青少年特发性脊柱侧凸的临床随访研究
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摘要
青少年特发性脊柱侧凸(Adolescent Idiopathic Scoliosis简称AIS),脊柱侧凸研究会(SRS)定义为10岁以上,骨骼发育未成熟期间,脊柱向侧方弯曲大于10°的脊柱畸形。它是青少年最常见的脊柱畸形之一。尽管目前对AIS的研究已经在各方面取得了突破,但仍然有许多问题尚存争议,而在非手术治疗AIS中,主要存在以下四个方面的问题:第一,生长发育和AIS的畸形变化之间有何关系;第二,支具治疗AIS的适应症及支具使用方案;第三,如何有效的预测侧凸畸形的发展变化趋势;第四,如何综合评价支具治疗AIS的疗效。本研究将在对AIS患者随访过程中对以上问题进行探讨和分析。
1.生长发育与青少年特发性脊柱侧凸
1.1坐高与站高的比率和青少年特发性脊柱侧凸关系的分析
目的探讨青少年特发性脊柱侧凸患者坐高与站高的比率是否和侧凸角度大小之间存在相关关系,并依据这一关系建立预测侧凸角度大小的数学方程。方法对46例轻、中度青少年特发性脊柱侧凸患者进行观察分析,男8例,女38例;年龄10岁～20岁,平均13.8岁;单弯。测量记录患者初次就诊时的实足年龄、站高、坐高以及Cobb角的大小,并根据对患者站高、坐高测量记录的数据,分别计算每位患者坐高与站高的比率。结果46例患者的坐高66.00cm～88.80cm(均数±标准差, 80.54cm±5.75cm);站高P126.00cm～174.80cm(均数±标准差,153.67cm±10.72cm);坐高与站高的比率0.50～0.55(均数±标准差,0.52±0.01);Cobb角10°～45°(均数±标准差,25.70°±9.66°)。患者的实足年龄、坐高、站高和Cobb角之间均没有相关关系( r分别为0 .147,0.0 15, ?0 .106; >0.05);而患者的坐高与站高的比率和Cobb角之间存在明显的正相关关系( r =0 .675;P <0 .05);并根据这一关系建立了预测轻、中度青少年特发性脊柱侧凸侧凸角度大小的数学方程。结论青少年特发性脊柱侧凸患者坐高与站高的比率和侧凸角度大小之间存在明显的正相关关系,可以依据坐高与站高的比率预测轻、中度青少年特发性脊柱侧凸单弯患者侧凸角度的大小。
2.青少年特发性脊柱侧凸的支具治疗
2.1支具治疗青少年特发性脊柱侧凸的临床随访研究
目的:评价支具治疗青少年特发性脊柱侧凸的临床疗效,分析影响支具治疗效果的相关因素,并探讨支具治疗的适应证。方法:对79例接受支具治疗的青少年特发性脊柱侧凸患者进行随访,男11例,女68例。在随访期间连续测量记录患者的Cobb角,侧凸类型,女性患者初潮与否,坐高,站高,Risser征,顶椎旋转度等。结果:全部病例完成12～60个月的随访,平均23.9月。初诊时年龄10～17岁,平均13.8岁;末次随访时21例(26.6%)畸形明显进展,畸形维持或稍进展者40例(50.6%),18例(22.8%)畸形改善。初诊时原发弯Cobb角大于45°组侧凸进展率较Cobb角≤35°组高,侧凸改善率较Cobb角≤35°组低(P<0.05);顶椎旋转度Ⅲ度以上组侧凸进展率较0～Ⅱ度组高,侧凸改善率较0～Ⅱ度组低(P<0.05)。侧凸类型、Risser征等参数不同的患者畸形进展和改善的比率均存在不同程度的差别,但差异不具有显著性。结论:矫形支具能够有效控制或改善轻、中度特发性脊柱侧凸畸形,特别是侧凸角度在20°～35°的疗效较好,单独借助Risser征预测侧凸畸形变化趋势并不可靠,初始Cobb角大于45°,顶椎旋转度在Ⅲ度以上的患者,支具治疗的效果不佳,应尽早考虑手术矫形。
2.2支具治疗女性青少年特发性脊柱侧凸畸形加重的危险因素分析
