Grivas Theodoros B, Rodopoulos Georgios I, Bardakos Nikolaos V
Orthopaedic Surgery Dept., 'Thriassio' General Hospital, Magoula, Attica, Greece.
Stud Health Technol Inform. 2008;135:274-90.
The present review article aims at providing an update on the basic science and clinical information underlying the use of nocturnal braces for adolescent idiopathic scoliosis. The use of nocturnal braces has been dictated by the encouraging results recorded by some studies on part-time bracing, combined with increasing concerns on poor patient compliance noted with the use of full-time bracing. The cardinal feature of nighttime braces lays in their ability to hypercorrect the scoliotic curvature, thereby eliminating the asymmetric water accumulation that occurs in the apical and adjacent intervertebral discs, thus restoring a close-to-normal force application through the Hueter-Volkmann principle and preventing curve progression. The two nighttime braces mostly used hypercorrect the spine through different mechanisms, one acting by bending the spine and the other by the application of opposing forces. Based on the clinical results available, nighttime braces constitute an attractive option for single-major lumbar/thoracolumbar curves not exceeding 35 degrees in magnitude. Multi-center, randomized studies using strict criteria set forth by the Scoliosis Research Society and the Study group On Scoliosis Orthopaedic and Rehabilitation Treatment are needed to better define the role of nocturnal bracing in the conservative treatment of adolescent idiopathic scoliosis.
本综述文章旨在提供有关青少年特发性脊柱侧凸夜间支具使用的基础科学和临床信息的最新情况。夜间支具的使用是由一些关于部分时间佩戴支具的研究记录的令人鼓舞的结果所决定的，同时人们对使用全天佩戴支具时患者依从性差的问题也越来越关注。夜间支具的主要特点在于它们能够过度矫正脊柱侧凸的弯曲度，从而消除在顶椎和相邻椎间盘处出现的不对称积水，进而通过休特尔 - 福尔克曼原理恢复接近正常的力的施加，并防止弯曲进展。两种最常用的夜间支具通过不同机制过度矫正脊柱，一种通过弯曲脊柱起作用，另一种通过施加相反的力起作用。根据现有的临床结果，夜间支具对于单一主要的腰椎/胸腰段弯曲度不超过35度的情况是一个有吸引力的选择。需要进行多中心、随机研究，采用脊柱侧凸研究学会和脊柱侧凸矫形与康复治疗研究组制定的严格标准，以更好地确定夜间支具在青少年特发性脊柱侧凸保守治疗中的作用。
