Wong M S, Li M, Ng B, Lam T P, Ying M, Wong A, Cheng J
Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
Stud Health Technol Inform. 2012;176:375-8.
Patient with moderate AIS is usually prescribed with spinal orthosis aiming to mechanically support and prevent the spine from further deterioration. In the conventional fitting method, pre-brace X-ray is the main reference, thus, the pressure pad of spinal orthosis may not be accurately located to the strategic areas because the spinal deformities could change 3-dimensionally once pressure pad is applied. A high correlation (r > 0.98) between Cobb's angle and spinous process angle (SPA) was found in the recent studies. With the advancements of 3D clinical ultrasound (3D CUS), tracing SPA along a scoliotic spine becomes possible and this can be used to estimate Cobb's angle. This study aimed to evaluate the effect of pressure pad location of spinal orthosis in the treatment of AIS and 3D CUS was used to trace SPA for estimation of Cobb's angle. The in-brace X-rays were assessed for confirmation of treatment effectiveness. The subjects were divided into ultrasound-guided fitting group A (n=21) and conventional fitting group B (n=22). In the group A, pressure pads were tested at 5 locations - the prescribed location as in the conventional fitting (referred to the pre-brace X-ray), and 1 cm and 2 cm above and below the prescribed location, and 3D CUS was applied to trace the SPA in these 5 pad locations, and the pad location with the lowest estimated Cobb's angle was selected in the final fitting. The assessments of in-brace X-rays showed that the mean Cobb's angle of group A decreased from 28.9° (pre-brace) to 18.6° (immediate in-brace) while the mean Cobb's angle of group B decreased from 27.1° (pre-brace) to 22.5° (immediate in-brace). There was a significant difference (p < 0.05) in the correction of Cobb's angle between the two groups. The results showed that accurate pressure pad location does play an important role in the reduction of Cobb's angle and 3D CUS can be considered as a non-invasive and effective assessment tool to improve orthotic treatment of AIS.
中度青少年特发性脊柱侧弯（AIS）患者通常会佩戴脊柱矫形器，旨在提供机械支撑并防止脊柱进一步恶化。在传统的适配方法中，支具佩戴前的X线片是主要参考依据，然而，由于一旦施加压力垫，脊柱畸形可能会发生三维变化，脊柱矫形器的压力垫可能无法准确放置在关键区域。最近的研究发现Cobb角与棘突角（SPA）之间存在高度相关性（r > 0.98）。随着三维临床超声（3D CUS）技术的进步，沿着脊柱侧弯的脊柱追踪SPA成为可能，并且可用于估计Cobb角。本研究旨在评估脊柱矫形器压力垫位置对AIS治疗的效果，并使用3D CUS追踪SPA以估计Cobb角。通过佩戴支具后的X线片评估来确认治疗效果。受试者被分为超声引导适配组A（n = 21）和传统适配组B（n = 22）。在A组中，在5个位置测试压力垫——传统适配中的规定位置（参考支具佩戴前的X线片），以及规定位置上方和下方1 cm和2 cm处，并在这5个垫位置应用3D CUS追踪SPA，最终适配时选择估计Cobb角最低的垫位置。佩戴支具后的X线片评估显示，A组的平均Cobb角从28.9°（支具佩戴前）降至18.6°（支具佩戴后即刻），而B组的平均Cobb角从27.1°（支具佩戴前）降至22.5°（支具佩戴后即刻）。两组之间Cobb角的矫正存在显著差异（p < 0.05）。结果表明，准确的压力垫位置在降低Cobb角方面确实起着重要作用，并且3D CUS可被视为一种无创且有效的评估工具，以改善AIS的矫形治疗。