目的:观察支具治疗女性青少年特发性脊柱侧凸的畸形变化情况并分析侧凸畸形进展的危险因素。方法:对65例接受支具治疗的女性青少年特发性脊柱侧凸患者进行随访。在随访期间连续测量记录患者的Cobb角,侧凸类型,月经初潮与否,坐高,站高,Risser征,顶椎旋转度等。分析初诊时和末次随访时侧凸变化情况,并从上述多项参数中筛选引起侧凸加重的危险因素。结果:全部病例完成12～60个月的随访,平均24.1月。初诊时年龄10～16岁,平均13.7岁;末次随访时17例(26.15%)患者侧凸进展超过5°,初诊时原发弯Cobb角大于35°,顶椎旋转在Ⅲ度以上的患者,侧凸明显进展的比率较高(P<0.05)。通过Logistic逐步回归分析,发现初诊时原发弯Cobb角大于35°,顶椎旋转度Ⅲ度以上,年身高增长在30mm以上的患者,是侧凸进展到5°以上的危险因素。结论:初诊时原发弯Cobb角值,顶椎旋转度及身高增长速度是预测女性青少年特发性脊柱侧凸进展的重要因素,借助Risser征预测侧凸进展并不可靠,初始原发弯Cobb角大于35°,顶椎旋转度在Ⅲ度以上,年身高增长在30mm以上的患者,侧凸进展的危险性较高。
3.青少年特发性脊柱侧凸健康相关的生活质量及心理状况评价
3.1 SRS-22问卷在中国青少年特发性脊柱侧凸患者中的修订
目的:将脊柱侧凸研究会问卷(SRS-22 Questionnaire)引入中国,评价该问卷在中国青少年特发性脊柱侧凸患者中的测量特性。方法:依据国际生活质量评价(The International Quality of Life Assessment,IQOLA)计划规则,将SRS-22患者问卷翻译改编为中文,由专家组研究确定最终版本。使用该问卷对86例(男11例,女75例)正规支具治疗的青少年特发性脊柱侧凸患者进行初次测评,患儿年龄在10岁～18岁,平均13.9岁;侧凸角度在25°～45°,平均35.6°。初测3～4周后,对其中30例患者进行重测。结果: SRS-22问卷总体α系数为0.88,重测信度为0.97。问卷中的五个因素的α系数分别为:功能活动,0.70;疼痛,0.80;自我形象,0.80;心理状况,0.88;对治疗的满意程度,0.81;重测信度分别为:功能活动,0.85;疼痛,0.96;自我形象,0.96;心理状况,0.95;对治疗的满意程度,0.91。因素分析产生5个公共因素,结果累积解释方差贡献为67.66%。结论:SRS-22问卷翻译改编成中文后具备合格的信度和效度,可以应用该问卷测量中国青少年特发性脊柱侧凸患者的生活质量。
Adolescent idiopathic scoliosis(AIS)is defined by Scoliosis Research Society(SRS)as age greater than ten years, lateral deviation of the normal vertical line of the spine which, when measured by X-ray, is greater than ten degrees before skeletal maturity. It is one of the commonest spine deformities in adolescents.Although a lot of scientific breakthroughs on adolescent idiopathic scoliosis have been obtained in various fields, there are still many controversies, particularly for non-surgical regime. The questions need to be answered in regard to AIS during nonoperation treatment such as: Firstly, what relationships between growth and deformed change exist in AIS. Secondly, the indications of brace treatment and weaning program. Thirdly, how to predict curve progression of scoliosis; lastly, how to assess the effect of bracing in an all-round way. This investigation was designed to find the answers for above questions.
