Lou Edmond, Hill Douglas, Raso Jim
Glenrose Rehabilitation Hospital, 10230-111 Ave Edmonton, AB, Canada.
Stud Health Technol Inform. 2008;135:265-73.
Adolescent idiopathic scoliosis (AIS) presents as an abnormal curvature of spine with vertebral rotation. It may impact the patient for their entire life. Approximately 0.25% of adolescents will require treatment. Brace treatment is the most commonly used non-surgical treatment for AIS. Its goal is stop the progression and maintain the curve at an acceptable level through the high risk growth phase of adolescence. However, its effectiveness is controversial and the actual biomechanical action of the brace is not fully understood. Recently, the Scoliosis Research society (SRS) created a standard criterion for AIS brace studies. However, to evaluate the effectiveness of the brace treatment, the spine flexibility, in brace correction and patient's compliance should also be included in a study. Although bracing has been used for more than 50 years, there are still many unknowns. How much wear time per day is needed for an optimum treatment outcome? How much brace tightness is optimal? What is the best weaning protocol? What is the best method to determine the curve flexibility? How much in-brace correction is needed to obtain good results? Without accurate and precise methods to objectively measure or answer the above questions, it is misleading to state whether or not brace treatment is effective. Therefore, a lot of research is still required before one can answer the effectiveness of the brace treatment.
青少年特发性脊柱侧凸(AIS)表现为伴有椎体旋转的脊柱异常弯曲。它可能会影响患者一生。约0.25%的青少年需要治疗。支具治疗是AIS最常用的非手术治疗方法。其目标是在青少年高风险生长阶段阻止侧弯进展,并将弯曲维持在可接受水平。然而,其有效性存在争议,且支具实际的生物力学作用尚未完全明确。最近,脊柱侧凸研究学会(SRS)制定了AIS支具研究的标准规范。然而,为评估支具治疗的有效性,一项研究还应纳入脊柱柔韧性、支具矫正情况和患者依从性。尽管支具治疗已使用超过50年,但仍有许多未知之处。为获得最佳治疗效果,每天需要佩戴多长时间?最佳的支具紧度是多少?最佳的撤支具方案是什么?确定弯曲柔韧性的最佳方法是什么?为取得良好效果需要多少支具内矫正量?如果没有准确精确的方法来客观测量或回答上述问题,声称支具治疗是否有效是具有误导性的。因此,在能够回答支具治疗的有效性之前,仍需要大量研究。