Cheneau支具治疗青少年特发性脊柱侧凸

目的探讨Cheneau支具治疗青少年特发性脊柱侧凸的临床效果.方法我们分析了1998年5月～2000年12月共38例特发性脊柱侧凸患者,均给予了Cheneau支具治疗.结果经平均15个月随访(5～30个月),除1例因中止治疗使角度加大而改行手术外,其余患者均得到不同程度的改善,平均矫正12°(-6～24°),无明显并发症.结论我们认为对于Risser征为0,侧凸角度>20°的特发性侧凸患者应尽早行支具治疗.     

青少年特发性脊柱侧凸支具治疗研究分析

[目的]探讨胸腰骶支具治疗青少年特发性脊柱侧凸的临床疗效,为开展青少年特发性脊柱侧凸的筛查和临床治疗提供参考依据。[方法]对2004年10月~2012年2月在云南部分地区筛查中确诊为青少年特发性脊柱侧凸的132例患者进行Lenke分型,并予胸腰骶支具治疗,比较治疗前后Cobb角。[结果]Lenke1型治疗前后Cobb角平均减小9°,差异具有统计学意义(P0.05),Lenke3型治疗前后胸弯Cobb角平均减小5.2°,胸腰弯Cobb角平均减小6.4°,差异均具有统计学意义(P0.05),Lenke5型治疗前后Cobb角平均减小12.7°,差异具有统计学意义(P0.05),Lenke6型治疗前后胸弯Cobb角平均减小2.0°,胸腰弯Cobb角平均减小6.8°,差异没有统计学意义(P0.05)。[结论]12~16岁是青少年特发性脊柱侧凸重点普查对象,胸腰骶支具对减缓或阻止Lenke1型、Lenke3型和Lenke5型畸形具有显著作用,而对Lenke6型没有明显效果,支具治疗对阻止或减缓病情发展不受年龄、性别和分型的影响。     

支具治疗青少年特发性脊柱侧凸的研究进展

支具治疗青少年特发性脊柱侧凸的研究已经接近半个世纪,目前,国内外学者认为佩戴支具治疗是青少年特发性脊柱侧凸的一种很有效的保守治疗方法.然而,对于支具治疗的相关问题的研究一直是国内外学者不断研究和关注的重点.文章就近年来支具治疗的研究进展进行综述,探求目前对于支具治疗相关性问题(比如对生活质量、生长发育的影响等)最新研究进展.     

支具治疗青少年特发性脊柱侧凸的临床随访

目的评价支具治疗青少年特发性脊柱侧凸的临床疗效,分析影响疗效的相关因素,并探讨支具治疗的适应证。方法对79例接受支具治疗的青少年特发性脊柱侧凸患者进行随访,记录患者的Cobb角,侧凸类型,女性患者初潮与否,坐高,站高,Risser征,顶椎旋转度等。结果随访12～60个月,平均23．9个月。末次随访时21例（26．6％）畸形明显进展,40例（50．6％）畸形维持或稍进展,18例（22．8％）畸形改善。初诊时原发弯Cobb角〉45°组侧凸进展率较Cobb角≤35°组高,侧凸改善率较Cobb角≤35°组低（P〈0．05）;顶椎旋转度Ⅲ°以上组侧凸进展率较0～Ⅱ°组高,侧凸改善率较0～Ⅱ°组低（P〈0．05）。侧凸类型、Risser征等参数不同的患者畸形进展和改善的比率均存在不同程度的差别,但差异不具有显著性（P〉0．05）。结论矫形支具能够有效控制或改善轻、中度特发性脊柱侧凸畸形。单独借助Risser征预测侧凸畸形变化趋势并不可靠。初始Cobb角〉45°,顶椎旋转度在Ⅲ°以上的患者,如果支具治疗的效果不佳,应考虑尽早手术矫形。     