1. Growth and adolescent idiopathic scoliosis
1.1 Correlation of sitting height to standing height ratio with Cobb’s angle in children with idiopathic scoliosis/A mathematical analysis in the cases with single curve
Objective To identify any statistically significant correlation of sitting height to standing height ratio with Cobb’s angle value in children with idiopathic scoliosis, and to establish a mathematical formula for the prediction of scoliosis progression in the cases with single curve. Methods The criteria for patient admission in this study include:(1)no previous history of medical treatment;(2)older than 10 years of age;(3)mild and moderate scoliosis(Cobb’s angle<45°);(4)single curve;(5)no sign of degenerative disorders;(6)equal lower limbs without any anomalies. Forty-six children (38 females, 8 males) with mild or moderate idiopathic scoliosis were selected in accordance with the above criteria. The age of these patients ranged from 10 to 20 years, with the average of 13.8 years at the first examination. Chronological age, sitting height, standing height and Cobb’s angle values were measured and well documented. According to the measurement of sitting height and standing height in these patients, the ratio of sitting height to standing height was calculated. Results The sitting heights in 46 patients ranged from 66.00 cm to 88.80 cm(mean±standard deviation, 80.54cm±5.75cm); The standing heights ranged from 126.00 cm to 174.80 cm(mean±standard deviation, 153.67cm±10.72cm); ratio of sitting height to standing height ranged from 0.50 to 0.55(mean±standard deviation, 0.52±0.01); The Cobb’s angles ranged from 10°to 45°(mean±standard deviation, 25.70°±9.66°). There were no statistically correlation between Cobb’s angle values, chronological age, sitting height, and standing height. However, a statistically significant positive correlation between the ratio of sitting height to standing height and the Cobb’s angle value was demonstrated. Conclusions There is a significant positive correlation between ratios of sitting height to standing height and Cobb’s angle values in children with idiopathic scoliosis. The ratio of sitting height to standing height as a useful parameter can be used to predict the development of Cobb’s angle in children with mild or moderate idiopathic scoliosis.
2. Clinical follow-up studies on adolescents who are bracing with idiopathic scoliosis
2.1 A clinical follow-up study on treatment of adolescent idiopathic scoliosis with brace
Objective:To evaluate clinical outcomes of bracing and to analyze factors that influence the effects of treatment in adolescents with idiopathic scoliosis, and to reveal or to advise the indications of bracing. Methods:Seventy-nine patients(11 males; 68 females) with AIS who had no history of prior therapy were treated with a brace. Several parameters were consecutively measured and documented during the period of follow-up including Cobb’s angles, curve patterns, menarche status,sitting heights, standing heights, Risser sign, apical vertebral rotation. Results:The average duration of followed-up study was 30 months (12 months to 60 months).Twenty-one patients (26.6%) presented curve deterioration, 40 patients have no obvious curve change, 18 patients (22.8%) got a curve improvement. There was significantly lower percentage of curve progression and higher percentage of curve improvement in cases with Cobb’s angle less than 35°at the first visit(P<0.05). The percentage of curve progression was significantly greater in the cases with apical vertebral rotation beyond grade III while the percentage of curve improvement was lower (P<0.05). Curve patterns, Risser sign and other parameters were also found to make their effects on the percentage of curve progression and improvement, which, however, were not statistically significant(P>0.05). Conclusion:Bracing can limit or improve mild and moderate curve of idiopathic scoliosis effectively, especially in cases with initial curve magnitude ranging from 20°to 35°, Outcome measurement for AIS can not be relied only upon Risser sign. Surgery is advised as soon as possible for the cases with initial Cobb’s angles greater than 45°and initial apical vertebral rotation beyond gradeⅢwhile bracing did not result in any improvement.
