Bernard J-C, Jemni S, Schneider M, Boussard D, Saillard V, Bard R, Lecante C, Barral F, Berne G, Pourret S, Mulatier A, Notin G
Service enfants-adolescents, Centre médicochirurgical de réadaptation des Massues, 92, rue Edmond-Locard, 69322 Lyon cedex 05, France.
Ann Readapt Med Phys. 2005 Dec;48(9):637-49. doi: 10.1016/j.annrmp.2005.08.004. Epub 2005 Sep 12.
The purpose of this retrospective study was to investigate whether treatment with a carbon brace (CMCR) stops the progression of idiopathic scoliosis in children and adolescents affected by combined or thoraco-lumbar scoliosis.
We compared clinical features (hump and vital capacity) and radiolographic data (Cobb angle, sacral slope, lumbar lordosis and thoracic kyphosis) at brace set-up and removal in 115 children and adolescents with combined or thoraco-lumbar scoliosis. The impact of the brace was evaluated in 2 subgroups: patients who started the treatment at Risser stages 0, 1 or 2 and those who started the treatment at Risser stages 3 or 4. With 95 patients, a questionnaire was used to evaluate the physical and psychological tolerance of the brace and technical difficulties during treatment with the orthosis.
At brace set-up, the immediate angular correction was about 50% compared to the pre-brace angle; the reduction of the vital capacity was weak. After brace removal, radiographic data showed significant improvement in thoraco-lumbar scoliosis and in the lumbar curve of patients with combined scoliosis, although the thoracic curvature of the combined scoliosis was unchanged. No significant efficiency on the hump was observed.
The CMCR brace can stop the progression of moderate combined or thoraco-lumbar scoliosis in growing children and adolescents, with little consequence to vital capacity, but seems to have no efficacy on the hump. This type of orthosis provides a better outcome in terms of thoracic mobility and vital capacity. The CMCR brace is indicated for children and growing teenagers with flexible, progressive scoliosis. This "mobile" brace definitely has its place in the current therapeutic arsenal.
本回顾性研究旨在调查使用碳纤维支具(CMCR)治疗是否能阻止患有复合型或胸腰段脊柱侧弯的儿童及青少年特发性脊柱侧弯的进展。
我们比较了115例患有复合型或胸腰段脊柱侧弯的儿童及青少年在佩戴支具起始和去除时的临床特征(驼背和肺活量)及放射学数据(Cobb角、骶骨斜率、腰椎前凸和胸椎后凸)。在两个亚组中评估了支具的影响:在Risser分期0、1或2期开始治疗的患者以及在Risser分期3或4期开始治疗的患者。对95例患者,使用问卷评估了支具的身体和心理耐受性以及使用矫形器治疗期间的技术困难。
在佩戴支具时,与支具佩戴前角度相比,即时角度矫正约为50%;肺活量的降低较弱。去除支具后,放射学数据显示胸腰段脊柱侧弯以及复合型脊柱侧弯患者的腰椎曲线有显著改善,尽管复合型脊柱侧弯的胸椎曲度未改变。未观察到对驼背有显著疗效。
CMCR支具可阻止生长中的儿童及青少年中度复合型或胸腰段脊柱侧弯的进展,对肺活量影响较小,但似乎对驼背无效。这种类型的矫形器在胸廓活动度和肺活量方面提供了更好的结果。CMCR支具适用于患有柔韧性、进行性脊柱侧弯的儿童及青少年。这种“可移动”支具在当前的治疗手段中确实有其用武之地。