Capek Vojtech, Westin Olof, Brisby Helena, Wessberg Per
Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborgsvagen 31, SE-431 80 Molndal, Sweden.
Spine Surgery Unit, Orthopedic Clinic, Sahlgrenska University Hospital, Bruna straket 11B, SE-413 45 Gothenburg, Sweden.
N Am Spine Soc J. 2022 Oct 22;12:100178. doi: 10.1016/j.xnsj.2022.100178. eCollection 2022 Dec.
Progressive moderate scoliotic curves in patients with adolescent idiopathic scoliosis (AIS) are usually treated with a fulltime brace, e.g., the Boston brace (BB). The Providence nighttime brace (PNB), is an alternative which is designed to reach the same treatment effectiveness by nighttime wear only. Few studies compared treatment effectiveness between full and nighttime bracing with contradictory results.
Immature female patients older than 10 years with progressive moderate AIS curves with an apex below T6 were randomized into PNB (=62) or BB (=49) treatment. Inclusion criteria were AIS, age ≥ 10 years, no previous treatment, main curve Cobb angle 20°-40° and skeletal immaturity. The increase of the main curve by > 5° of Cobb angle at the final follow-up was established as the primary outcome measure. Secondary outcome measures included (1) the Scoliosis Research Society assessment criteria of effectiveness for brace studies, (2) progression of secondary curves, (3) in-brace correction and (4) compliance to the treatment. The patients were followed until 1 year after reaching maturity.
A total of 105 patients (=62 and =43 in PNB and BB group, respectively) completed the follow-up (95%). In the PNB group, 71% patients were treated successfully compared to 65% patients in the BB group (=.67). No significant difference of the curve progression was found between the groups (3.1°±6.3° and 2.6°±8.3° in PNB and BB group, respectively; =.73). No significant differences were found for the thoracic or thoracolumbar/lumbar subgroups. PNB showed a superior in-brace correction for all curve types. One of four secondary curves progressed > 5°. The compliance to the treatment was significantly higher in the PNB than BB group.
Both brace regimes are equally effective in treating moderate AIS curves with apex of the main curve below T6 in immature female patients older than 10 years.
青少年特发性脊柱侧凸（AIS）患者的进展性中度脊柱侧凸曲线通常采用全天候支具治疗，例如波士顿支具（BB）。普罗维登斯夜间支具（PNB）是一种替代方案，其设计目的是仅通过夜间佩戴来达到相同的治疗效果。很少有研究比较全天佩戴和夜间佩戴支具的治疗效果，结果相互矛盾。
年龄超过10岁、患有进展性中度AIS曲线且顶点在T6以下的未成熟女性患者被随机分为PNB组（=62）或BB组（=49）进行治疗。纳入标准为AIS、年龄≥10岁、既往未接受过治疗、主弯Cobb角20°-40°且骨骼未成熟。将最终随访时主弯Cobb角增加>5°确定为主要结局指标。次要结局指标包括：（1）脊柱侧凸研究学会支具研究有效性评估标准；（2）次弯进展；（3）支具内矫正；（4）治疗依从性。对患者进行随访直至达到成熟后1年。
共有105例患者（PNB组和BB组分别为62例和43例）完成随访（95%）。PNB组71%的患者治疗成功，而BB组为65%（P =.67）。两组间曲线进展无显著差异（PNB组和BB组分别为3.1°±6.3°和2.6°±8.3°；P =.73）。胸段或胸腰段/腰段亚组间无显著差异。PNB对所有曲线类型均显示出更好的支具内矫正效果。四条次弯中有一条进展>5°。PNB组的治疗依从性显著高于BB组。
对于年龄超过10岁的未成熟女性患者，两种支具治疗方案在治疗主弯顶点在T6以下的中度AIS曲线方面同样有效。