2.2 Prognostic factors of progression of adolescent idiopathic scoliosis in girls treated with a brace
Objective: To investigate curve behavior and to analyze which of nine factors were of significant value in predicting the progression of the scoliotic curve in girls with AIS treated with a brace. Methods:sixty -five girls with AIS were braced. Cobb’s angles, curve patterns, menarche status,sitting heights, standing heights, Risser sign, apical vertebral rotation, etc were consecutively measured and documented during the period of follow-up. Curve behavior between the first visit and final follow-up was analyzed. Several different parameters which may contribute to progression of curve were selected. Results:The patients aged 10-16 years(mean,13.7years) were followed for 12 months to 60 months(mean 24.1 months) .At the time of final follow-up, seventeen patients(26.15%) presented curve progress more than 5 degrees. The percentage of curve progression was significantly greater in the cases with apical vertebral rotation beyond grade III and Cobb’s angle greater than 35°at the first visit(P<0.05). After performing a logistic regression analysis, initial Cobb’s angles greater than 35 degrees, apical vertebral rotation beyond grade III, and standing height increasing greater than 30mm in one year were found to be prognostic for the progression of more than 5 degrees. Conclusion: Initial Cobb’s angles,apical vertebral rotation , and standing height increasing velocity are important prognostic factors of progression in the girls with AIS. Risser sign was an unreliable parameter for predicting the progression of scoliosis, However, in our series, the risk of progression was higher in patients whose initial Cobb’s angles greater than 35 degrees, apical vertebral rotation beyond grade III , and standing height increasing greater than 30mm in one year.
3. The health-related quality of life and psychological status in AIS
3. 1 SRS-22 Questionnaire for Chinese adolescents with idiopathic scoliosis
Objective:To develop the SRS-22 Questionnaire for the use of Chinese adolescents with idiopathic scoliosis;To evaluate the metric qualities of this questionnaire.Methods:Transcultural adaptation of the SRS-22 Questionnaire was carried out according to the International Quality of Life Assessment Project guidelines, The final version was confirmed by a committee of experts .The Questionnaire was finished by eighty-six adolescents with idiopathic scoliosis who treated with a brace including 11 males and 75 females,aged ten to eighteen years old (mean,13.9 years). Curve magnitude ranged from 25°to 45°( mean, 35.6°). A subgroup of 30 patients completed the questionnaire again in three to four weeks. Results: The overall alpha coefficient of the questionnaire was 0.88. Coefficients for individual domains were as follows: function/activity, 0.70; pain, 0.80; self-image, 0.80; mental health, 0.88; and satisfaction, 0.81. The questionnaire as a whole had a test-retest correlation coefficient of 0.97. Test-retest