Dupuis Sarah, Fortin Carole, Caouette Christiane, Leclair Isabelle, Aubin Carl-Éric
Department of Mechanical Engineering, École Polytechnique de Montréal, P.O. Box 6097, Downtown Station, Station "Centre-ville", Montreal, Quebec, H3C 3A7, Canada.
Research Centre, Sainte-Justine University Hospital Centre, 3175 chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada.
BMC Musculoskelet Disord. 2018 Jun 21;19(1):200. doi: 10.1186/s12891-018-2112-9.
Global postural re-education (GPR) is a physiotherapy treatment approach for pediatric idiopathic scoliosis (IS), where the physiotherapist qualitatively assesses scoliotic curvature reduction potential (with a manual correction) and patient's ability to self-correct (self-correction). To the author's knowledge, there are no studies regarding GPR applied to IS, hence there is a need to better understand the biomechanics of GPR curve reduction postures. The objective was to biomechanically and quantitatively evaluate those two re-education corrections using a computer model combined with experimental testing.
Finite elements models of 16 patients with IS (10.5-15.4 years old, average Cobb angle of 33°) where built from surface scans and 3D radiographic reconstructions taken in normal standing and self-corrected postures. The forces applied with the therapist's hands over the trunk during manual correction were recorded and used in the FEM to simulate this posture. Self-correction was simulated by moving the thoracic and lumbar apical vertebrae from their presenting position to their self-corrected position as seen on radiographs. A stiffness index was defined for each posture as the global force required to stay in the posture divided by the thoracic curve reduction (force/Cobb angle reduction).
The average force applied by the therapist during manual correction was 31 N and resulted in a simulated average reduction of 26% (p < 0.05), while kyphosis slightly increased and lordosis remained unchanged. The actual self-correction reduced the thoracic curve by an average of 33% (p < 0.05), while the lumbar curve remained unchanged. The thoracic kyphosis and lumbar lordosis were reduced on average by 6° and 5° (p < 0.05). Self-correction simulations correlated with actual self-correction (r = 0.9).
This study allowed quantification of thoracic curve reducibility obtained by external forces applications as well as patient's capacity to self-correct their posture, two corrections commonly used in the GPR approach.
整体姿势再教育（GPR）是一种针对小儿特发性脊柱侧弯（IS）的物理治疗方法，物理治疗师通过手动矫正定性评估脊柱侧弯的矫正潜力以及患者自我矫正的能力。据作者所知，尚无关于GPR应用于IS的研究，因此有必要更好地了解GPR矫正姿势的生物力学原理。目的是通过计算机模型结合实验测试，对这两种再教育矫正方法进行生物力学和定量评估。
根据16例IS患者（年龄10.5 - 15.4岁，平均Cobb角33°）在正常站立和自我矫正姿势下的表面扫描和三维放射学重建构建有限元模型。记录物理治疗师在手动矫正过程中施加于患者躯干的力，并用于有限元模型以模拟该姿势。通过将胸椎和腰椎顶椎从其当前位置移动到放射照片上显示的自我矫正位置来模拟自我矫正。为每个姿势定义一个刚度指数，即保持该姿势所需的总力除以胸椎曲线减少量（力/Cobb角减少量）。
物理治疗师在手动矫正过程中施加的平均力为31N，模拟平均减少26%（p < 0.05），而驼背略有增加，脊柱前凸保持不变。实际自我矫正使胸椎曲线平均减少33%（p < 0.05），而腰椎曲线保持不变。胸椎后凸和腰椎前凸平均分别减少6°和5°（p < 0.05）。自我矫正模拟与实际自我矫正相关（r = 0.9）。
本研究能够量化通过外力施加获得的胸椎曲线可矫正性以及患者自我矫正姿势的能力，这是GPR方法中常用的两种矫正方式。
