热塑矫形器及其材料在青少年特发性脊柱侧凸治疗中的应用

背景:矫形器治疗是目前公认的适于未发育成熟轻中度特发性脊柱侧凸患者惟一有效的非手术治疗方法.目的:回顾性分析热塑矫形器治疗青少年特发性脊柱侧凸临床疗效.方法:1997-04/2004-03在海南省人民医院康复医学部矫形科收治特发性脊柱侧凸患者113例.佩戴热塑矫形器(brace)从开始2.0-3.0 /d,逐渐增加22 h/d.复查时cobb's角减少大于30%,则佩戴时间减至20 h/d,Risser征Ⅳ度或月经初潮1年后佩戴时间减至4 h/d.同时每天完成1 h矫正体操,包括腰背肌锻练:5点式(即头、双肘及双足支撑)和3点式(即头、双足支撑)锻练.随访2年后复测cobb's角,监测cobb's角变化.结果与结论:全部病例随访2年,有效98例(86.7%);治疗无效15例(13.3%),出现脊柱侧凸进展加重.脊柱侧凸cobb's角在20°-30°者68例,有效63例(92.6%).31°-45°者45例,有效35例(77.8%).未发现材料方面的特殊不良反应.结果证明,热塑矫形器结合矫正体操综合治疗特发性脊柱侧凸疗效明显,可减少∞bb's角度,改善侧凸,防止或延缓特发性脊柱侧凸进展.     

舍努式矫形器压力面积对青少年特发性脊柱侧凸疗效的影响

目的通过比较2组特发性脊柱侧凸患者穿戴不同压力面积舍努式矫形器后的疗效，以期为临床设计、制作舍努式矫形器提供参考资料。 方法选取T6以下椎体为顶椎的特发性脊柱侧凸青少年患者30例，将其随机分为A，B两组，分别穿戴跨度为3个椎体面积和5~6个椎体面积作为压力区域的舍努式矫形器，并测量装配前、后科布氏（Cobb）角和顶椎旋转角度以及穿戴矫形器后的疼痛指数。 结果A组患者Cobb角的矫正率为17%，B组患者Cobb角的矫正率为29%，组间差异具有统计学意义（P<0.05）；2组患者顶椎旋转角度组间差异无统计学意义（P&rt;0.05）；A组患者疼痛指数为5.00，B组为2.07，组间差异具有统计学意义（P<0.05）。 结论适当增大舍努式矫形器压力面积有利于提高脊柱侧弯患者矫正角度，并且能使患者穿戴更舒适，值得临床推广、应用。     

脊柱侧凸特定运动疗法治疗轻度青少年特发性脊柱侧凸患者的疗效观察

目的探讨以脊柱侧凸特定运动疗法为核心的康复干预对轻度特发性脊柱侧凸患者的疗效。 方法将30例轻度特发性脊柱侧凸患者分为观察组及康复治疗组。观察组患者给予常规健康宣教,康复治疗组患者给予脊柱侧凸特定运动疗法治疗,每周训练2~3次,每次治疗60min,共治疗12周。比较治疗前、后2组患者躯干旋转角度、冠状面Cobb角、椎体旋转角度、静态平衡功能(跌倒指数)、骨强度［包括桡骨远端声速(SOS)、Z值、百分位等指标］、竖脊肌表面肌电信号、肺功能［用力肺活量(FVC)、第一秒用力呼气量(FEV1)、用力肺活量占预计值百分比(FVC/Pred%)、第一秒用力呼气容积占预计值百分比(FEV1 pred%)、用力呼气量占用力肺活量比值(FEV1/FVC%)］、生活质量改善情况等。 结果与治疗前比较,观察组患者治疗后最大Cobb角显著增大(P<0.01),治疗前、后躯干旋转角度、椎体旋转角度、跌倒指数、SOS、Z值、百分位、FVC、FEV1、FVC pred%、FEV1 pred%、FEV1/FVC%及生活质量各维度得分差异均无统计学意义(P<0.05),治疗前、后顶椎水平竖脊肌凹侧激活率均显著小于凸侧激活率(P<0.01)。康复治疗组治疗前、后躯干旋转角、最大Cobb角、椎体旋转角度、跌倒指数差异均无统计学意义(P>0.05),治疗后骨强度SOS、Z值、百分位、FVC、FEV1、功能活动维度得分均显著优于治疗前水平(P<0.05),治疗前顶椎水平竖脊肌凹侧激活率小于凸侧(P<0.05),治疗后双侧顶椎水平竖脊肌激活率间差异无统计学意义(P>0.05)。 结论早期进行以脊柱侧凸特定运动疗法为核心的康复治疗可阻止轻度青少年特发性脊柱侧凸患者侧凸畸形进展,提高骨强度,改善肺功能,减少双侧竖脊肌肌肉运动控制差异,提高患者生活质量,该疗法值得临床推广、应用。     

