Negrini Stefano, Donzelli Sabrina, Lusini Monia, Zaina Fabio
Physical and Rehabilitation Medicine, University of Brescia, Italy.
Stud Health Technol Inform. 2012;176:393-6.
Recently it has been shown that idiopathic scoliosis (IS) curves can be reduced with bracing, and it has been proposed that this could be useful in non-surgically treated high degree curves even after Risser 3. Moreover, bracing has been shown to be able to improve aesthetics, and this could be another reason to treat some patients with cosmetic needs. Our aim is to preliminary check if results can be obtained in IS patients after Risser 3.
Design. Retrospective uncontrolled cohort study. Inclusion criteria. All IS patients treated on a voluntary basis for aesthetic reasons and/or for curve reduction; Risser 4-5 at start; end of treatment reached. Population. 34 females and 2 males, age 16.2±1.6 years, Cobb angle 27.6°±8.9°. Treatment. Lyon or SPoRT braces 18 to 24 hours/day, specific SEAS exercises, rapid weaning (2-3 hours every 6 months). Outcome criteria: SRS (unchanged; worsened over 6°; over 45° at the end of treatment; surgically treated), radiographic and clinical. Statistics. ANOVA and chi-test.
The reported compliance during the 2.8 ± 1.1 treatment years was 95.1%, while residual growth was 0.9 ± 1.1 cm. Improvements were found in 39% of this cohort, (46% in curves over 30°). Only 1 patient progressed 6°. We found highly statistically significant reductions of maximal (-4.4°), thoracic (-6.0°) and thoracolumbar (-6.6°) curves. Statistically significant improvements were found for Aesthetic Index.
Before 20 years of age, even in skeletally mature patients, it is possible to reach radiographic and aesthetic improvements, although not as good as during growth. Correction is based on bone growth, but ligaments and neuromuscular control of posture can also be involved.
最近研究表明，特发性脊柱侧凸（IS）曲线可通过支具矫正，有人提出，即使在Risser 3期后，这对于非手术治疗的高度曲线也可能有用。此外，支具已被证明能够改善美观，这可能是治疗一些有美容需求患者的另一个原因。我们的目的是初步检查Risser 3期后的IS患者是否能取得治疗效果。
设计。回顾性非对照队列研究。纳入标准。所有因美学原因和/或为了减少曲线而自愿接受治疗的IS患者；开始时Risser 4 - 5期；达到治疗结束。研究对象。34名女性和2名男性，年龄16.2±1.6岁，Cobb角27.6°±8.9°。治疗。Lyon或SPoRT支具每天佩戴18至24小时，进行特定的SEAS锻炼，快速减少佩戴时间（每6个月减少2 - 3小时）。疗效标准：SRS（不变；恶化超过6°；治疗结束时超过45°；接受手术治疗），影像学和临床评估。统计学方法。方差分析和卡方检验。
在2.8±1.1年的治疗期间，报告的依从率为95.1%，而剩余生长量为0.9±1.1厘米。该队列中39%的患者有改善（曲线超过30°的患者中46%有改善）。只有1名患者进展了6°。我们发现最大曲线（-4.4°）、胸椎曲线（-6.0°）和胸腰段曲线（-6.6°）有高度统计学意义的降低。美学指数有统计学意义的改善。
在20岁之前，即使是骨骼成熟的患者，也有可能在影像学和美观方面取得改善，尽管不如生长期间那么好。矫正基于骨骼生长，但韧带和姿势的神经肌肉控制也可能起作用。
