支具治疗中度特发性脊柱侧凸患儿59例8年随访

背景:对于中度脊柱侧弯畸形患者的治疗干预方法的选择至关重要.目的:观察规律佩戴支具治疗中度特发性脊柱侧凸的疗效,并与间断佩戴和未佩戴矫形支具比较.设计、时间及地点:回顾性病例对比分析,1996-01/2004-12中山大学附属第二医院.对象:中度脊柱侧凸患儿59例,男21例,女38例,年龄12～16岁.34例患儿进行支具治疗,其中部分患儿遵医嘱规律佩戴,每天20～22 h;另有部分患儿没有坚持规律佩戴,每天8～10 h.另25例因各种原因未遵医嘱佩戴支具而行体操疗法.方法:观察时间为3～7年,平均时间为4.5年.支具的佩戴终止时间以Risser征5度为主要参考指标.通过摄X-ray的脊柱全长片,对比患者观察前后的侧弯角度,原Cobb角> 20°现Cobb < 10°为消退, Cobb角减少5°以上为减轻,Cobb角相差在5°内为未变,Cobb角增加5°以上为进展, Cobb角大于40°,最终选择手术治疗为失败.主要观察指标:各组治疗结束后临床疗效.结果:规律佩戴支具组有效率达90.9%,间断佩戴支具组有效率达50.0%,未佩戴支具组有效率为48.0%.经比较支具规律组优于支具间断组和无支具组(P < 0.05).结论:坚持正确规律佩戴支具(佩戴时间不应少于20 h)治疗中度特发性脊柱侧凸疗效确切.     

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.     

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。     

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。     

Boston矫形器治疗青少年特发性脊柱侧凸的疗效分析

目的研究Boston矫形器对青少年特发性脊柱侧凸(AIS)的临床治疗效果。方法选择1997年3月至2002年12月使用Boston矫形器治疗并得到随访的AIS患者108例,观察并比较患者治疗前、后的Cobb角、顶椎偏离中线距离(AVT)、顶椎旋转度(AVR)、躯干位移(TS)以及肺活量(VC)、第1秒用力呼气容积占用力肺活量的百分比(FEV1／FVC)、每分钟最大通气量(MVV)、残气量(RV)等指标,分析并评价Boston矫形器的疗效。结果矫形器治疗前,脊柱侧凸的Cobb角为(38．2±10．8)°,矫形器治疗2年后Cobb角平均为(24．4±8．9)°,治疗前、后比较差异有统计学意义(P<0．01),矫正率为36．1％。矫形器治疗后, AVT、AVR和TS与治疗前比较,有显著改善(P<0．01);而肺功能各项指标(包括VC、FEV1／FVC、MVV和RV)的正常率并无明显改变(P>0．05)。Risser。征Ⅰ度(包括0度)患者矫正率分别与Risser征Ⅱ度、Ⅲ度患者比较,差异均有统计学意义(P<0．05)。除3例患者因出现侧凸进展改行手术矫形外,其他患者侧凸畸形均得到显著改善,肺功能无明显损害。结论Boston矫形器对AIS的临床治疗有效,Risser征可以作为预测AIS矫形器矫形效果的指标之一。     

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。     

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。     

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。     

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。     

New brace design combining CAD/CAM and biomechanical simulation for the treatment of adolescent idiopathic scoliosis

Background

A numerical based brace design platform, including biomechanical simulation, Computer Aided Design and Computer Aided Manufacturing (CAD/CAM) was developed to rationalize braces for the treatment of adolescent idiopathic scoliosis. The objective of this study was to test the feasibility of the approach and assess the effectiveness of braces issued from this platform as compared to standard brace design.

Methods

The biomechanical finite element model was built using the 3D reconstruction of the trunk skeleton from bi-planar radiographs and of the torso surface from surface topography. The finite element model is linked to a CAD/CAM software (Rodin4D), allowing the iterative design and simulation of the correction provided by the brace, as well as predicting pressures exerted on the torso. The resulting brace design was then fabricated using a numerical controlled carver. A brace designed using this platform (New Brace) as well as a standard thoraco-lumbo-sacral orthosis (Standard Brace) were built for six scoliotic patients. Both brace effectiveness was assessed using radiographs and compared to the simulations.

Findings

The New Brace corrected on average the spine deformities within 5° of Cobb angle of the simulated correction and with a similar correction as compared to the Standard Brace (average correction of 16° vs. 11° (MT); P = 0.1 and 13° vs. 16° (TL/L); P = 0.5 for the Standard Brace and the New Brace respectively). The two braces had a similar 10° lordosing effect of the thoracic curve. The coronal balance was quite similar (7.3 vs. 6.8 mm balance improvement respectively for New Brace vs. Standard Brace).

Interpretation

These first clinical results showed the feasibility of building computer-assisted braces, equivalent to standard orthosis. An extended study on more cases is under way to fully assess this new design paradigm, which in the long term would allow improving brace design and rationalize the conservative treatments of scoliosis.     

Manual therapy treatment for adolescent idiopathic scoliosis

Background

Adolescent idiopathic scoliosis (AIS) is a common orthopedic condition with a prevalence of 2%–3% in children aged 10–16 years. Conservative interventions remain controversial and are usually based on physical therapy exercises and treatments. Manual therapy techniques may also serve as adequate treatments for AIS due to their ability to improve range of motion and decrease muscle tone and pain.

Evaluation of the Chêneau brace in adolescent idiopathic scoliosis]

OBJECTIVE: We aimed to evaluate the Chêneau brace in the orthopedic treatment of adolescent idiopathic scoliosis to better determine the indications under which it could be prescribed. MATERIALS AND METHODS: This was a retrospective study including 63 patients treated by Chêneau brace for adolescent idiopathic scoliosis between 1997 and 2006. The Cobb angles of the curves in the frontal and sagittal planes as well as rotations and rib hump were measured at the beginning of treatment, with the brace, at the end of treatment and 2 years after discontinuing the brace. A variation of+/-10 degrees in angle was selected to judge the results. RESULTS: At the end of the treatment, 25.4% of the curves were improved and 60.3% stabilized, with 14.3% aggravated; 5 patients (7.9%) required surgery. At 2 years, the reduction in angle was 1.8 degrees, on average. The best results were obtained for the lumbar and dorsolumbar curves. A significant improvement was noted for the dorsal curves; the major double curves are not as accessible to the treatment. For curves whose initial angle was less than 30 degrees , an initial reduction of higher than 50% with the brace presented the best improvement at the end of the follow-up. We note a significant reduction of the rib hump but not accompanied by a reduction of rotation. Finally, we note a deleterious effect in the sagittal curves, with a slight flatness of the spinal profile. CONCLUSION: The continuous wearing of the Chêneau brace can stabilize the evolution of adolescent idiopathic scoliosis, apart from the forms with major double curves, which are not as accessible to the treatment. However, the improvement comes at the price of a slight flatness of the curves of the spine in the sagittal plane. The loss of the correction after discontinuing the brace is minor. We emphasize, therefore, the necessity to monitor the sagittal aspect of the spine as well as the possibility of early treatment, strict surveillance and prolonged follow-up.     

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。