Upadhyay S S, Nelson I W, Ho E K, Hsu L C, Leong J C
Duchess of Kent Children's Hospital, Sandy Bay.
Spine (Phila Pa 1976). 1995 Mar 1;20(5):537-45. doi: 10.1097/00007632-199503010-00006.
Eighty-five patients with adolescent idiopathic scoliosis treated with Milwaukee or thoracolumbosacral orthoses at The Duchess of Kent Children's Hospital were studied longitudinally at 4-6-month intervals until maturity for spinal curvature and vertebral rotation, or until termination of brace treatment for persons who experienced brace failure who went on to have surgery.
To identify radiologic features so that it may be possible to predict outcome of brace treatment early on.
The structural curve with poor flexibility and large rotational prominence have been found to be associated with poor prognosis for brace treatment. However, early response to bracing for spinal deformity and its relationship to final outcome of brace treatment in a longitudinal study is not available in the literature.
Vertebral rotation and Cobb angles measured from anteroposterior radiographs of the spine obtained before bracing and 1-2 months after bracing were found valuable for prediction. Changes in post-brace Cobb angle and vertebral rotation were considered as an increase or reduction only when there was an increase or reduction of minimum 5 degrees or more from their prebrace measurements.
Those patients who showed increase in vertebral rotation and/or in Cobb angle after brace application were shown to have progression of curves leading to brace failure in 93% of patients, and 79% of these required surgery. The patients with no change in both vertebral rotation and Cobb angle after bracing often experienced brace failure (69%). Two patients (15%) required surgery. The results show that reduction of both Cobb angle and vertebral rotation after application of a brace is a prognostic indicator for a good outcome (97%), and no patients required surgery. Most of the patients with lumbar scoliosis (91%) showed such reductions.
The findings show a strong association between changes in vertebral rotation and the Cobb angle after application of a brace and the final outcome. Reduction in both is indicative of a good outcome, whereas increase in one or both indicates brace failure.
对在肯特公爵儿童医院接受密尔沃基或胸腰骶支具治疗的85例青少年特发性脊柱侧凸患者进行纵向研究，每隔4 - 6个月进行一次检查，直至脊柱弯曲和椎体旋转达到成熟，对于支具治疗失败并继而接受手术的患者，则直至支具治疗终止。
确定放射学特征，以便能够早期预测支具治疗的结果。
已发现柔韧性差且旋转隆起大的结构性弯曲与支具治疗的不良预后相关。然而，在一项纵向研究中，脊柱畸形对支具治疗的早期反应及其与支具治疗最终结果的关系在文献中尚无报道。
发现从支具治疗前及治疗后1 - 2个月获得的脊柱前后位X线片测量的椎体旋转和Cobb角对于预测很有价值。仅当支具治疗后的Cobb角和椎体旋转较支具治疗前测量值至少增加或减少5度或更多时，才将其变化视为增加或减少。
那些在佩戴支具后椎体旋转和/或Cobb角增加的患者，其曲线进展导致93%的患者支具治疗失败，其中79%的患者需要手术。佩戴支具后椎体旋转和Cobb角均无变化的患者也常出现支具治疗失败（69%）。两名患者（15%）需要手术。结果表明，佩戴支具后Cobb角和椎体旋转均减小是预后良好的指标（97%），且无患者需要手术。大多数腰椎脊柱侧凸患者（91%）表现出这种减小。
研究结果表明，佩戴支具后椎体旋转和Cobb角的变化与最终结果之间存在密切关联。两者均减小表明预后良好，而其中一项或两项增加则表明支具治疗失败。
