Edelmann P
North German Scoliosis Center, Cuxhaven.
Acta Orthop Belg. 1992;58 Suppl 1:85-90.
A German multicenter study with consequent long-term follow-up of patients with idiopathic scoliosis after Milwaukee brace treatment in one out of seven Orthopaedic Clinics showed that brace weaning at the bone age of Risser 4 is followed by early loss of curve correction. According to Oberthaler et al. patients, who were furnished with a brace as outpatients, are inclined to practice a part-time wearing with different brace free intervals. In a longterm follow-up study of 328 patients with idiopathic scoliosis treated at the North German Scoliosis Center in Cuxhaven 123 compliant patients were examined 4 1/2 years after brace weaning. All were asked to wear their braces 23 hours a day and were weaned only at Risser 4-5 or Risser 5. The control rate was 93%. A gain of correction between 9 and 22% was the result. We analysed the composition of the group of 81 noncompliant patients. As far as we could find out the percentage of really non-compliant patients was only 19% compared with a total of 212 patients, who had finished their brace treatment at least 5 years ago. Eight patients (4%) with prebrace values of over 40 degrees Cobb had to be operated, though they were compliant. Based on these results, strict brace treatment in progressive idiopathic scoliosis is recommended, unless no more physiologic way of treatment is available.
一项德国多中心研究对七家骨科诊所之一接受密尔沃基支具治疗的特发性脊柱侧凸患者进行了长期随访，结果显示，在里塞尔4期骨龄时停止使用支具后，脊柱侧弯矫正效果会早期丧失。根据奥伯塔勒等人的研究，作为门诊患者佩戴支具的患者倾向于间断佩戴，有不同的不佩戴支具间隔时间。在对库克斯港北德脊柱侧弯中心治疗的328例特发性脊柱侧凸患者的长期随访研究中，对123例依从性好的患者在停止使用支具4年半后进行了检查。所有患者被要求每天佩戴支具23小时，仅在里塞尔4 - 5期或里塞尔5期时停止使用支具。控制率为93%。矫正效果提高了9%至22%。我们分析了81例不依从患者的构成情况。据我们所知，与总共212例至少在5年前完成支具治疗的患者相比，真正不依从的患者比例仅为19%。8例（4%）支具治疗前科布角超过40度的患者尽管依从性好，但仍不得不接受手术。基于这些结果，对于进展性特发性脊柱侧凸，除非没有更多生理性治疗方法，否则建议进行严格的支具治疗。
