Almansour Haidara, Pepke Wojciech, Bruckner Thomas, Diebo Bassel G, Akbar Michael
Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany.
Institute of Medical Biometry and Informatics, University of Heidelberg, 69118 Heidelberg, Germany.
J Clin Med. 2019 Oct 28;8(11):1804. doi: 10.3390/jcm8111804.
The three-dimensional nature of adolescent idiopathic scoliosis (AIS) necessitates a tridimensional assessment and management. Bracing constitutes the mainstay conservative treatment for mild adolescent idiopathic scoliosis. In the literature hitherto, there has been uncertainty regarding the behavior of the spine, pelvis, and vertebral orientations in the context of bracing, especially in the transverse plane. This poses a challenge to healthcare providers, patients, and their families, as brace treatment, although not as invasive as surgery, is laden with medical and psychological complications and could be considered traumatizing. Hence, a thorough understanding of initial three-dimensional spinal behavior in the context of bracing is important. The purpose of this retrospective study was to investigate the immediate 3D impact of Chêneau-type brace. Thirty-eight patients with AIS undergoing Chêneau-type bracing were included. Patients were stratified according to their structural curve topography into thoracic, thoracolumbar, and lumbar groups. 3D reconstruction of the spine using a dedicated biplanar stereoradiography software with and without the brace was performed. The examined anthropometric radiographic measures were pre- to in-brace variations and differences of spinopelvic parameters and vertebral orientations in the coronal, sagittal, and transverse planes. The complex impact of the Chêneau-type brace on different curves in three planes was delineated. In the coronal plane, the Cobb angle was significantly decreased in all types of curves, and the coronal tilt correction was concentrated in specific segments. The impact of the brace in this study on the sagittal profile was variable, including the loss of thoracic kyphosis and lumbar lordosis. In the transverse plane, an axial vertebral rotation change and detorsion above the apex occurred in the thoracolumbar curves. The results from this exploratory study could shed some light on the initial 3D spinal behavior in the context of bracing and may be of beneficial for treating physicians and brace makers.
青少年特发性脊柱侧凸（AIS）的三维特性需要进行三维评估和治疗。支具治疗是轻度青少年特发性脊柱侧凸的主要保守治疗方法。在迄今为止的文献中，对于脊柱、骨盆和椎体在支具治疗情况下的方位变化，尤其是在横断面内的变化，存在不确定性。这给医疗服务提供者、患者及其家属带来了挑战，因为支具治疗虽然不像手术那样具有侵入性，但却伴随着医学和心理方面的并发症，且可能被视为一种创伤。因此，全面了解支具治疗情况下脊柱最初的三维变化情况非常重要。这项回顾性研究的目的是调查施诺型支具的即时三维影响。纳入了38例接受施诺型支具治疗的AIS患者。根据其结构性弯曲的形态将患者分为胸椎、胸腰段和腰椎组。使用专门的双平面立体放射摄影软件对佩戴支具前后的脊柱进行三维重建。所检测的人体测量学放射学指标为佩戴支具前后脊柱骨盆参数和椎体在冠状面、矢状面和横断面方位的变化及差异。明确了施诺型支具在三个平面上对不同弯曲的复杂影响。在冠状面，所有类型的弯曲中Cobb角均显著减小，冠状面倾斜矫正集中在特定节段。本研究中支具对矢状面轮廓的影响各不相同，包括胸椎后凸和腰椎前凸的丢失。在横断面，胸腰段弯曲的顶椎上方出现了轴向椎体旋转变化和去旋转。这项探索性研究的结果可以为支具治疗情况下脊柱最初的三维变化情况提供一些启示，可能对治疗医生和支具制造商有益。