色努支具治疗青少年特发性脊柱侧凸的疗效及影响因素分析

目的 ：观察色努支具治疗青少年特发性脊柱侧凸的疗效,探究影响疗效的相关因素。方法 ：2016年1月～2018年6月采用色努支具治疗的青少年特发性脊柱侧凸患者49例,其中女性46例,男性3例,治疗初始年龄12.6±1.3岁（10～15岁）,初始主弯Cobb角32.5°±6.9°（20°～45°）,初始Risser征2.2±1.6。收集患者的临床资料：年龄、每日佩戴时间等信息;影像学资料：初始、佩戴支具即刻和随访的系列脊柱全长X线片。通过佩戴支具即刻X线片计算初始支具矫正率。评估治疗后结果：Cobb角减少≥6°定义为“改善”,Cobb角变化5°以内定义为“稳定”,Cobb角增大≥6°定义为“进展”,前两者为治疗成功。观察初始支具矫正率在各组结果中的差异;分析畸形进展的患者相关因素：畸形严重程度（20°～29°,30°～39°及40°～45°三组）、Risser征（0～4）和侧凸类型（胸弯、胸腰弯/腰弯、双主弯三种类型）;并分析影响初始支具矫正率的可能因素。结果：49例患者平均治疗2.0±1.0年,所有患儿每天支具佩戴时间在18～20h以上,依从性良好。随访2.0±1.0年（1～5年）,末次...     

Milwaukee支具治疗青少年特发性脊柱侧凸的疗效分析与应用体会

目的：评估Milwaukee支具在青少年特发性脊柱侧凸（AIS）中的应用价值。方法：对154例AIS患者接受支具规范治疗与非规范治疗平均随访21个月的临床疗效进行比较分析。结果：规范治疗组免于手术率及治疗有效率与非规范组存在显著性差异。结论：Milwaukee支具能有效地控制青少年特发性脊柱侧凸畸形的进展,应提倡早期规范化治疗,切忌非规范使用,昼量避免过早施行终末期手术。     

特发性脊柱侧凸支具治疗的研究进展

随着生物力学研究的深入,各种新的脊柱侧凸手术矫正器械不断涌现,治疗效果日益提高。脊柱侧凸的支具疗法是否必要、有效,其地位如何等是人们关注的问题,下面将就这方面的研究进展作一简述。１支具治疗的历史及现状支具治疗脊柱侧凸是一种古老的方法,可以追溯到１６世...     

特发性脊柱侧凸的支具治疗

支具治疗是脊柱侧凸非手术治疗的最重要方法之一,其目的主要是阻止骨骼未发育成熟小儿脊柱畸形的进一步发展。尽管支具治疗在临床上已被广泛应用,对其在脊柱侧凸治疗中的作用仍然存在着相当多的争论。本文重点对近年来有关特发性脊柱侧凸支具治疗的研究进展作一简要综述...     

支具治疗对女性青少年特发性脊柱侧凸患者肺功能的影响

目的:观察支具治疗对女性青少年特发性脊柱侧凸(AIS)患者肺功能的影响。方法:2001年2月~2009年12月283例女性AIS患者在我院接受矫形手术治疗,术前检测患者用力肺活量(FVC)、第1秒用力呼气容积(FEV1),记录预计值、实测值及实测值占预计值百分比。根据术前是否曾接受支具治疗分为2组,支具治疗组80例(A组),未接受支具治疗组203例(B组)。分析2组患者术前肺功能参数的差异,同时对A组患者肺功能FVC及FEV1的实测值占预计值百分比(FVC%、FEV1%)与术时年龄、身高、主弯冠状面Cobb角、主侧凸累及节段数、主胸弯矢状面Cobb角、每日支具治疗时间、支具治疗总时长进行多元线性回归分析。结果:A、B组患者FVC预计值分别为3.23±0.40L和3.20±0.40L,FEV1预计值分别为2.76±0.40L和2.73±0.30L,A组与B组比较均无统计学差异(P>0.05);A、B组FVC实测值分别为2.58±0.60L和2.72±0.60L,FEV1实测值分别为2.34±0.50L和2.49±0.50L,A、B组FVC%分别为(80.3±16.5)%和(85.4±16.5)%、FEV1%分别为(85.6±18.4)%和(91.3±16.9)%,A组FEV1实测值、FVC%及FEV1%较B组均明显降低(P<0.05),其中主弯为胸弯患者(173例)明显(P<0.05),而主弯为胸腰弯/腰弯患者(110例)不明显(P>0.05)。A组患者中,胸段侧凸矢状面Cobb角与FVC%、FEV1%呈正相关(P<0.05),支具治疗总时长与FEV1%呈负相关(P<0.05);而术时年龄、身高、主弯冠状面Cobb角、主侧凸累及节段数、每日支具治疗时间(8~23h,平均18.7h)与FVC%及FEV1%均无显著相关性(P>0.05)。结论:支具治疗可使女性青少年特发性胸段脊柱侧凸患者肺功能FVC%及FEV1%下降,支具治疗总时长和胸段侧凸矢状面Cobb角可能是影响患者肺功能FVC%及FEV1%的相关因素。     

