长期随访显示非手术治疗对中度青少年特发性脊柱侧凸无效:一项综合荟萃分析。

IF 2.3 Q2 ORTHOPEDICS
Eduardo Hevia, Jesús Burgos, Vicente García, María Teresa de Santos Moreno, Ibrahim Khalil, Gonzalo Mariscal, Carlos Barrios
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引用次数: 0

摘要

本系统综述和荟萃分析旨在评估中度青少年特发性脊柱侧凸(AIS)保守治疗的结果,重点关注长期曲线行为、手术率、患者报告的结果以及随访时间的影响。根据PRISMA(系统评价和荟萃分析的首选报告项目)指南进行了全面的文献检索。使用Review Manager进行统计分析,包括平均差异、风险比、合并发生率和随机效应模型。采用I2统计量评估异质性。结果测量为x线曲线进展、显著(bbb50°)进展的患者百分比、手术率、矢状面改变、背部疼痛率、生活质量量表和功能结果。纳入13项研究,涉及1492例AIS曲线在30°-45°范围内的患者,保守治疗,至少随访10年。在随访20年以上(平均年龄34.5岁)时,曲线平均恶化-5.69°(95%可信区间[CI], -11.66至0.29)。在随访25年以上(平均年龄49.8岁)时,曲线平均恶化了-14.32°(95% CI, -20.14至-8.50)。显著进展发生率为35.68% (95% CI, 22.85 ~ 48.50)。手术率为14.20% (95% CI, 0.87 ~ 27.53)。矢状位对齐(胸后凸和腰椎前凸)在最后随访时保持在正常范围内,与基线相比没有明显变化。背部疼痛率为63.35% (95% CI, 38.36 ~ 88.34)。这些发现强调了保守管理的AIS患者的弯曲进展和疼痛的惊人发生率。对保守适应症和手术适应症进行重新评估是必要的,以减轻长期影响并改善该人群的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Long-term follow-up reveals non-utility of nonsurgical management in moderate adolescent idiopathic scoliosis: a comprehensive meta-analysis.

This systematic review and meta-analysis aimed to evaluate the outcomes of conservative management of moderate adolescent idiopathic scoliosis (AIS), focusing on long-term curve behavior, surgical rates, patient-reported outcomes, and the influence of follow-up duration. A comprehensive literature search was conducted adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Statistical analyses, using Review Manager, encompassed mean differences, risk ratios, pooled incidences, and random-effects models. Heterogeneity was assessed using the I2 statistic. The outcome measures were radiographic curve progression, percentage of patients with significant (>5°) progression, surgery rates, sagittal profile changes, back pain rates, quality of life scales, and functional outcomes. Thirteen studies involving 1,492 patients with AIS curves within 30°-45°, treated conservatively, with a minimum 10-year follow-up, were included. At 20+ years of follow-up (mean age, 34.5 years), curves worsened by an average of -5.69° (95% confidence interval [CI], -11.66 to 0.29). At 25+ years of follow-up (mean age, 49.8 years), curves worsened by an average of -14.32° (95% CI, -20.14 to -8.50). The incidence of significant progression was 35.68% (95% CI, 22.85 to 48.50). The surgery rate was 14.20% (95% CI, 0.87 to 27.53). Sagittal alignment (thoracic kyphosis and lumbar lordosis) remained within normal ranges at the final follow-up, with no significant changes from baseline. Back pain rate was 63.35% (95% CI, 38.36 to 88.34). These findings highlight the alarming incidence of curve progression and pain in conservatively managed AIS patients. A critical re-evaluation of conservative versus operative indications is imperative to mitigate long-term impacts and improve outcomes for this population.

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来源期刊
Asian Spine Journal
Asian Spine Journal ORTHOPEDICS-
CiteScore
5.10
自引率
4.30%
发文量
108
审稿时长
24 weeks
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