青少年特发性脊柱侧凸的康复

青少年特发性脊柱侧凸（adolescentidiopathicscoliosis，AIS）是在青春前期或骨骼成熟前发生的一种脊柱畸形，影响青少年健康发育，发病率约为1％-1．17％，其中女性多于男性，比例约为9：1。有的脊柱侧凸有明确致病原因，如先天性脊柱侧凸，继发于骨骼、肌肉、神经系统疾患的侧凸；但更多的是原因不明的脊柱侧凸，即特发性（原发性）脊柱侧凸。脊柱侧凸如得不到及时发现与处理，其中部分患者侧凸情况会逐渐加重，形成严重的畸形。严重的脊柱侧凸不仅会造成身体外观异常、脊柱运动功能障碍或因骨盆倾斜而跛行，而且还可因胸廓畸形造成心、肺功能障碍。少数严重的脊柱侧凸可造成脊髓受压而致下肢瘫痪及排便功能障碍。因此，AIS的早期诊断、早期治疗与康复极为重要。     

脊柱侧凸特定性训练对轻度青少年特发性脊柱侧凸的治疗价值

  目的  观察脊柱侧凸特定性训练(scoliosis specific exercise, SSE)对轻度青少年特发性脊柱侧凸(adolescent idiopathic scoliosis, AIS)的矫正效果。  方法  回顾性收集2016年1月至3月, 在北京协和医院确诊并开始在物理医学康复科门诊接受SSE矫形治疗的轻度AIS患者临床资料。比较患者治疗前后Cobb角和轴向躯干旋转(axial trunk rotation, ATR)角, 采用脊柱侧凸研究学会患者问卷-22 (Scoliosis Research Society Patient Questionnaire-22, SRS-22)分析患者对治疗效果的主观评价。  结果  共31例符合纳入和排除标准的患者入选本研究。患者治疗后Cobb角和ATR角均较治疗前减小(Cobb角:16.29°±5.05°比19.23°±2.85°, t=2.955, P=0.006;ATR角:5.97°±2.22°比7.16°±1.66°, t=4.799, P=0.000)。SRS-22量表评分中, 治疗后满意度评分较治疗前显著增加[5.0(4.0, 5.0)分比3.0(3.0, 3.0)分, Z=0.000, P < 0.05]。  结论  SSE能延缓甚至改善轻度AIS患者的脊柱畸形。     

Rodin 4D技术与传统石膏技术制作青少年特发性脊柱侧凸矫形器的临床疗效观察

目的:观察Rodin 4D技术制作青少年特发性脊柱侧凸(AIS)矫形器与传统石膏技术制作AIS矫形器的疗效差异。方法:对2014年1月至2017年1月上海市残联康复中心与苏州市残联康复服务训练中心收治的青少年特发性脊柱侧凸患者30例,主弯角度(25°Cobb40°),年龄10—16岁,进行佩戴AIS矫形器干预。上海市残联康复中心收治AIS患者20例,其中,通过Rodin 4D技术制作矫形器10例(本地Rodin 4D组),传统石膏技术制作矫形器10例(石膏组);苏州市残联康复服务训练中心收治AIS患者10例,通过Rodin 4D脊柱扫描远程网络传输技术,将10例AIS患者评估数据网络传输至上海市残联康复中心,由上海市残联康复中心负责矫形器制作(远程Rodin 4D组)。所有AIS患者每日佩戴矫形器时间为20—22h,总计佩戴时间为1年,并对其干预前后进行Cobb角测量,观察疗效差异。结果:3组AIS患者矫形器干预前后Cobb角度均有改善,治疗前后差异有显著性意义(P0.05);本地Rodin 4D组与远程Rodin 4D组治疗后Cobb角度差异无显著性意义(P0.05);本地及远程Rodin 4D组与石膏组治疗前后Cobb角度差异有显著性意义(P0.05)。结论:应用Rodin 4D技术制作AIS矫形器疗效优于传统石膏技术,可推广应用Rodin 4D远程制作AIS矫形器模式。     

