Biomechanics and Musculoskeletal Rehabilitation Laboratory, Health Science Post-Graduate Department, Medicine School, University Santo Amaro, São Paulo 04829-300, SP, Brazil.
Spine Group, Rehabilitation Clinic, São Paulo 13025-270, SP, Brazil.
Medicina (Kaunas). 2022 Jul 29;58(8):1024. doi: 10.3390/medicina58081024.
: Adolescent idiopathic scoliosis (AIS) is a prevalent spinal disorder in adolescents. Previous studies have shown biomechanical changes of the gait in the lower limb of AIS patients. To minimize the progression of scoliotic curvature, a spinal brace is used, which has been shown to be efficient. Usually, a brace is worn strictly for 20-22 h every day. To our knowledge, no study has assessed the short- and long-term effects of spinal brace use with or without an exercise program (6 months) to improve clinical and biomechanical parameters. The aim of our study was to verify the effects of short- and long-term spinal brace use, with or without an exercise program on the spine, body balance, and plantar load distribution during gait in AIS. : A prospective randomized study was conducted with intention-to-treat analysis in forty-five adolescents diagnosed with AIS undergoing conservative treatment at a center specialized in spinal rehabilitation. Adolescents were evaluated at two stages of intervention: (1) spinal orthopedic brace, with acute use 24 h/day ( = 22) and (2) spinal orthopedic brace, with acute use between 15-18 h/day associated with a specific rehabilitation exercise protocol for six consecutive months (six months and 12 total sessions, = 23). The evaluated parameters were: spine pain, using a visual analog scale (VAS); Cobb angle measurement using radiograph exams, as well as the Risser sign; and static balance and plantar pressure of the feet during gait, carried out using a pressure platform. : AIS patients showed significant improvements in the main scoliotic curvature, with a 12-degree reduction in Cobb angle pre- and post-short-term immediate use of spinal brace and a 5.3 degree correction after six months of spinal brace use in combination with specific exercises (long term). In addition, short- and long-term brace use with an exercise program showed a significant increase in anteroposterior and mediolateral balance and a reduction in plantar overload on the heel during gait, with an effect size between moderate and high. : Intervention via the short- or long-term use of a spinal brace combined with specific exercises in adolescents with idiopathic scoliosis proved to be effective for correcting scoliotic curvature. In addition, intervention also showed improvements to the antero-posterior and mediolateral body balance and a reduction in the plantar load on the rearfoot region during gait, demonstrating effective mechanical action on the spine.
青少年特发性脊柱侧凸（AIS）是青少年中常见的脊柱疾病。先前的研究表明，AIS 患者的下肢步态存在生物力学变化。为了尽量减少脊柱侧凸曲率的进展，会使用脊柱矫形器，事实证明其是有效的。通常，患者每天严格佩戴矫形器 20-22 小时。据我们所知，尚无研究评估脊柱矫形器使用（6 个月）有无运动方案对改善临床和生物力学参数的短期和长期效果。我们的研究目的是验证短期和长期使用脊柱矫形器，有无运动方案对 AIS 脊柱、身体平衡和步态足底负荷分布的影响。
一项前瞻性随机研究，采用意向治疗分析，纳入 45 名在专门从事脊柱康复的中心接受保守治疗的 AIS 青少年。青少年在两个干预阶段进行评估：（1）脊柱矫形器，急性使用 24 小时/天（n=22），（2）脊柱矫形器，急性使用 15-18 小时/天，并结合特定的康复运动方案连续使用 6 个月（6 个月和总共 12 次，n=23）。评估参数包括：脊柱疼痛，使用视觉模拟量表（VAS）评估；放射检查 Cobb 角测量，以及 Risser 征；以及使用压力平台进行步态时的静态平衡和足底压力。
AIS 患者的主要脊柱侧凸曲率有显著改善，脊柱矫形器短期急性使用前、后 Cobb 角降低 12 度，6 个月脊柱矫形器联合特定运动方案使用后矫正 5.3 度（长期）。此外，带运动方案的短、长期矫形器使用均显著增加了前后和左右方向的平衡，步态时足跟部的足底负荷减轻，效果大小为中至高。
通过短期或长期使用脊柱矫形器结合特定运动方案干预青少年特发性脊柱侧凸，可有效矫正脊柱侧凸。此外，干预还改善了前后和左右方向的身体平衡，步态时后足区域的足底负荷减轻，对脊柱起到了有效的机械作用。
