Gur Gozde, Turgut Elif, Ayhan Cigdem, Baltaci Gul, Yakut Yavuz
Hacettepe University, Faculty of Health Sciences, School of Physical Therapy and Rehabilitation Sciences, Ankara, Turkey.
Hacettepe University, Faculty of Health Sciences, School of Physical Therapy and Rehabilitation Sciences, Ankara, Turkey.
Clin Biomech (Bristol). 2017 Aug;47:14-19. doi: 10.1016/j.clinbiomech.2017.05.010. Epub 2017 May 22.
Bracing is the most common nonsurgical treatment for adolescent idiopathic scoliosis. Spinal braces affect glenohumeral and scapulothoracic motion because they restrict trunk movements. However, the potential spinal-bracing effects on scapular kinematics are unknown. The present study aimed to investigate the acute effects of spinal bracing on scapular kinematics in adolescent idiopathic scoliosis.
Scapular kinematics, including scapular internal/external rotation, posterior/anterior tilting, and downward/upward rotation during scapular plane elevation, were evaluated in 27 in-brace and out-of-brace adolescent idiopathic scoliosis patients with a three-dimensional electromagnetic tracking system. Data on the position and orientation of the scapula at 30°, 60°, 90°, and 120° humerothoracic elevation were used for statistical comparisons. The paired t-test was used to assess the differences between the mean values of in-brace and out-of-brace conditions.
The in-brace condition showed significantly increased (P<0.05) scapular anterior tilting and decreased internal rotation in the resting position on the convex and concave sides; increased scapular downward rotation at 120° humerothoracic elevation on the convex side and at 30°, 60°, 90°, and 120° humerothoracic elevation on the concave side; increased scapular anterior tilt at 30°, 60°, 90°, and 120° humerothoracic elevation on the convex and concave sides; and decreased (P<0.05) maximal humerothoracic elevation of the arm.
Spinal bracing affects scapular kinematics. Observed changes in scapular kinematics with brace may also affect upper extremity function for adolescents with idiopathic scoliosis. Therefore, clinicians should include assessments of the glenohumeral and scapulothoracic joints when designing rehabilitation protocols for patients with adolescent idiopathic scoliosis.
支具治疗是青少年特发性脊柱侧凸最常见的非手术治疗方法。脊柱支具会限制躯干运动，从而影响盂肱关节和肩胛胸壁关节的活动。然而，脊柱支具对肩胛运动学的潜在影响尚不清楚。本研究旨在探讨脊柱支具对青少年特发性脊柱侧凸患者肩胛运动学的急性影响。
采用三维电磁跟踪系统，对27例佩戴支具和未佩戴支具的青少年特发性脊柱侧凸患者的肩胛运动学进行评估，包括肩胛平面抬高过程中的肩胛内/外旋转、后/前倾斜以及向下/向上旋转。使用肩胛胸壁抬高30°、60°、90°和120°时肩胛骨的位置和方向数据进行统计比较。采用配对t检验评估佩戴支具和未佩戴支具状态下平均值之间的差异。
佩戴支具状态下，凸侧和凹侧在静息位时肩胛前倾斜显著增加（P<0.05），内旋减少；凸侧在肩胛胸壁抬高120°时以及凹侧在肩胛胸壁抬高30°、60°、90°和120°时肩胛向下旋转增加；凸侧和凹侧在肩胛胸壁抬高30°、60°、90°和120°时肩胛前倾斜增加；手臂最大肩胛胸壁抬高降低（P<0.05）。
脊柱支具会影响肩胛运动学。观察到的佩戴支具时肩胛运动学的变化也可能影响青少年特发性脊柱侧凸患者的上肢功能。因此，临床医生在为青少年特发性脊柱侧凸患者设计康复方案时应包括对盂肱关节和肩胛胸壁关节的评估。
