Kotwicki Tomasz, Jozwiak Marek
Department of Paediatric Orthopaedics and Traumatology, University of Medical Sciences of Poznan, Poland.
Disabil Rehabil. 2008;30(10):792-8. doi: 10.1080/09638280801889584.
The principles of conservative management of neuromuscular scoliosis in childhood and adolescence are presented.
Analysis of personal experience and literature review. The topic is discussed separately for patients with flaccid or spastic paresis.
These demonstrate that conservative management might be proposed for patients with neuromuscular scoliosis in many clinical situations. In spastic disorders, it maintains the symmetry around the hip joints. Bracing is technically difficult and often is not tolerated well by cerebral palsy children. In patients with flaccid paresis, the fitting and the use of brace is easier than in spastic patients. The flexibility of the spinal curvature is more important. Functional benefits of conservative management of neuromuscular scoliosis comprise stable sitting, easier use of upper limbs, discharge of the abdomen from the collapsing trunk, increased diaphragm excursion, and, not always, prevention of curve progression.
Specific natural history and multiple medical problems associated with the disease make the treatment of children with neuromuscular scoliosis an extremely complex issue, best addressed when a team approach is applied. Continuously improving techniques of conservative management, comprising bracing and physiotherapy, together with correctly timed surgery incorporated in the process of rehabilitation, provide the optimal care for patients.
阐述儿童及青少年神经肌肉型脊柱侧弯的保守治疗原则。
分析个人经验并进行文献综述。分别针对弛缓性或痉挛性麻痹患者讨论该主题。
这些表明在许多临床情况下，神经肌肉型脊柱侧弯患者可采用保守治疗。在痉挛性疾病中，它能维持髋关节周围的对称性。支具治疗技术难度大，脑瘫患儿通常耐受性不佳。在弛缓性麻痹患者中，支具的适配和使用比痉挛性患者更容易。脊柱侧弯的柔韧性更为重要。神经肌肉型脊柱侧弯保守治疗的功能益处包括稳定坐姿、上肢使用更便捷、腹部免受塌陷躯干的压迫、膈肌活动度增加，且并不总是能预防侧弯进展。
该疾病特定的自然病程及多种医学问题使得神经肌肉型脊柱侧弯患儿的治疗成为一个极其复杂的问题，采用团队协作方法时能得到最佳解决。不断改进包括支具治疗和物理治疗在内的保守治疗技术，以及在康复过程中适时进行手术，可为患者提供最佳治疗。