女性青少年特发性脊柱侧凸患者停止支具治疗后的侧凸进展及其相关因素

目的 :分析发育成熟的女性青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患儿在停止支具治疗后长期随访中的侧凸进展情况,并探讨其相关因素。方法:回顾性分析于我院门诊就诊符合SRS(scoliosis research society)支具治疗标准的女性AIS患儿130例,初诊年龄11.8±1.4岁(10~14岁)。所有患儿均随访至支具治疗结束后至少2年,且至少具有佩戴支具后初次随访、停止支具治疗时、停止支具治疗后6个月、1年、2年及末次随访时的资料。在每次随访时的全脊柱正位X线片上测量主弯侧凸Cobb角,并评估侧凸进展超过5°的患儿及比例、侧凸进展度数和进展速率。末次随访时侧凸进展超过5°定义为侧凸进展,采用独立样本t检验比较侧凸进展组和非进展组患儿的初诊年龄、月经初潮年龄、初诊Cobb角、初始矫正率、停止支具治疗年龄。结果:与停止支具治疗时相比,停止支具治疗后6个月、1年、2年及末次随访时的侧凸进展超过5°的患儿分别为33例(25.4%)、42例(32.3%)、61例(46.9%)和63例(48.5%);侧凸进展度数分别为2.0°±4.4°、3.2°±5.0°、4.9°±5.5°和5.1°±6.9°;侧凸进展速率分别为0.33°±0.71°/月、0.20°±0.41°/月、0.14°±0.29°/月和0.01°±0.19°/月。停止支具治疗后侧凸非进展组和进展组患儿的初诊年龄、月经初潮年龄、初诊Cobb角、初始矫正率、停止支具治疗时年龄等无显著性差异(P0.05),而停止支具治疗时的Cobb角有统计学差异(P0.05)。结论:行支具治疗的AIS患儿停止支具治疗后仍有较高的侧凸进展风险,停止支具治疗后的6个月内为侧凸进展高风险和高速率期;停止支具治疗时的侧凸Cobb角越大发生侧凸进展的风险越高。     

Part-time bracing of adolescent idiopathic scoliosis

Forty-four patients with fifty-five scoliotic curves were studied to determine the efficacy of part-time bracing. All patients were skeletally immature at the initiation of treatment with the brace. All but one of the patients had a curve of at least 25 degrees that had shown 5 degrees of documented progression. Each patient wore the brace for sixteen hours a day, most patients preferring not to wear it during school hours. The patients all completed the course of treatment. Because of the margin of error in radiographic measurements, a change in the magnitude of the curve of 5 degrees or more was considered significant. Twenty-five patients, with twenty-seven curves, showed a change of less than 5 degrees from the initiation of brace treatment to final follow-up. The other nineteen patients (twenty-eight curves) showed a change of more than 5 degrees in at least one of the curves, with four of them showing worsening and the other fifteen showing improvement.     

