脊柱侧弯畸形对矫形干预的时间依赖性反应：佩戴或取下脊柱矫形器后何时应进行X光检查？
Time-dependent response of scoliotic curvature to orthotic intervention: when should a radiograph be obtained after putting on or taking off a spinal orthosis?
作者信息
Li Meng, Wong M S, Luk Keith D K, Wong Kenneth W H, Cheung Kenneth M C
机构信息
*Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong †Department of Orthopaedics & Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong; and ‡Department of Prosthetics & Orthotics, Queen Mary Hospital, Pok Fu Lam, Hong Kong.
出版信息
Spine (Phila Pa 1976). 2014 Aug 1;39(17):1408-16. doi: 10.1097/BRS.0000000000000423.
STUDY DESIGN
A prospective study; 2-group design.
OBJECTIVE
This study aims to assess the time response of scoliotic spines to orthotic intervention using clinical ultrasound.
SUMMARY OF BACKGROUND DATA
Patients with moderate adolescent idiopathic scoliosis are generally advised orthotic treatment. However, the time to reach maximum correction after donning spinal orthosis or the time to return to pretreatment curvature after doffing spinal orthosis is not fully understood.
METHOD
Subjects were divided into 2 groups, the don-orthosis group and the doff-orthosis group where the time reaching maximum correction and the time returning to pretreatment curvature were investigated accordingly. To avoid excessive radiation exposure via obtaining repeated radiographs, a validated method of estimating Cobb angle using radiation-free clinical ultrasound was applied at an interval of every 30 minutes up to 180 minutes. The spinal flexibility (estimated from supine radiographs) and body mass index were collected from the subjects for analyses.
RESULT
Nine female patients with adolescent idiopathic scoliosis were recruited. There was no immediate change in the Cobb angles. A change of more than 5° could be observed in both groups only after 30 minutes and maximum change was found at/after 120 minutes. In the doff-orthosis group, the subject with the lowest body mass index took the longest time to increase more than 5° after doffing spinal orthosis. In the don-orthosis group, the subject with the highest body mass index took the longest time to achieve curve correction more than 5°.
CONCLUSION
This investigation demonstrated that there is a time lag between application of spinal orthosis and its effect on scoliotic curvature. This is likely due to the low-stiff and viscoelastic properties of the spine. The clinical relevance of this study is that for patients with scoliosis undergoing orthotic treatment, radiograph should not be obtained within 2 hours of putting on or taking off spinal orthosis because it may not show the maximum effect.
LEVEL OF EVIDENCE
研究设计
前瞻性研究；两组设计。
目的
本研究旨在使用临床超声评估脊柱侧弯的脊柱对矫形干预的时间反应。
背景数据总结
一般建议中度青少年特发性脊柱侧弯患者进行矫形治疗。然而，佩戴脊柱矫形器后达到最大矫正的时间或脱下脊柱矫形器后恢复到治疗前曲度的时间尚未完全明确。
方法
将受试者分为两组，即佩戴矫形器组和脱下矫形器组，分别研究达到最大矫正的时间和恢复到治疗前曲度的时间。为避免因重复进行X线摄影而导致过度辐射暴露，采用经验证的无辐射临床超声估计Cobb角的方法，每隔30分钟进行一次，直至180分钟。收集受试者的脊柱柔韧性（根据仰卧位X线片估计）和体重指数进行分析。
结果
招募了9名青少年特发性脊柱侧弯女性患者。Cobb角无即刻变化。两组均仅在30分钟后可观察到超过5°的变化，最大变化出现在120分钟时/120分钟后。在脱下矫形器组中，体重指数最低的受试者在脱下脊柱矫形器后增加超过5°所需时间最长。在佩戴矫形器组中，体重指数最高的受试者实现超过5°的曲线矫正所需时间最长。
结论
本研究表明，脊柱矫形器的应用与其对脊柱侧弯曲度的影响之间存在时间滞后。这可能是由于脊柱的低刚度和粘弹性特性所致。本研究的临床意义在于，对于接受矫形治疗的脊柱侧弯患者，在佩戴或脱下脊柱矫形器后2小时内不应进行X线摄影，因为此时可能无法显示最大效果。
证据级别
4级。
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