Rigo M, Negrini S, Weiss H R, Grivas T B, Maruyama T, Kotwicki T
E.Salvá Institute, Vía Augusta 185, 08021 Barcelona, Spain.
Scoliosis. 2006 Jul 20;1:11. doi: 10.1186/1748-7161-1-11.
The effectiveness of orthotic treatment continues to be controversial in international medical literature due to differences in the reported results and conclusions of various studies. Heterogeneity of the samples has been suggested as a reason for conflicting results. Besides the obvious theoretical differences between the brace concepts, the variability in the technical factors can also explain the contradictory results between same brace types. This paper will investigate the degree of variability among responses of scoliosis specialists from the Brace Study Ground of the International Society on Scoliosis Orthopedic and Rehabilitation Treatment SOSORT. Ultimately, this information could be a foundation for establishing a consensus and framework for future prospective controlled studies.
A preliminary questionnaire on the topic of 'brace action' relative to the theory of three-dimensional scoliosis correction and brace treatment was developed and circulated to specialists interested in the conservative treatment of adolescent idiopathic scoliosis. A particular case was presented (main thoracic curve with minor lumbar). Several key points emerged and were used to develop a second questionnaire which was discussed and full filed after the SOSORT consensus meeting (Milano, Italy, January 2005).
Twenty-one questionnaires were completed. The Chêneau brace was the most frequently recommended. The importance of the three point system mechanism was stressed. Options about proper pad placement on the thoracic convexity were divided 50% for the pad reaching or involving the apical vertebra and 50% for the pad acting caudal to the apical vertebra. There was agreement about the direction of the vector force, 85% selecting a 'dorso lateral to ventro medial' direction but about the shape of the pad to produce such a force. Principles related to three-dimensional correction achieved high consensus (80%-85%), but suggested methods of correction were quite diverse.
This study reveals that among participating SOSORT specialists there continues to be a strongly held and conflicting if not a contentious opinion regarding brace design and treatment. If the goal of a 'treatment consensus' is realistic and achievable, significantly more effort will be required to reconcile these differences.
由于各项研究报告的结果和结论存在差异，支具治疗的有效性在国际医学文献中一直存在争议。样本的异质性被认为是导致结果相互矛盾的一个原因。除了支具概念之间明显的理论差异外，技术因素的变异性也可以解释相同支具类型之间相互矛盾的结果。本文将调查国际脊柱侧弯矫形与康复治疗学会（SOSORT）支具研究小组中脊柱侧弯专家反应的变异程度。最终，这些信息可为建立未来前瞻性对照研究的共识和框架奠定基础。
针对三维脊柱侧弯矫正理论和支具治疗中“支具作用”这一主题，编制了一份初步问卷，并分发给对青少年特发性脊柱侧弯保守治疗感兴趣的专家。呈现了一个特定病例（主要为胸弯伴轻度腰弯）。出现了几个关键点，并据此编制了第二份问卷，该问卷在SOSORT共识会议（2005年1月，意大利米兰）后进行了讨论并填写完整。
共完成21份问卷。最常被推荐的是Chêneau支具。强调了三点系统机制的重要性。关于在胸段凸侧正确放置衬垫的选择，50%的人认为衬垫应到达或涉及顶椎，50%的人认为衬垫应作用于顶椎下方。在矢量力的方向上达成了一致，85%的人选择“从背外侧到腹内侧”的方向，但对于产生这种力的衬垫形状存在分歧。与三维矫正相关的原则达成了较高的共识（80%-85%），但建议的矫正方法却大不相同。
本研究表明，在参与调查的SOSORT专家中，对于支具设计和治疗仍存在强烈且相互矛盾甚至有争议的观点。如果“治疗共识”的目标是现实可行的，那么就需要付出更多努力来调和这些差异。
