Sponseller Paul D
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD 21224-2780, USA.
J Pediatr Orthop. 2011 Jan-Feb;31(1 Suppl):S53-60. doi: 10.1097/BPO.0b013e3181f73e87.
The use of orthoses in adolescent idiopathic scoliosis has a long history. The purpose of this article is to summarize the current practice of bracing in the treatment of adolescent idiopathic scoliosis.
The literature from the past 25 years was reviewed for primary papers that contained accepted inclusion criteria for bracing, meta-analyses, and summaries of existing opinion. Recent literature was also reviewed for current bracing practices.
The highest level of existing evidence comes from a prospective center-randomized study by Nachemson et al, which showed that bracing was effective for single curves of 25 to 35 degrees in female patients with a starting Risser score of 0 to 2. Two other studies with meta-analyses came to opposite conclusions because of variations in the examined investigations. Although there are few studies that compare different types of treatment, most show an improved outcome versus historical controls. The yearly number of peer-reviewed papers on the topic has increased markedly over this time. Two prospective randomized multicenter trials are underway. Reviews suggest that most orthopaedic specialists recommend bracing but that they differ on expected results. There is also a proliferation of interest in bracing by nonorthopaedists, with more varied indications. There are many types of full-time and part-time braces, and their designs and indications are described.
Brace treatment for adolescent idiopathic scoliosis continues to be frequently used, and the number of brace types has increased. Predicting progressive curves and refining indications requires additional investigation.
支具在青少年特发性脊柱侧凸治疗中的应用历史悠久。本文旨在总结目前支具治疗青少年特发性脊柱侧凸的实践情况。
回顾过去25年的文献，查找包含支具治疗公认纳入标准的原始论文、荟萃分析以及现有观点总结。同时回顾近期文献以了解当前的支具治疗实践。
现有最高水平的证据来自纳赫姆森等人进行的一项前瞻性中心随机研究，该研究表明，对于起始里塞尔评分0至2分的女性患者，25至35度的单弯支具治疗有效。另外两项荟萃分析研究得出了相反结论，原因在于所审查的研究存在差异。尽管比较不同治疗方法的研究较少，但大多数研究表明与历史对照相比结果有所改善。在此期间，关于该主题的同行评审论文数量显著增加。两项前瞻性随机多中心试验正在进行中。综述表明，大多数骨科专家推荐支具治疗，但他们对预期结果存在分歧。非骨科医生对支具治疗的兴趣也在增加，适应证更加多样。有许多种全时和部分时间佩戴的支具，对其设计和适应证进行了描述。
青少年特发性脊柱侧凸的支具治疗仍被频繁使用，支具类型数量有所增加。预测进展性侧弯并完善适应证需要进一步研究。
