Aubin Carl-Eric, Labelle Hubert, Cheriet Farida, Villemure Isabelle, Mathieu Pierre A, Dansereau Jean
CHU Sainte-Justine, Montréal (Québec), Canada.
Med Sci (Paris). 2007 Nov;23(11):904-9. doi: 10.1051/medsci/20072311904.
Adolescent idiopathic scoliosis involves complex tridimensional deformities of the spine, rib cage and pelvis. Moderate curves generally are treated using an orthosis. This paper presents different studies performed over the last fifteen years related to the biomechanical evaluation and optimization of the orthopedic treatment of scoliotic deformities. Patient specific 3D models of the spine, pelvis and rib cage are computed from calibrated radiographs, and are used to calculate 2D and 3D clinical indices. The torso shape is acquired using surface topography. With such internal and external 3D models, the efficacy of the most frequently used orthoses can be analyzed and new treatments can be developed. Pressures generated by a brace on the patient's trunk were measured using a flexible matrix of pressure sensors and displayed over the patient's internal geometry in order to analyze the brace efficacy. Patient specific finite element models have been developed, including the osseo-ligamentous structures as well as the muscles, the neuro-control, trunk growth and its adaptation to the stress. These models were used to analyze the effects of the Boston brace. The electro-myographic activity also was measured to analyze the << active >> correction mechanisms. Adjustment techniques and software are used to help the orthotists with real time feedback when the brace is being fabricated and adjusted to the patient. Residual growth potential is also being added to the computer model to simulate the long term effect of a brace. The improvement of the orthotic treatments of scoliotic deformities is very encouraging. The exploitation of such tools is expected to allow reaching optimal treatment personalized to each patient. double dagger.
青少年特发性脊柱侧弯涉及脊柱、胸廓和骨盆的复杂三维畸形。中度侧弯通常采用支具治疗。本文介绍了过去十五年间进行的不同研究，这些研究与脊柱侧弯畸形的骨科治疗的生物力学评估及优化有关。根据校准后的X光片计算出患者特定的脊柱、骨盆和胸廓三维模型，并用于计算二维和三维临床指标。通过表面地形测量获取躯干形状。利用这些内部和外部三维模型，可以分析最常用支具的疗效并开发新的治疗方法。使用柔性压力传感器矩阵测量支具对患者躯干产生的压力，并在患者内部几何结构上显示，以分析支具疗效。已经开发了患者特定的有限元模型，包括骨韧带结构以及肌肉、神经控制、躯干生长及其对压力的适应。这些模型用于分析波士顿支具的效果。还测量了肌电图活动以分析“主动”矫正机制。在制作支具并根据患者情况进行调整时，使用调整技术和软件为矫形师提供实时反馈。残余生长潜力也被添加到计算机模型中，以模拟支具的长期效果。脊柱侧弯畸形矫形治疗的改进非常令人鼓舞。预计利用此类工具能够实现针对每个患者的个性化最佳治疗。双剑号。
