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脊柱侧弯支具治疗:细节决定成败。

Scoliosis Bracing: Details Make the Difference.

作者信息

Benes Gregory, Roye Benjamin D, Stikeleather Luke, Hresko M Timothy, Sucato Daniel J, Welborn Michelle C, McClellan Catherine, Sponseller Paul D

机构信息

Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.

Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY.

出版信息

J Pediatr Soc North Am. 2024 Feb 5;5(4):776. doi: 10.55275/JPOSNA-2023-776. eCollection 2023 Nov.

Abstract

Effective bracing for idiopathic scoliosis is influenced by factors such as age, skeletal maturity, and curve attributes, with success reliant on patient adherence and engagement. The purpose of this paper is to highlight strategies for successful treatment. Using standardized, effective communication detailing patient data, including radiographic measurements, supports clear communication between orthopaedic surgeon, orthotist, and patient. Consistent orthotist visits are important to ensure correct brace fit by evaluating aspects like tightness, comfort, and deformity correction. Monitoring growth metrics like height and weight can signal necessary adjustments. An initial in-brace x-ray facilitates early refinements with subsequent imaging based on growth stages. Adherence monitors augment treatment by tracking brace-wear patterns. Weaning protocols, aiming to reduce brace wear gradually while curbing curve progression, are influenced by factors such as curve size, brace comfort, and skeletal maturity markers. Overcoming barriers like physical discomfort and self-consciousness is pivotal for effective treatment. Emphasizing resilience, choice, and emotional support ensures enhanced patient commitment and satisfaction, leading to the best possible outcomes. •Increased time in brace leads to success in a dose-response fashion.•Effective, convenient methods of communication between the orthotist and orthopaedic surgeon are key to optimizing patient outcomes.•Adherence monitors can bolster patient engagement and autonomy and improve outcomes.•Patient support sources and psychologically informed techniques can diminish perceived barriers to brace wear.

摘要

特发性脊柱侧弯的有效支具治疗受年龄、骨骼成熟度和侧弯特征等因素影响,其成功与否取决于患者的依从性和参与度。本文旨在强调成功治疗的策略。使用标准化、有效的沟通方式详细说明患者数据,包括影像学测量结果,有助于骨科医生、矫形师和患者之间进行清晰的沟通。定期拜访矫形师很重要,通过评估松紧度、舒适度和畸形矫正等方面来确保支具佩戴合适。监测身高和体重等生长指标可以提示必要的调整。初次佩戴支具后的X光检查有助于早期优化,后续可根据生长阶段进行成像检查。依从性监测器通过跟踪支具佩戴模式来加强治疗效果。旨在逐渐减少支具佩戴时间同时控制侧弯进展的撤减方案,受侧弯大小、支具舒适度和骨骼成熟度指标等因素影响。克服身体不适和自我意识等障碍对有效治疗至关重要。强调恢复力、选择权和情感支持可确保患者增强投入度和满意度,从而实现最佳治疗效果。•佩戴支具时间增加会以剂量反应方式带来成功。•矫形师与骨科医生之间有效、便捷的沟通方法是优化患者治疗效果的关键。•依从性监测器可增强患者参与度和自主性并改善治疗效果。•患者支持来源和心理指导技术可减少对佩戴支具的感知障碍。

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