Department of Orthopaedics, Texas Scottish Rite Hospital for Children, Dallas, TX 75219, USA.
J Bone Joint Surg Am. 2010 Jun;92(6):1343-52. doi: 10.2106/JBJS.I.01142.
The efficacy of brace treatment for patients with adolescent idiopathic scoliosis remains controversial, and effectiveness remains unproven. We accurately measured the number of hours of brace wear for patients with this condition to determine if increased wear correlated with lack of curve progression.
Of 126 patients with adolescent idiopathic scoliosis curves measuring between 25 degrees and 45 degrees , 100 completed a prospective study in which they were managed with a Boston brace fitted with a heat sensor that measured the exact number of hours of brace wear. Orthopaedic teams prescribed either sixteen or twenty-three hours of brace wear and were blinded to the wear data. At the completion of treatment, the number of hours of brace wear were compared with the frequency of curve progression of > or =6 degrees and with curve progression requiring surgery.
The total number of hours of brace wear correlated with the lack of curve progression. This effect was most significant in patients who were at Risser stage 0 (p = 0.0003) or Risser stage 1 (p = 0.07) at the beginning of treatment and in patients with an open triradiate cartilage at the beginning of treatment. Logistic regression analyses showed a "dose-response" curve in which the greater number of hours of brace wear correlated with lack of curve progression. Brace wear to school and immediately afterward was most successful. Curves did not progress in 82% of patients who wore the brace more than twelve hours per day, compared with only 31% of those who wore the brace fewer than seven hours per day (p = 0.0005). The number of hours of brace wear also correlated inversely with the need for surgical treatment (p = 0.0005). The number of hours of wear were similar for the patients who were advised to wear the brace sixteen or twenty-three hours daily.
The Boston brace is an effective means of controlling curve progression in patients with adolescent idiopathic scoliosis when worn for more than twelve hours per day.
支具治疗青少年特发性脊柱侧凸的疗效仍存在争议，其有效性仍未得到证实。我们准确地测量了患有这种疾病的患者佩戴支具的时间，以确定佩戴时间的增加是否与曲线进展无关。
在 126 名青少年特发性脊柱侧凸曲线在 25 度至 45 度之间的患者中，有 100 名完成了一项前瞻性研究，他们使用波士顿支具进行治疗，该支具配备了一个热传感器，可以精确测量佩戴支具的时间。骨科团队规定佩戴支具的时间为 16 小时或 23 小时，并对佩戴数据进行了盲法处理。在治疗结束时，将支具佩戴时间与曲线进展大于或等于 6 度的频率以及需要手术的曲线进展进行比较。
支具佩戴总时间与曲线无进展相关。在治疗开始时 Risser 分期为 0 期（p=0.0003）或 1 期（p=0.07）或治疗开始时三射骨骺未闭合的患者中，这种效果最为显著。Logistic 回归分析显示存在“剂量反应”曲线，即佩戴支具时间增加与曲线无进展相关。在学校和之后立即佩戴支具的效果最佳。每天佩戴支具超过 12 小时的患者中，82%的患者曲线无进展，而每天佩戴支具少于 7 小时的患者中只有 31%曲线无进展（p=0.0005）。佩戴支具时间也与手术治疗的需要呈负相关（p=0.0005）。建议每天佩戴支具 16 或 23 小时的患者佩戴支具的时间相似。
当每天佩戴支具超过 12 小时时，波士顿支具是控制青少年特发性脊柱侧凸患者曲线进展的有效手段。
