Negrini Stefano, Marchini Gianfranco, Tessadri Fabrizio
ISICO (Italian Scientific Spine Institute), Milan, Italy.
Scoliosis. 2011 May 9;6:8. doi: 10.1186/1748-7161-6-8.
Bracing is an effective strategy for scoliosis treatment, but there is no consensus on the best type of brace, nor on the way in which it should act on the spine to achieve good correction. The aim of this paper is to present the family of SPoRT (Symmetric, Patient-oriented, Rigid, Three-dimensional, active) braces: Sforzesco (the first introduced), Sibilla and Lapadula.
The Sforzesco brace was developed following specific principles of correction. Due to its overall symmetry, the brace provides space over pathological depressions and pushes over elevations. Correction is reached through construction of the envelope, pushes, escapes, stops, and drivers. The real novelty is the drivers, introduced for the first time with the Sforzesco brace; they allow to achieve the main action of the brace: a three-dimensional elongation pushing the spine in a down-up direction.Brace prescription is made plane by plane: frontal (on the "slopes", another novelty of this concept, i.e. the laterally flexed sections of the spine), horizontal, and sagittal. The brace is built modelling the trunk shape obtained either by a plaster cast mould or by CAD-CAM construction. Brace checking is essential, since SPoRT braces are adjustable and customisable according to each individual curve pattern.Treatment time and duration is individually tailored (18-23 hours per day until Risser 3, then gradual reduction). SEAS (Scientific Exercises Approach to Scoliosis) exercises are a key factor to achieve success.
The Sforzesco brace has shown to be more effective than the Lyon brace (matched case/control), equally effective as the Risser plaster cast (prospective cohort with retrospective controls), more effective than the Risser cast + Lyon brace in treating curves over 45 degrees Cobb (prospective cohort), and is able to improve aesthetic appearance (prospective cohort).
The SPoRT concept of bracing (three-dimensional elongation pushing in a down-up direction) is different from the other corrective systems: 3-point, traction, postural, and movement-based. The Sforzesco brace, being comparable to casting, may be the best brace for the worst cases.
支具治疗是脊柱侧弯治疗的一种有效策略，但对于最佳支具类型以及其作用于脊柱以实现良好矫正的方式尚无共识。本文旨在介绍SPoRT（对称、以患者为导向、刚性、三维、主动）支具系列：斯福尔扎斯科（最先推出的）、西比拉和拉帕杜拉。
斯福尔扎斯科支具是依据特定的矫正原则研发的。由于其整体对称性，该支具在病理性凹陷处提供空间并在隆起处施加推力。通过构建包络、推力、避让、阻挡和驱动装置来实现矫正。真正的创新之处在于驱动装置，它首次随斯福尔扎斯科支具引入；它们能够实现支具的主要作用：一种三维伸展，沿上下方向推动脊柱。支具处方是逐平面制定的：额状面（在“斜坡”上，这一概念的另一个创新点，即脊柱的侧屈段）、水平面和矢状面。支具是根据通过石膏铸模或CAD - CAM构建获得的躯干形状进行建模制作的。支具检查至关重要，因为SPoRT支具可根据每个个体的曲线模式进行调整和定制。治疗时间和时长是因人而异的（每天佩戴18 - 23小时直至Risser 3级，然后逐渐减少佩戴时间）。SEAS（脊柱侧弯科学运动疗法）运动是取得成功的关键因素。
斯福尔扎斯科支具已显示出比里昂支具更有效（配对病例/对照），与里塞尔石膏模型效果相当（前瞻性队列与回顾性对照），在治疗Cobb角超过45度的曲线时比里塞尔模型 + 里昂支具更有效（前瞻性队列），并且能够改善美观度（前瞻性队列）。
SPoRT支具概念（沿上下方向的三维伸展）与其他矫正系统不同：三点式、牵引式、姿势式和基于运动的系统。斯福尔扎斯科支具与石膏模型效果相当，对于最严重的病例可能是最佳支具。
