention using standing full spine posteroanterior radiographs and full leg length radiographs. Statistical analysis was undertaken to evaluate curve correction and its associations with other influencing factors.
RESULTS: The mean structural and functional LLD were 7.1 ± 4.5 mm and 7.1 ± 4.1 mm, respectively. Among the 20 patients, four exhibited structural LLD greater than 10 mm. The average follow-up duration was 6.4 ± 1.9 months (range: 3-8 months). Following sole lift intervention (7.0 ± 3.0 mm), a significant reduction was observed in the TL/L curve compared to the pre-sole lifting measurements (15.6° ± 6.2° vs. 12.1° ± 7.2°, p < 0.001), as well as a notable decrease in the thoracic curve (12.2° ± 4.0° vs. 8.6° ± 6.3°, p = 0.064). Nine patients experienced a significant curve reduction of ≥5°, while eight showed a reduction between 0° and 5°; however, two patients exhibited no change in curve magnitude. Furthermore, the correction rate of the TL/L curve correlated significantly with functional LLD (r = -0.484, p = 0.030) and
pelvic obliquity (r = -0.556, p = 0.011), highlighting the active
pelvic compensation in maintaining balance between the spine and lower limbs. Conversely, no significant correlation was observed between curve correction and structural LLD (p > 0.05). Additionally, even after adjusting for other influencing factors, the TL/L Cobb angle remained significantly different between pre- and post-sole lifting (p = 0.037).
CONCLUSIONS: This study confirmed the effectiveness of sole lift intervention in correcting TL/L and thoracic curves among the mild IS children with a main TL/L curve, providing a supplementary conservative treatment option for patients with the lower limb at the convexity of the main curve. Moreover, our findings underscored the active compensation of the lower limbs and the pelvis in the etiopathogenesis of IS, highlighting the importance of considering their influence in treatment strategies.