轻中度青少年特发性脊柱侧凸患者肺功能研究

目的:研究轻中度青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者肺功能特征。方法:选取68例AIS患者作为AIS组,20例健康青少年作为正常对照组,采用肺功能仪测定研究对象用力肺活量(FVC)、FVC预计值(FVC pred)、FVC占预计值百分数(FVC pred%)、第1秒用力呼气量(FEV1)、FEV1预计值(FEV1 pred)、FEV1占预计值百分数(FEV1 pred%)、FEV1占FVC百分数(FEV1/FVC%)。结果:AIS组FEV1 pred%、FEV1/FVC%分别为(85.60±11.60)、(88.40±6.84),对照组分别为(93.20±9.39)、(91.00±3.13),AIS组FEV1 pred%、FEV1/FVC%均低于正常对照组,差异有显著性意义。不同侧凸类型、不同性别AIS患者FVC pred%、FEV1 pred%、FEV1/FVC%差异无显著性意义。患者年龄与FVC、FVC pred、FEV1、FEV1 pred正相关,患者Cobb角与肺功能指标无关。结论:轻、中度AIS患者存在肺功能障碍,患者肺功能与年龄正相关,与侧凸类型、性别、Cobb角没有相关性。     

青少年特发性脊柱侧凸患者步态特征的研究进展

青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)是指在青少年生长发育快速阶段出现的不明原因的复杂脊柱三维畸形,其在10～18岁青少年人群中发病率高达2％～4％[1-2].尽管AIS的主要临床症状是脊柱畸形,但鉴于青少年正处于生长发育和运动的高峰期,其运动和步态障碍目前已被广...     

色奴矫形器结合运动疗法治疗青少年特发性脊柱侧突疗效分析

目的观察分析色奴矫形器结合运动疗法治疗青少年特发性脊柱侧突的疗效。方法为特发性脊柱侧突患者制作和配戴色奴矫形器,并指导患者做矫正体操。结果配戴色奴矫形器2年后,患者的脊柱侧突Cobb角平均改善16.6°,与治疗前相比,差异有统计学意义(P<0.01)。结论坚持配戴色奴矫形器和进行运动疗法是矫治特发性脊柱侧突的较好方法。     

Bracing adolescent idiopathic scoliosis: A systematic review of the literature of effective conservative treatment looking for end results 5 years after weaning

Purpose. The purpose of this study is to investigate long-term radiological and clinical outcomes of brace treatment, comparing to those of the natural history or surgical treatment.

Method. Review of literature.

Results. Most of the ling-term follow-up study of brace treatment showed initial improvement with use of the brace, slight improvement compared with the original curve at the time of the brace discontinuation, and an additional loss of correction at the time of the follow-up. The rate of loss of correction was comparable to the progression rate observed in the natural history after skeletal maturity, and the effect of the brace treatment remained even with some loss of correction after the treatment. Clinical outcomes investigated were pain, function, and activity of the patients, including marital status, child bearing, and job performance. Most of the studies concluded that quality of life of the patients treated by brace was comparable to that of the control, with some exception reported regarding back pain and some kind of activities.

Conclusion. Brace treatment is effective even in the long-term for the treatment of adolescent idiopathic scoliosis. Curve progression after the treatment was equivalent to that in the natural history. Quality of life of the patients treated by brace was comparable to that of the normal control.     

Bracing adolescent idiopathic scoliosis: a systematic review of the literature of effective conservative treatment looking for end results 5 years after weaning

Purpose. The purpose of this study is to investigate long-term radiological and clinical outcomes of brace treatment, comparing to those of the natural history or surgical treatment.

Method. Review of literature.

Results. Most of the ling-term follow-up study of brace treatment showed initial improvement with use of the brace, slight improvement compared with the original curve at the time of the brace discontinuation, and an additional loss of correction at the time of the follow-up. The rate of loss of correction was comparable to the progression rate observed in the natural history after skeletal maturity, and the effect of the brace treatment remained even with some loss of correction after the treatment. Clinical outcomes investigated were pain, function, and activity of the patients, including marital status, child bearing, and job performance. Most of the studies concluded that quality of life of the patients treated by brace was comparable to that of the control, with some exception reported regarding back pain and some kind of activities.

