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目的 :分析行支具治疗的特发性脊柱侧凸(idiopathic scoliosis,IS)患儿侧凸进展速率(Cobb velocity,CV)的相关因素,并探讨脊柱生长速率(spine length velocity,SLV)对IS患儿侧凸进展的预测价值。方法:于我院门诊行正规支具治疗的女性IS患儿23例,初诊时Risser征为0,无神经系统异常。其中胸主弯19例,胸腰弯4例,平均随访3.3年。患儿每次随访均拍摄站立位全脊柱正位片及左手掌正位片,测量主弯的Cobb角、Risser征、脊柱长度及骨龄(digital skeletal age,DSA)评分。另外记录患儿每次随访时的实足年龄、月经状态及身高等资料,计算患儿每次随访时的CV、SLV及身高生长速率(height velocity,HV)。采用Spearman相关系数分析IS患儿SLV及CV的相关因素。结果:本组患儿平均初诊年龄10.8±1.3岁;月经年龄12.2±2.0岁;初诊DSA评分384.6±51.9;初诊脊柱长度311.6±23.6mm;平均初诊身高145.5±7.8cm;平均初诊Cobb角23.0°±6.9°。随访时患儿平均SLV为19.1±17.1mm/年;平均HV为5.4±4.1cm/年;平均CV为5.7°±8.1°/年。另外,SLV高峰期(大于20mm/年)与CV高峰期(大于5°/年)均发生于实足年龄10~13岁之间。Spearman相关性分析表明,SLV与实足年龄、Risser征、DSA评分、HV及CV呈显著相关(r=-0.337、-0.292、-0.199、0.374和0.456,P<0.05);CV与实足年龄、DSA评分及HV呈显著相关(r=-0.192、-0.188和0.281,P<0.05)。结论:IS患儿侧凸进展速率与年龄、DSA评分、HV及SLV显著相关。SLV与年龄、Risser征、DSA评分及HV显著相关,是较好的评估IS患儿生长潜能和侧凸进展的指标。SLV大于20mm/年时提示较高的侧凸进展风险。
OBJECTIVE: To analyze the related factors of Cobb velocity (CV) in children with idiopathic scoliosis (IS) and to explore the effect of spine length velocity (SLV) on IS Prognostic value of the progress of children with scoliosis. METHODS: Twenty-three women with IS were admitted to our hospital for out-patient support. The Risser sign was 0 at first visit and no neurological abnormalities were observed. Among them, there were 19 cases of thoracolumbar curve and 4 cases of thoracolumbar curve with an average follow-up of 3.3 years. At each follow-up, the children were followed up to take a full spine orthophoric and left-handed orthopanal radiographs. Cobb angle, Risser sign, spine length and digital skeletal age (DSA) scores were measured. In addition, records of each child’s follow-up of the full-time age, menstrual status and height data were calculated at each follow-up of CV, SLV and height velocity (height velocity, HV). Spearman correlation coefficient was used to analyze the related factors of SLV and CV in children with IS. Results: The average age of first visit in this group was 10.8 ± 1.3 years; the age of menstruation was 12.2 ± 2.0 years; the initial DSA score was 384.6 ± 51.9; the initial length of the spine was 311.6 ± 23.6mm; the average newly diagnosed height was 145.5 ± 7.8cm; ± 6.9 °. The average SLV at follow-up was 19.1 ± 17.1 mm / year; the mean HV was 5.4 ± 4.1 cm / year; and the mean CV was 5.7 ° ± 8.1 ° / year. In addition, both the peak of SLV (more than 20mm / year) and the peak of CV (more than 5 ° / year) occurred between the actual age of 10 to 13 years old. Spearman correlation analysis showed that SLV was significantly correlated with age, Risser sign, DSA score, HV and CV (r = -0.337, -0.292, -0.199,0.374 and 0.456, P <0.05) Score and HV were significantly correlated (r = -0.192, -0.188 and 0.281, P <0.05). Conclusion: The progression rate of scoliosis in children with IS was significantly correlated with age, DSA score, HV and SLV. SLV is significantly associated with age, Risser sign, DSA score, and HV, and is a good indicator of growth potential and scoliosis in children with IS. A SLV greater than 20 mm / year suggests a higher risk of scoliosis progression.