性别对青少年特发性脊柱侧凸患者支具治疗效果的影响

目的:比较男、女性青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者支具治疗的效果,探讨性别因素对支具治疗效果的影响。方法:2003年7月~2009年7月在我院完成支具治疗的男性AIS患者19例(A组),初诊时平均年龄14.0±2.0岁,平均主弯Cobb角28.8°±5.7°,初始Boston支具治疗6例,Milwaukee支具治疗13例;随机抽取同时期完成支具治疗的女性AIS患者57例(B组),初诊时平均年龄13.0±1.4岁,平均主弯Cobb角29.4°±6.1°,初始Boston支具治疗17例,Milwaukee支具治疗40例。定义末次随访时Cobb角大于初诊6°或治疗期间建议行矫形手术者为侧凸进展。结果:两组初诊时Risser征(P=0.786)、Cobb角(P=0.790)、弯型分布(P=0.350)和应用支具类型分布(P=0.350)等无显著性差异。A组和B组平均支具治疗时长分别为2.1±0.7年和2.5±0.9年,平均依从性分别为84.4%±7.6%和87.1%±5.7%。A组患者中发生侧凸进展8例(42%),其中需手术治疗者6例(32%);B组中侧凸进展12例(21%),其中需手术治疗者10例(18%)。男性患者侧凸进展比例高于女性,但统计学差异不明显(P=0.071)。两组中,生长发育状态低下、侧凸Cobb角大及主胸弯型患者侧凸进展比例高。结论:支具治疗可有效控制多数AIS患者的侧凸进展,女性患者支具治疗效果可能好于男性患者。     

青少年特发性脊柱侧凸的支具治疗

目的探讨青少年特发性脊柱侧凸支具治疗的适应证,并评价其临床疗效。方法77例骨骼发育未成熟的青少年特发性脊柱侧凸患者接受Milwaukee支具或Boston支具矫正,男15例,女62例;年龄10～15岁,平均12.7岁。胸腰双主弯26例、单胸弯37例、单胸腰弯或腰弯14例。原发弯Cobb角22°～62°,平均35.9°;20°～35°者37例,>35°者40例。Risser征0度38例、Ⅰ度19例、Ⅱ度13例、Ⅲ度7例。每3～6个月定期复查,复查时均摄佩带支具前、后的站立位全脊柱正位X线片,测量初次就诊及末次随访时的Cobb角、顶椎旋转度及Risser征。结果全部病例随访24～60个月,平均30个月。29.9%的病例出现脊柱侧凸进展,不同类型脊柱侧凸中胸腰双主弯进展率最低,但与其他类型比较差异无显著性。Risser征越小,初诊支具矫正率越大、侧凸进展率越高,且Risser征Ⅰ度组(包括0度)与Ⅱ度组之间、Ⅰ度组与Ⅲ度组之间初诊支具矫正率的差异有显著性(P<0.05)。原发弯Cobb角20°～35°组的初诊支具矫正率大于Cobb角>35°组(P<0.05);而侧凸进展率低于Cobb角>35°组,但差异无显著性。21例因出现侧凸进展而采用手术矫形,支具治疗使其中13例的手术时间推迟了12～20个月。结论Risser征可作为预测青少年特发性脊柱侧凸支具矫正成功率的一个指标。不同类型脊柱侧凸中胸     

Hybrid instrumentation for correction of adolescent idiopathic scoliosis

New technology and instrumentation techniques are continually entering the spine field, leaving the scoliosis surgeon with a wide variety of options for the treatment of adolescent idiopathic scoliosis. All-screw constructs are currently the most popular. However, they remain controversial because of possible complications, and also because they have been associated with a decrease in thoracic kyphosis, not observed with hybrid instrumentation. The aim of the present study was to evaluate a hybrid construct: hooks and wires proximally, but pedicle screws distally. Forty-three patients with a minimum 2-year follow-up were included. The mean preoperative Cobb angle of the major curve was 60.85 degrees +/- 21 degrees. At the final evaluation it was reduced to 28.44 degrees +/- 11.9 degrees (mean correction 53.3%, p < 0.0001). The mean translation of the apical vertebra was corrected from -19.13 +/- 49 mm to -9.42 +/- 28.9 mm. The average thoracic kyphosis improved from 24 degrees +/- 14.3 degrees preoperatively to 30.7 degrees +/- 7.1 degrees, representing a mean correction of 28%. Kyphosis at the T10-L2 level was within normal values in all patients at the final evaluation. Complications included one superficial infection, one implant removal due to late onset wound infection, and 2 revisions to extend the fusion more distally. In other words, operative treatment with hybrid instrumentation yielded satisfactory results, with less risk of neurological damage. An excellent outcome in all planes could be safely achieved and maintained for a minimum of 2 years. CONCLUSION: why use an expensive all-screw construct, knowing that a hybrid construct is kyphosis sparing, cheaper, safer and more resistant to pull-out?     

