Curve Progression in Idiopathic Scoliosis Follow-up Study to Skeletal Maturity
Curve Progression in Idiopathic Scoliosis Follow-up Study to Skeletal Maturity
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DOI：
10.1097/brs.0b013e31819c9431
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发表时间：
2009-04-01
期刊：
影响因子：
3
通讯作者：
Wong, Hee-Kit
中科院分区：
文献类型：
--
作者：
Tan, Ken-Jin;Moe, Maung Maung;Wong, Hee-Kit
研究设计。这是一项为期一年的脊柱侧弯前瞻性流行病学患病率研究，对一群学生进行骨骼成熟度的随访研究。本研究旨在确定在骨骼发育不成熟的青少年特发性脊柱侧凸患者中，在骨骼成熟时曲度进展到30级的预后因素。特发性脊柱侧弯的自然病史尚不清楚。以前的报告侧重于曲线级数的特征，其中级数已预先定义为5度至6度的特定角度。然而，骨骼成熟时的绝对曲线大小更能预测长期的曲线行为，而不是在骨骼生长的较短时期内以特定大小的曲线进展。人们普遍认为，低于30的曲线在骨骼成熟后极不可能进展。因此，确定影响骨骼成熟时曲线发展到绝对值超过30的因素将对临床实践有更大的帮助。符合研究标准的186名患者是从学校筛查发现的279名特发性脊柱侧凸患者中挑选出来的，并进行了随访，直到骨骼成熟。使用初始年龄、性别、青春期状态和初始弯曲程度作为危险因素，预测骨骼成熟时弯曲进展到30以上的概率。首次出现时的曲度是最重要的预测因素，在骨骼成熟时曲度发展到30以上。初始Cobb角为25的受试者操作特性最好，为0.80，其阳性预测值为68.4%，阴性预测值为91.9%。初始Cobb角大小是预测骨骼成熟后的长期曲线进展和行为的最重要的指标。我们建议初始Cobb角为25作为长期曲线进展的重要阈值。在我们的研究中，初始年龄、性别和青春期状况是较不重要的预后因素。
Study Design. This is a follow-up study to skeletal maturity on a cohort of students screened for a 1-year prospective epidemiological prevalence study for scoliosis.Objectives. This study aims to identify the prognostic factors for curve progression to a magnitude of 30 at skeletal maturity in skeletally immature patients with adolescent idiopathic scoliosis.Summary of Background Data. The natural history of idiopathic scoliosis is not well understood. Previous reports have focused on the characteristics of curve progression where progression has been predefined at specific angles of 5 degrees to 6 degrees. However, the absolute curve magnitude at skeletal maturity is more predictive of long-term curve behavior rather than curve progression of a defined magnitude over shorter periods of skeletal growth. It is generally agreed that curves less than 30 are highly unlikely to progress after skeletal maturity. Hence, defining the factors that influence curve progression to an absolute magnitude of more than 30 at skeletal maturity would more significantly aid clinical practice.Methods. One hundred eighty-six patients who fulfilled the study criteria were selected from an initial 279 patients with idiopathic scoliosis detected by school screening, and who were followed-up till skeletal maturity. The initial age, gender, pubertal status, and initial curve magnitude were used as risk factors to predict the probability of curve progression to more than 30 at skeletal maturity.Results. Curve magnitude at first presentation was the most important predictive factor for curve progression to a magnitude of more than 30 at skeletal maturity. An initial Cobb angle of 25 had the best receiver-operating characteristic of 0.80 with a positive predictive value of 68.4% and a negative predictive value of 91.9% for curve progression to 30 or more at skeletal maturity.Conclusion. Initial Cobb angle magnitude is the most important predictor of long-term curve progression and behavior past skeletal maturity. We suggest an initial Cobb angle of 25 as an important threshold magnitude for long-term curve progression. Initial age, gender, and pubertal status were less important prognostic factors in our study.