Brunner Reinald
Orthopaedic Department, Children's Hospital, University of Basel, Switzerland.
J Child Orthop. 2020 Feb 1;14(1):2-8. doi: 10.1302/1863-2548.14.190127.
Cerebral palsy (CP) is characterized by poor motor control. The more severe the affection is, the more patients are prone to deformities. Patients with Gross Motor Function Classification System level V run an up to 90% risk for spinal deformities. These are caused by poor trunk control under load. Although trunk tone is impossible to assess it seems to be low in the majority of patients, leading to collapse under gravity. The constant malposition results in growth asymmetry which leads to fixation and deterioration of the deformity.
Brace treatment has a poor reputation in respect to the final outcome. Conventional braces as constructed for other spinal deformities are indeed difficult for patients with CP as they cannot change position in the brace and do not tolerate pressure on the belly for reflux problems. Respecting these points improves the tolerance of braces but still the time of use is far from the necessary when the trunk is upright. Nevertheless, they can help to postpone surgery for scoliosis, but they are very inefficient for sagittal plane deformities.
The lack of trunk control further leads to an impairment of head control and upper extremity function. Providing stability improves these problems. Braces are superior to seating shells for both treating deformity and providing stability as they remain close to the skin and follow movements. Supports on seating shells in contrast are too far away for controlling the deformity and provide stability only if the patient doesn't move forward.
脑瘫（CP）的特点是运动控制能力差。病情越严重，患者越容易出现畸形。粗大运动功能分类系统为V级的患者发生脊柱畸形的风险高达90%。这是由负重时躯干控制不佳所致。尽管躯干肌张力难以评估，但大多数患者的躯干肌张力似乎较低，导致在重力作用下塌陷。持续的姿势不良导致生长不对称，进而导致畸形固定并加重。
就最终效果而言，支具治疗的声誉不佳。为其他脊柱畸形设计的传统支具对脑瘫患者确实困难，因为他们无法在支具内改变姿势，且因反流问题无法耐受腹部受压。考虑到这些因素可提高对支具的耐受性，但当躯干直立时，使用时间仍远未达到所需时长。尽管如此，它们有助于推迟脊柱侧弯手术，但对矢状面畸形的效果非常不佳。
躯干控制能力不足还会进一步导致头部控制和上肢功能受损。提供稳定性可改善这些问题。支具在治疗畸形和提供稳定性方面优于座椅外壳，因为它们贴近皮肤并能跟随动作。相比之下，座椅外壳上的支撑装置距离太远，无法控制畸形，只有在患者不向前移动时才能提供稳定性。