Nighttime bracing with the Providence brace in adolescent girls with idiopathic scoliosis

STUDY DESIGN: A prospective study was conducted of 102 consecutive female patients with adolescent idiopathic scoliosis. Those patients with Risser 0, 1, and 2 met the criteria for inclusion and were treated only with the Providence brace. OBJECTIVES: To report the authors' experience with a hypercorrective nighttime brace and to evaluate the results with respect to risk factors for progression. Second, the study compares results with expectations from the natural history as reported by others. SUMMARY OF BACKGROUND DATA: Compliance with full-time brace treatment for adolescent idiopathic scoliosis has been a problem. Since the introduction of the Milwaukee brace, alternatives such as low-profile braces, reduced wearing schedules, and nighttime only bracing have been tried. However, many factors influence the success or failure besides compliance. These include in-brace correction, brace design, and the orthotist's skills. This is the first report of the results of treatment with a new nighttime brace that is made with CAD/CAM technology that can achieve higher initial in-brace corrections than other reported methods. METHODS: Results were analyzed with respect to curve size, curve pattern, maturity, and level of the primary curve apex. Both compliant and noncompliant patients were included in the analysis. A univariate analysis was done on those factors thought to influence success with bracing using the Pearson chi2 test. RESULTS: The average initial in-brace correction with a supine radiograph was 96% for major curves and 98% for minor curves. Seventy-five patients (74%) did not progress >5 degrees and 27 patients (26%) progressed > or =6 degrees or went on to surgery. Twenty-nine percent of Risser 0 or 1 patients progressed and 17% of patients Risser 2 progressed. The risk of progression anticipated by natural history data, which included all curve patterns, was 68% for Risser 0 and 1 and 23% for Risser 2. Risser 3 and 4 patients were excluded from the study. Seventy-six percent of patients with curve apexes between T8 and L1 had successful outcomes using the Providence brace. This is compared with a 74% success rate in the prospective Scoliosis Research Society study of patients wearing a thoraco lumbar sacral orthosis for 16 hours per day with curve apexes between T8 and L1. With the Providence brace, 63% of thoracic curves and 65% of double curves were successful. Ninety-four percent of lumbar curves and 93% of thoracolumbar curves were successful. CONCLUSION: Excellent initial in-brace correction of adolescent idiopathic scoliosis was observed with this computer-designed and manufactured recumbent brace. Patients with high apex curves cephalad to T8 (n = 31) had a success rate of 61% compared with a success rate of 79% (n = 71) if the apex was at or below T9. Compared with previous natural history and the prospective study data, the Providence brace is effective in preventing progression of adolescent idiopathic scoliosis for curves <35 degrees. It was effective for larger curves with a low apex. The authors' experience with patients with curves >35 degrees (n = 8) is too small to validate its effectiveness for larger curves with a higher apex.     

Biological factors and predictability of bracing in adolescent idiopathic scoliosis

Biological factors that could have a predictive value in treating idiopathic scoliosis by brace were studied in 107 patients (102 girls and 5 boys). The mean age of the patients was 14 years 6 months, and the mean Cobb angle of the curves was 36 degrees at start of treatment. The Boston brace was used for an average of 1 year 6 months, and mean follow-up time after weaning was 3 years. Scoliosis with an apex of Th 10-12 proved to be the most favorable for the final result, with a mean correction of 2 degrees. All other curves remained unchanged. Patients who had a period of rapid growth just before or during treatment had a better final result than the others. The final result was also better when treatment was started before menarche.