Negrini S, Marchini G
SICO, Italian Scientific Spine Institute, Milan, Italy.
Eura Medicophys. 2007 Jun;43(2):171-81; discussion 183-4. Epub 2006 Sep 24.
Bracing is considered to be effective in the treatment of adolescent idiopathic scoliosis. The concept prevailing today includes an asymmetrical construction, mainly using a mechanical three-point system. We developed the new Sforzesco brace, based on the SPoRT concept (Symmetric, Patient-oriented, Rigid, Three-dimensional, active). The aim of this study is to verify the results of this concept and brace, compared to three-point classical systems.
We performed a prospective, pair-controlled study. It was possible to match 15 patients, out of the first 18 consecutively treated with the Sforzesco brace (Group SPoRT), with previous patients treated with the Lyon brace (Group LY). SPoRT included 14.2+/-1.7 year old patients, with 47+/-7 degrees Cobb worst curves, and 11+/-4 degrees Bunnell; LY included 13.6+/-1.6 year old patients, with 43+/-7 degrees Cobb and 12+/-5 degrees Bunnell. The brace had to be worn 23 h per day and patients were evaluated after 6 months both clinically and radiographically (without the brace). Appropriate statistics were used.
At the baseline there were slight differences between the groups, with SPoRT worse than LY. All radiographic and clinical parameters decreased significantly with treatment in both groups, apart from thoracic Cobb degrees in LY. SPoRT had better results than LY (P<0.05) radiographically (worst curve -10+/-5 degrees vs -5+/-7 degrees, all curves -8+/-7 degrees vs -6+/-7 degrees), for sagittal profile (distance from plumbline: T12 -6+/-9 mm vs +2+/-8 and L3 -7+/-12 vs 0+/-10) and aesthetics of the shoulders (9 improved and 6 unchanged vs 5 and 8) and waists (10 improved and 5 unchanged vs 5 and 8). Finally, clinical results in terms of patient recovery were better in SPoRT than LY (12 improved and 3 unchanged vs 8 and 5).
When a new treatment is introduced, it is not possible to wait years (end of therapy) before verifying its utility, and in scoliosis bracing a short term study already gives very important clues. This study confirms the immediate efficacy of brace treatment (even in such high degree cases) whatever the brace concept used, with only 2 (out of 30) progressed curves. In SPoRT we had no progressions, and obtained a statistically significant 80% better radiographic results than LY in the worst scoliosis curve, and 40% in the average of all curves, as well as improved aesthetics and sagittal profile (that is crucial in scoliosis bracing). The Sforzesco brace should be used, and the SPoRT concept explored in the long term to verify if the classical three-point system should be totally (or partially) abandoned.
支具治疗被认为对青少年特发性脊柱侧弯有效。目前流行的理念包括不对称结构，主要采用机械三点系统。我们基于SPoRT概念（对称、以患者为导向、刚性、三维、主动）研发了新型斯福尔扎斯科支具。本研究的目的是将这一概念和支具的结果与三点经典系统进行比较验证。
我们进行了一项前瞻性配对对照研究。在最初连续接受斯福尔扎斯科支具治疗的18例患者（SPoRT组）中，有15例能够与先前接受里昂支具治疗的患者（LY组）进行匹配。SPoRT组患者年龄为14.2±1.7岁，Cobb角最严重弯曲度为47±7度，邦内尔角为11±4度；LY组患者年龄为13.6±1.6岁，Cobb角为43±7度，邦内尔角为12±5度。支具必须每天佩戴23小时，6个月后对患者进行临床和影像学评估（不佩戴支具）。采用了适当的统计学方法。
基线时两组之间存在细微差异，SPoRT组比LY组情况稍差。两组治疗后所有影像学和临床参数均显著下降，但LY组的胸椎Cobb角除外。在影像学方面（最严重弯曲度-10±5度对-5±7度，所有弯曲度-8±7度对-6±7度）、矢状面轮廓（与铅垂线的距离：T12 -6±9毫米对+2±8毫米，L3 -7±12毫米对0±10毫米）以及肩部美观度（9例改善，6例未改变对5例和8例）和腰部美观度（10例改善，5例未改变对5例和8例）方面，SPoRT组的结果优于LY组（P<0.05）。最后在患者恢复的临床结果方面，SPoRT组优于LY组（12例改善，3例未改变对8例和5例）。
当引入一种新的治疗方法时，不可能等待数年（治疗结束）才验证其效用，在脊柱侧弯支具治疗中，一项短期研究已经能给出非常重要的线索。本研究证实了无论使用何种支具概念，支具治疗都具有即时疗效（即使在如此严重的病例中），仅有2例（共30例）出现曲线进展。在SPoRT组中没有出现进展，在最严重的脊柱侧弯曲线中，影像学结果比LY组有统计学意义的显著改善，提高了80%，在所有曲线平均值方面提高了40%，同时改善了美观度和矢状面轮廓（这在脊柱侧弯支具治疗中至关重要）。应使用斯福尔扎斯科支具，并长期探索SPoRT概念，以验证是否应完全（或部分）摒弃经典三点系统。
