Weiss Hans-Rudolf, Werkmann Mario
Orthopedic Rehabilitation Services, D-55457 Gensingen, Alzeyerstr, 23, Germany.
Scoliosis. 2010 Sep 6;5:19. doi: 10.1186/1748-7161-5-19.
Bracing concepts in use today for the treatment of scoliosis include symmetric and asymmetric hard braces usually made of polyethylene (PE) and soft braces. The plaster cast method worldwide seems to be the most practiced technique for the construction of hard braces at the moment. CAD (Computer Aided Design) systems are available which allow brace adjustments without plaster. Another possibility is the use of the ScoliOlogiC™ off the shelf system enabling the Certified Prosthetist and Orthotist (CPO) to construct a light brace for scoliosis correction from a variety of pattern specific shells to be connected to an anterior and a posterior upright. This Chêneau light™ brace, developed according to the Chêneau principles, promises a reduced impediment of quality of life in the brace. The correction effects of the first 81 patients (main diagnosis Adolescent Idiopathic Scoliosis (AIS) [n = 64] or Early Onset Scoliosis (EOS) [n = 15]), treated according to the principles of the Chêneau light™ brace have shown a satisfactory in-brace correction exceeding 50% of the initial Cobb angle.
The ScoliOlogiC® off the shelf bracing system enables the CPO to construct a light brace for scoliosis correction from a variety of pattern specific shells to be connected to an anterior and a posterior upright. This brace, when finally adjusted is called Chêneau light™ brace. The advantage of this new bracing system is that the brace is available immediately, is easily adjustable and that it can also be easily modified. This avoids construction periods of sometimes more than 6 weeks, where the curve may drastically increase during periods of fast growth. The disadvantage of this bracing system is that there is a wide variability of possibilities to arrange the different shells during adjustment.
The Cobb angle in the whole group was reduced by an average of 16,4°, which corresponds to a correction effect of 51%. The differences were highly significant in the T-test (T = 17,4; p < 0,001). The best correction effects achieved with Chêneau braces reported in literature so far are about 40% in two different studies. The correction effect was highest in lumbar and thoracolumbar curve patterns (62%; n = 18). In thoracic scoliosis the correction effect was 36% (n = 41) and in double major curve patterns 50% (n = 22). The correction effect was affected in a slightly negative way due to age (r = -0,24; p = 0,014), negatively with the Risser stage (-0,29; p = 0,0096) and correlated negatively with the Cobb angle measured before treatment (r = -0,43; p < 0,0001).
The use of the Chêneau light™ brace leads to correction effects above average when compared to correction effects of other braces described in literature. The reduction of material seems to increase patient's comfort and reduces the stress patients may suffer from whilst in the brace.80% of the adolescent population of scoliosis patients can be braced with the Chêneau light™ brace. In certain patterns of curvature and in the younger population with an age of less than 11 years, other approaches have to be used, such as plaster based bracing or the application of CAD/CAM based orthoses.
目前用于治疗脊柱侧弯的支具理念包括通常由聚乙烯（PE）制成的对称和不对称硬支具以及软支具。目前，在全球范围内，石膏模型法似乎是制作硬支具最常用的技术。现在已有计算机辅助设计（CAD）系统，可在无需石膏的情况下调整支具。另一种可能性是使用ScoliOlogiC™现成系统，使认证假肢矫形师（CPO）能够从各种特定型号的外壳构建用于脊柱侧弯矫正的轻型支具，这些外壳可连接到前部和后部直立部件上。这种根据谢诺原理开发的Chêneau light™支具有望减少佩戴支具对生活质量的影响。按照Chêneau light™支具的原理对首批81例患者（主要诊断为青少年特发性脊柱侧弯（AIS）[n = 64]或早发性脊柱侧弯（EOS）[n = 15]）进行治疗，其支具内矫正效果令人满意，超过初始 Cobb 角的50%。
ScoliOlogiC®现成支具系统使CPO能够从各种特定型号的外壳构建用于脊柱侧弯矫正的轻型支具，这些外壳可连接到前部和后部直立部件上。这种支具在最终调整后称为Chêneau light™支具。这种新支具系统的优点是支具可立即提供，易于调整，并且也易于修改。这避免了有时长达6周以上的制作周期，在此期间，在快速生长阶段曲线可能会急剧增加。这种支具系统的缺点是在调整过程中安排不同外壳的可能性存在很大差异。
整个组的Cobb角平均减小了16.4°，相当于矫正效果为51%。在t检验中差异具有高度显著性（T = 17.4；p < 0.001）。迄今为止文献报道的使用谢诺支具所取得的最佳矫正效果在两项不同研究中约为40%。腰椎和胸腰段曲线模式的矫正效果最高（62%；n = 18）。在胸段脊柱侧弯中，矫正效果为36%（n = 41），在双主弯模式中为50%（n = 22）。矫正效果因年龄受到轻微负面影响（r = -0.24；p = 0.014），与Risser分期呈负相关（-0.29；p = 0.0096），并与治疗前测量的Cobb角呈负相关（r = -0.43；p < 0.0001）。
与文献中描述的其他支具的矫正效果相比，使用Chêneau light™支具可带来高于平均水平的矫正效果。材料的减少似乎提高了患者的舒适度，并减轻了患者佩戴支具时可能承受的压力。80%的青少年脊柱侧弯患者群体可以使用Chêneau light™支具进行支具治疗。在某些曲率模式以及年龄小于11岁的较年轻患者群体中，必须采用其他方法，如基于石膏的支具或应用基于CAD/CAM的矫形器。