Conclusion. Brace treatment is effective even in the long-term for the treatment of adolescent idiopathic scoliosis. Curve progression after the treatment was equivalent to that in the natural history. Quality of life of the patients treated by brace was comparable to that of the normal control.     

夜用式脊柱侧凸矫形器治疗脊柱单侧弯的临床疗效观察

目的：探讨分析夜用式脊柱侧凸矫形器对青少年特发性脊柱单侧弯的疗效。方法：脊柱单侧凸患者40例,分为观察组22例和对照组18例。观察组在睡觉时佩戴夜用式脊柱侧凸矫形器8-10h ,对照组佩戴传统色努式脊柱侧凸矫形器≥20h。观察2组患者治疗前后的Cobb角,顶椎偏离中线距离（AVT）、躯干位移（TS）和肺活量（VC）的改善。结果：治疗3个月后,2组患者的Cobb角度、AVT及TS距离均明显低于治疗前（P＜0．01）,且观察组更低于对照组（P＜0．01）;2组治疗后VC含量均明显高于治疗前,且观察组更高于对照组（P＜0．01）。结论：夜用式脊柱侧凸矫形器适合青少年C型侧凸治疗,其矫正效果明显优于传统的脊柱侧凸矫形器,值得临床推广应用。     

健康教育光盘在支具治疗青少年特发性脊柱侧弯的应用研究

目的探讨应用健康教育光盘在支具治疗青少年特发性脊柱侧弯中的应用效果。方法将制作健康教育光盘前后来我科进行支具治疗的脊柱侧弯患者分成两组：实验组44例,对照组48例。实验组给予观看健康教育光盘及文字资料,并辅以口头讲解及实践指导。对照组给予阅读文字资料及口头宣教。结果实验组患者的疾病相关知识知晓率、功能锻炼的正确掌握率及依从性均高于对照组（P〈0．05）。实验组44例患者中,有42例患者脊柱畸形外观及cobb’s角均有改善,总有效率为95．5％。结论应用健康教育光盘对支具治疗青少年特发性脊柱侧弯患者及家长进行健康教育,能明显提高健康教育效果和质量,从而提高佩戴支具的疗效。     

What a school screening program could contribute in clinical research of idiopathic scoliosis aetiology

Purpose. Scoliosis school screening (SSS) programs have clinically benefited many children through early detection and treatment, as it is clearly stated in the Consensus Paper which has been published by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). It is also through these SSS programs that almost all of our current knowledge on the natural history and curve progression of IS has been made known. The present study summarizes the contribution of SSS in research of IS aetiology.

Method. We reviewed all the reports in relation to research of IS aetiology, which were published in peer-review journals and were originated from the Thriasio SSS program.

Results. Analysis comprises of reports for (i) IS prevalence, (ii) aetiological studies originated from school screening referrals which implicate numerous environmental and biological factors in IS pathogenesis, (iii) suggestions for a more efficient screening, (iv) IS natural history, and (v) the evolving aim of SSS based on the reported research.

Conclusions. SSS should be adopted by policy makers, because its scope goes beyond the identification of IS at an early stage, contributing significantly into the research for IS aetiology.     

What a school screening program could contribute in clinical research of idiopathic scoliosis aetiology

Purpose. Scoliosis school screening (SSS) programs have clinically benefited many children through early detection and treatment, as it is clearly stated in the Consensus Paper which has been published by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). It is also through these SSS programs that almost all of our current knowledge on the natural history and curve progression of IS has been made known. The present study summarizes the contribution of SSS in research of IS aetiology.

Method. We reviewed all the reports in relation to research of IS aetiology, which were published in peer-review journals and were originated from the Thriasio SSS program.

Results. Analysis comprises of reports for (i) IS prevalence, (ii) aetiological studies originated from school screening referrals which implicate numerous environmental and biological factors in IS pathogenesis, (iii) suggestions for a more efficient screening, (iv) IS natural history, and (v) the evolving aim of SSS based on the reported research.

Conclusions. SSS should be adopted by policy makers, because its scope goes beyond the identification of IS at an early stage, contributing significantly into the research for IS aetiology.