ISICO (Italian Scientific Spine Institute), Milan, Italy.
Spine (Phila Pa 1976). 2010 Jun 1;35(13):1285-93. doi: 10.1097/BRS.0b013e3181dc48f4.
Cochrane systematic review.
To evaluate the efficacy of bracing in adolescent patients with adolescent idiopathic scoliosis (AIS).
AIS is a 3-dimensional deformity of the spine. Although AIS can progress during growth and cause a surface deformity, it is usually not symptomatic. However, in adulthood, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. Braces are traditionally recommended to stop curvature progression in some countries and criticized in others. They generally need to be worn full time, with treatment extending over years.
The following databases (up to July 2008) were searched with no language limitations: the Cochrane Central Register of Controlled Trials, MEDLINE (from January 1966), EMBASE (from January 1980), and CINHAL (from January 1982), and reference lists of the articles. An extensive handsearch of the gray literature was also conducted. Randomized controlled trials (RCTs) and prospective cohort studies were searched for comparing braces with no treatment, other treatment, surgery, and different types of braces. Two review authors independently assessed trial quality and extracted data.
We included 2 studies. There was very low quality evidence from 1 prospective cohort study with 286 girls that a brace curbed curve progression at the end of growth (success rate, 74% [95% confidence interval {CI}: 52%-84%]), better than observation (success rate, 34% [95% CI: 16%-49%]) and electrical stimulation (success rate, 33% [95% CI: 12%-60%]). There is low-quality evidence from 1 RCT with 43 girls that a rigid brace is more successful than an elastic one (SpineCor) at curbing curve progression when measured in Cobb degrees, but there were no significant differences between the 2 groups in the subjective perception of daily difficulties associated with wearing the brace.
There is very low quality evidence in favor of using braces, making generalization very difficult. Further research could change the actual results and our confidence in them; in the meantime, patients' choices should be informed by multidisciplinary discussion. Future research should focus on short- and long-term patient-centered outcomes, in addition to measures such as Cobb angles. RCTs and prospective cohort studies should follow both the Scoliosis Research Society and Society on Scoliosis Orthopedic and Rehabilitation Treatment criteria for bracing studies.
Cochrane 系统评价。
评估支具在青少年特发性脊柱侧凸（AIS）患者中的疗效。
AIS 是脊柱的三维畸形。尽管 AIS 在生长过程中可能会进展并导致表面畸形，但通常没有症状。然而，在成年后，如果最终脊柱曲率超过一定的临界阈值，健康问题和曲线进展的风险就会增加。在一些国家，支具被传统上推荐用于阻止曲线进展，而在其他国家则受到批评。它们通常需要全天佩戴，治疗时间长达数年。
无语言限制地搜索了以下数据库（截至 2008 年 7 月）：Cochrane 对照试验中心注册库、MEDLINE（从 1966 年 1 月开始）、EMBASE（从 1980 年 1 月开始）和 CINHAL（从 1982 年 1 月开始），以及文章的参考文献列表。还对灰色文献进行了广泛的手工搜索。搜索了比较支具与无治疗、其他治疗、手术和不同类型支具的随机对照试验（RCT）和前瞻性队列研究。两位综述作者独立评估了试验质量并提取了数据。
我们纳入了 2 项研究。来自 1 项前瞻性队列研究的证据质量非常低，该研究纳入了 286 名女孩，结果显示支具可以阻止生长结束时的曲线进展（成功率为 74%[95%置信区间{CI}：52%-84%]），优于观察（成功率为 34%[95% CI：16%-49%]）和电刺激（成功率为 33%[95% CI：12%-60%]）。来自 1 项纳入 43 名女孩的 RCT 的证据质量较低，结果显示刚性支具在 Cobb 角度测量时比弹性支具（SpineCor）更能成功抑制曲线进展，但两组在佩戴支具时日常困难的主观感知方面无显著差异。
支持使用支具的证据质量非常低，这使得推广非常困难。进一步的研究可能会改变实际结果和我们对这些结果的信心；同时，患者的选择应该由多学科讨论来告知。未来的研究应侧重于短期和长期的以患者为中心的结果，以及 Cobb 角等措施。RCT 和前瞻性队列研究应遵循 Scoliosis Research Society 和 Society on Scoliosis Orthopedic and Rehabilitation Treatment 制定的支具研究标准。
Zotero 插件