一种基于恢复胸腰段前凸的、适用于青少年脊柱侧凸和后凸的新型支具治疗方法。治疗至少一年后的影像学和主观临床结果。
A new brace treatment similar for adolescent scoliosis and kyphosis based on restoration of thoracolumbar lordosis. Radiological and subjective clinical results after at least one year of treatment.
作者信息
van Loon Piet Jm, Roukens Monique, Kuit Joop Dj, Thunnissen Frederik Btm
机构信息
Department Orthopaedic Surgery, Gelre Ziekenhuizen Apeldoorn, Albert Schweitzerlaan 31, 7300, DS, Apeldoorn, The Netherlands.
出版信息
Scoliosis. 2012 Oct 29;7(1):19. doi: 10.1186/1748-7161-7-19.
STUDY DESIGN
A prospective treatment study with a new brace was conducted Objective. To evaluate radiological and subjective clinical results after one year conservative brace treatment with pressure onto lordosis at the thoracolumbar joint in children with scoliosis and kyphosis.
SUMMARY OF BACKGROUND DATA
Conservative brace treatment of adolescent scoliosis is not proven to be effective in terms of lasting correction. Conservative treatment in kyphotic deformities may lead to satisfactory correction. None of the brace or casting techniques is based on sagittal forces only applied at the thoracolumbar spine (TLI= thoracolumbar lordotic intervention). Previously we showed in patients with scoliosis after forced lordosis at the thoracolumbar spine a radiological instantaneous reduction in both coronal curves of double major scoliosis.
METHODS
A consecutive series of 91 children with adolescent scoliosis and kyphosis were treated with a modified symmetric 30 degrees Boston brace to ensure only forced lordosis at the thoracolumbar spine. Scoliosis was defined with a Cobb angle of at least one of the curves [greater than or equal to] 25 degrees and kyphosis with or without a curve <25 degrees in the coronal plane. Standing radiographs were made i) at start, ii) in brace at beginning and iii) after one year treatment without brace.
RESULTS
Before treatment start 'in brace' radiographs showed a strong reduction of the Cobb angles in different curves in kyphosis and scoliosis groups (sagittal n = 5 all p < 0.001, pelvic obliquity p < 0.001). After one year of brace treatment in scoliosis and kyphosis group the measurements on radiographs made without brace revealed an improvement in 3 Cobb angles each.
CONCLUSION
Conservative treatment using thoracolumbar lordotic intervention in scoliotic and kyphotic deformities in adolescence demonstrates a marked improvement after one year also in clinical and postural criteria. An effect not obtained with current brace techniques.
研究设计
采用一种新型支具进行前瞻性治疗研究。目的：评估脊柱侧凸和后凸患儿在胸腰段关节施加压力进行为期一年的保守支具治疗后的影像学和主观临床结果。
背景数据总结
青少年脊柱侧凸的保守支具治疗在持久矫正方面尚未被证明有效。后凸畸形的保守治疗可能会带来满意的矫正效果。目前没有一种支具或石膏技术仅基于在胸腰椎施加的矢状力（胸腰前凸干预，TLI）。此前我们发现，脊柱侧凸患者在胸腰椎强制前凸后，双主弯脊柱侧凸的冠状面曲线在影像学上会立即出现减小。
方法
连续纳入91例青少年脊柱侧凸和后凸患儿，使用改良的30度对称波士顿支具进行治疗，以确保仅在胸腰椎施加强制前凸。脊柱侧凸定义为至少一条曲线的Cobb角≥25度，后凸定义为冠状面有或无<25度的曲线。分别在治疗开始时、佩戴支具初期以及去除支具治疗一年后拍摄站立位X线片。
结果
在开始治疗前，“佩戴支具”时的X线片显示，后凸和脊柱侧凸组不同曲线的Cobb角均有明显减小（矢状面n = 5，所有p < 0.001，骨盆倾斜度p < 0.001）。脊柱侧凸和后凸组在佩戴支具治疗一年后，去除支具拍摄的X线片测量结果显示，每个组的3个Cobb角均有改善。
结论
在青少年脊柱侧凸和后凸畸形中采用胸腰前凸干预的保守治疗，在一年后临床和姿势标准方面也显示出显著改善。这是目前支具技术所未获得的效果。
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