correlation coefficients for individual domains were as follows: function, 0.85; pain, 0.96; self-image, 0.96; mental health, 0.95; and satisfaction, 0.91. Five common factors were acquired from factorial analysis, and the cumulative contribution rate was 67.66%. Conclusion:The Chinese Version of the SRS-22 Questionnaire has eligible reliability and validity,it can be used to measure health-related quality of life of adolescents with idiopathic scoliosis in china.
1.生长发育与青少年特发性脊柱侧凸
1.1坐高与站高的比率和青少年特发性脊柱侧凸关系的分析
目的探讨青少年特发性脊柱侧凸患者坐高与站高的比率是否和侧凸角度大小之间存在相关关系,并依据这一关系建立预测侧凸角度大小的数学方程。方法对46例轻、中度青少年特发性脊柱侧凸患者进行观察分析,男8例,女38例;年龄10岁～20岁,平均13.8岁;单弯。测量记录患者初次就诊时的实足年龄、站高、坐高以及Cobb角的大小,并根据对患者站高、坐高测量记录的数据,分别计算每位患者坐高与站高的比率。结果46例患者的坐高66.00cm～88.80cm(均数±标准差, 80.54cm±5.75cm);站高P126.00cm～174.80cm(均数±标准差,153.67cm±10.72cm);坐高与站高的比率0.50～0.55(均数±标准差,0.52±0.01);Cobb角10°～45°(均数±标准差,25.70°±9.66°)。患者的实足年龄、坐高、站高和Cobb角之间均没有相关关系( r分别为0 .147,0.0 15, ?0 .106; >0.05);而患者的坐高与站高的比率和Cobb角之间存在明显的正相关关系( r =0 .675;P <0 .05);并根据这一关系建立了预测轻、中度青少年特发性脊柱侧凸侧凸角度大小的数学方程。结论青少年特发性脊柱侧凸患者坐高与站高的比率和侧凸角度大小之间存在明显的正相关关系,可以依据坐高与站高的比率预测轻、中度青少年特发性脊柱侧凸单弯患者侧凸角度的大小。
2.青少年特发性脊柱侧凸的支具治疗
2.1支具治疗青少年特发性脊柱侧凸的临床随访研究
目的:评价支具治疗青少年特发性脊柱侧凸的临床疗效,分析影响支具治疗效果的相关因素,并探讨支具治疗的适应证。方法:对79例接受支具治疗的青少年特发性脊柱侧凸患者进行随访,男11例,女68例。在随访期间连续测量记录患者的Cobb角,侧凸类型,女性患者初潮与否,坐高,站高,Risser征,顶椎旋转度等。结果:全部病例完成12～60个月的随访,平均23.9月。初诊时年龄10～17岁,平均13.8岁;末次随访时21例(26.6%)畸形明显进展,畸形维持或稍进展者40例(50.6%),18例(22.8%)畸形改善。初诊时原发弯Cobb角大于45°组侧凸进展率较Cobb角≤35°组高,侧凸改善率较Cobb角≤35°组低(P<0.05);顶椎旋转度Ⅲ度以上组侧凸进展率较0～Ⅱ度组高,侧凸改善率较0～Ⅱ度组低(P<0.05)。侧凸类型、Risser征等参数不同的患者畸形进展和改善的比率均存在不同程度的差别,但差异不具有显著性。结论:矫形支具能够有效控制或改善轻、中度特发性脊柱侧凸畸形,特别是侧凸角度在20°～35°的疗效较好,单独借助Risser征预测侧凸畸形变化趋势并不可靠,初始Cobb角大于45°,顶椎旋转度在Ⅲ度以上的患者,支具治疗的效果不佳,应尽早考虑手术矫形。
2.2支具治疗女性青少年特发性脊柱侧凸畸形加重的危险因素分析
目的:观察支具治疗女性青少年特发性脊柱侧凸的畸形变化情况并分析侧凸畸形进展的危险因素。方法:对65例接受支具治疗的女性青少年特发性脊柱侧凸患者进行随访。在随访期间连续测量记录患者的Cobb角,侧凸类型,月经初潮与否,坐高,站高,Risser征,顶椎旋转度等。分析初诊时和末次随访时侧凸变化情况,并从上述多项参数中筛选引起侧凸加重的危险因素。结果:全部病例完成12～60个月的随访,平均24.1月。初诊时年龄10～16岁,平均13.7岁;末次随访时17例(26.15%)患者侧凸进展超过5°,初诊时原发弯Cobb角大于35°,顶椎旋转在Ⅲ度以上的患者,侧凸明显进展的比率较高(P<0.05)。通过Logistic逐步回归分析,发现初诊时原发弯Cobb角大于35°,顶椎旋转度Ⅲ度以上,年身高增长在30mm以上的患者,是侧凸进展到5°以上的危险因素。结论:初诊时原发弯Cobb角值,顶椎旋转度及身高增长速度是预测女性青少年特发性脊柱侧凸进展的重要因素,借助Risser征预测侧凸进展并不可靠,初始原发弯Cobb角大于35°,顶椎旋转度在Ⅲ度以上,年身高增长在30mm以上的患者,侧凸进展的危险性较高。
3.青少年特发性脊柱侧凸健康相关的生活质量及心理状况评价
3.1 SRS-22问卷在中国青少年特发性脊柱侧凸患者中的修订
目的:将脊柱侧凸研究会问卷(SRS-22 Questionnaire)引入中国,评价该问卷在中国青少年特发性脊柱侧凸患者中的测量特性。方法:依据国际生活质量评价(The International Quality of Life Assessment,IQOLA)计划规则,将SRS-22患者问卷翻译改编为中文,由专家组研究确定最终版本。使用该问卷对86例(男11例,女75例)正规支具治疗的青少年特发性脊柱侧凸患者进行初次测评,患儿年龄在10岁～18岁,平均13.9岁;侧凸角度在25°～45°,平均35.6°。初测3～4周后,对其中30例患者进行重测。结果: SRS-22问卷总体α系数为0.88,重测信度为0.97。问卷中的五个因素的α系数分别为:功能活动,0.70;疼痛,0.80;自我形象,0.80;心理状况,0.88;对治疗的满意程度,0.81;重测信度分别为:功能活动,0.85;疼痛,0.96;自我形象,0.96;心理状况,0.95;对治疗的满意程度,0.91。因素分析产生5个公共因素,结果累积解释方差贡献为67.66%。结论:SRS-22问卷翻译改编成中文后具备合格的信度和效度,可以应用该问卷测量中国青少年特发性脊柱侧凸患者的生活质量。
Adolescent idiopathic scoliosis(AIS)is defined by Scoliosis Research Society(SRS)as age greater than ten years, lateral deviation of the normal vertical line of the spine which, when measured by X-ray, is greater than ten degrees before skeletal maturity. It is one of the commonest spine deformities in adolescents.Although a lot of scientific breakthroughs on adolescent idiopathic scoliosis have been obtained in various fields, there are still many controversies, particularly for non-surgical regime. The questions need to be answered in regard to AIS during nonoperation treatment such as: Firstly, what relationships between growth and deformed change exist in AIS. Secondly, the indications of brace treatment and weaning program. Thirdly, how to predict curve progression of scoliosis; lastly, how to assess the effect of bracing in an all-round way. This investigation was designed to find the answers for above questions.
1. Growth and adolescent idiopathic scoliosis
1.1 Correlation of sitting height to standing height ratio with Cobb’s angle in children with idiopathic scoliosis/A mathematical analysis in the cases with single curve
Objective To identify any statistically significant correlation of sitting height to standing height ratio with Cobb’s angle value in children with idiopathic scoliosis, and to establish a mathematical formula for the prediction of scoliosis progression in the cases with single curve. Methods The criteria for patient admission in this study include:(1)no previous history of medical treatment;(2)older than 10 years of age;(3)mild and moderate scoliosis(Cobb’s angle<45°);(4)single curve;(5)no sign of degenerative disorders;(6)equal lower limbs without any anomalies. Forty-six children (38 females, 8 males) with mild or moderate idiopathic scoliosis were selected in accordance with the above criteria. The age of these patients ranged from 10 to 20 years, with the average of 13.8 years at the first examination. Chronological age, sitting height, standing height and Cobb’s angle values were measured and well documented. According to the measurement of sitting height and standing height in these patients, the ratio of sitting height to standing height was calculated. Results The sitting heights in 46 patients ranged from 66.00 cm to 88.80 cm(mean±standard deviation, 80.54cm±5.75cm); The standing heights ranged from 126.00 cm to 174.80 cm(mean±standard deviation, 153.67cm±10.72cm); ratio of sitting height to standing height ranged from 0.50 to 0.55(mean±standard deviation, 0.52±0.01); The Cobb’s angles ranged from 10°to 45°(mean±standard deviation, 25.70°±9.66°). There were no statistically correlation between Cobb’s angle values, chronological age, sitting height, and standing height. However, a statistically significant positive correlation between the ratio of sitting height to standing height and the Cobb’s angle value was demonstrated. Conclusions There is a significant positive correlation between ratios of sitting height to standing height and Cobb’s angle values in children with idiopathic scoliosis. The ratio of sitting height to standing height as a useful parameter can be used to predict the development of Cobb’s angle in children with mild or moderate idiopathic scoliosis.
2. Clinical follow-up studies on adolescents who are bracing with idiopathic scoliosis
2.1 A clinical follow-up study on treatment of adolescent idiopathic scoliosis with brace
Objective:To evaluate clinical outcomes of bracing and to analyze factors that influence the effects of treatment in adolescents with idiopathic scoliosis, and to reveal or to advise the indications of bracing. Methods:Seventy-nine patients(11 males; 68 females) with AIS who had no history of prior therapy were treated with a brace. Several parameters were consecutively measured and documented during the period of follow-up including Cobb’s angles, curve patterns, menarche status,sitting heights, standing heights, Risser sign, apical vertebral rotation. Results:The average duration of followed-up study was 30 months (12 months to 60 months).Twenty-one patients (26.6%) presented curve deterioration, 40 patients have no obvious curve change, 18 patients (22.8%) got a curve improvement. There was significantly lower percentage of curve progression and higher percentage of curve improvement in cases with Cobb’s angle less than 35°at the first visit(P<0.05). The percentage of curve progression was significantly greater in the cases with apical vertebral rotation beyond grade III while the percentage of curve improvement was lower (P<0.05). Curve patterns, Risser sign and other parameters were also found to make their effects on the percentage of curve progression and improvement, which, however, were not statistically significant(P>0.05). Conclusion:Bracing can limit or improve mild and moderate curve of idiopathic scoliosis effectively, especially in cases with initial curve magnitude ranging from 20°to 35°, Outcome measurement for AIS can not be relied only upon Risser sign. Surgery is advised as soon as possible for the cases with initial Cobb’s angles greater than 45°and initial apical vertebral rotation beyond gradeⅢwhile bracing did not result in any improvement.
2.2 Prognostic factors of progression of adolescent idiopathic scoliosis in girls treated with a brace
Objective: To investigate curve behavior and to analyze which of nine factors were of significant value in predicting the progression of the scoliotic curve in girls with AIS treated with a brace. Methods:sixty -five girls with AIS were braced. Cobb’s angles, curve patterns, menarche status,sitting heights, standing heights, Risser sign, apical vertebral rotation, etc were consecutively measured and documented during the period of follow-up. Curve behavior between the first visit and final follow-up was analyzed. Several different parameters which may contribute to progression of curve were selected. Results:The patients aged 10-16 years(mean,13.7years) were followed for 12 months to 60 months(mean 24.1 months) .At the time of final follow-up, seventeen patients(26.15%) presented curve progress more than 5 degrees. The percentage of curve progression was significantly greater in the cases with apical vertebral rotation beyond grade III and Cobb’s angle greater than 35°at the first visit(P<0.05). After performing a logistic regression analysis, initial Cobb’s angles greater than 35 degrees, apical vertebral rotation beyond grade III, and standing height increasing greater than 30mm in one year were found to be prognostic for the progression of more than 5 degrees. Conclusion: Initial Cobb’s angles,apical vertebral rotation , and standing height increasing velocity are important prognostic factors of progression in the girls with AIS. Risser sign was an unreliable parameter for predicting the progression of scoliosis, However, in our series, the risk of progression was higher in patients whose initial Cobb’s angles greater than 35 degrees, apical vertebral rotation beyond grade III , and standing height increasing greater than 30mm in one year.
3. The health-related quality of life and psychological status in AIS
3. 1 SRS-22 Questionnaire for Chinese adolescents with idiopathic scoliosis
Objective:To develop the SRS-22 Questionnaire for the use of Chinese adolescents with idiopathic scoliosis;To evaluate the metric qualities of this questionnaire.Methods:Transcultural adaptation of the SRS-22 Questionnaire was carried out according to the International Quality of Life Assessment Project guidelines, The final version was confirmed by a committee of experts .The Questionnaire was finished by eighty-six adolescents with idiopathic scoliosis who treated with a brace including 11 males and 75 females,aged ten to eighteen years old (mean,13.9 years). Curve magnitude ranged from 25°to 45°( mean, 35.6°). A subgroup of 30 patients completed the questionnaire again in three to four weeks. Results: The overall alpha coefficient of the questionnaire was 0.88. Coefficients for individual domains were as follows: function/activity, 0.70; pain, 0.80; self-image, 0.80; mental health, 0.88; and satisfaction, 0.81. The questionnaire as a whole had a test-retest correlation coefficient of 0.97. Test-retest correlation coefficients for individual domains were as follows: function, 0.85; pain, 0.96; self-image, 0.96; mental health, 0.95; and satisfaction, 0.91. Five common factors were acquired from factorial analysis, and the cumulative contribution rate was 67.66%. Conclusion:The Chinese Version of the SRS-22 Questionnaire has eligible reliability and validity,it can be used to measure health-related quality of life of adolescents with idiopathic scoliosis in china.
引文
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