Bracing adolescent idiopathic scoliosis today

Purpose. The purpose of this report is to give an overview of the existing literature on bracing for scoliosis, and to introduce a special issue of the journal on this topic. We look critically at this treatment, considering not only the possible efficacy but also other key points such as compliance, acceptability and the patient's quality of life, as well as the variability of existing braces.

Method. Review of the literature.

Results. Bracing is questioned in terms of efficacy, but in most cases no alternative exists other than to wait for eventual surgery, or perhaps to do nothing and facing the likelihood of problems with increasing age. Compliance is a critical point, but it isn't a reason to quit. On the contrary, it should be a stimulus for professionals to find the better ways to help their patients in this respect. When faced with the possible alternatives, patients do prefer bracing to the so-called ‘wait and see’ strategy, but we must continue to work to reduce the impairment to quality of life due to the orthosis. The actual variability of braces should be faced, and the BRACE MAP classification is proposed as a unifying tool for the future.

Conclusions. Bracing is not the best possible treatment, but in the case of scoliosis the alternatives are even more challenging. Thanks to the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) serious research is ongoing, and in the next few years we will have more data, not only on efficacy but also on compliance, acceptability and quality of life, biomechanics, evaluation tools, informatics in bracing, etc. Hopefully this will lead to better results and choices for our patients.     

肺功能正常的46例青少年特发性脊柱侧凸患者心肺运动试验结果分析

目的 分析肺功能正常的青少年特发性脊柱侧凸（AIS）患者心肺运动试验（CPET）结果,并探讨运动耐力的相关影响因素。 方法 回顾性分析2016年6月至2017年3月本院收治的临床资料完整、肺功能正常的AIS患者术前CPET结果,分析侧凸部位、侧凸程度对CPET结果的影响,并探讨肺功能、体重指数（BMI）、年龄与运动耐力的相关性。 结果 共纳入病例46例,其中单胸弯组17例,单胸腰弯组11例,胸弯+胸腰弯组18例。①46例患者中10例（21.74%）患者运动耐力正常,轻、中、重度运动耐力减退者分别有24例（52.17%）、11例（23.92%）、1例（2.17%）。②单胸弯组峰值每分钟通气量（peak VE）为［（43.11±8.47）L/min］,显著低于单胸腰弯组的［（50.81±10.11）L/min］,差异有统计学意义（P<0.05）。胸弯+胸腰弯组无氧阈值公斤摄氧量（VO2AT/kg）显著低于单胸弯组和单胸腰弯组,差异均有统计学意义（P<0.05）。③单胸弯患者中,中度侧凸7例（中度胸弯组）、重度侧凸10例（重度胸弯组）,2组CPET相关指标组间比较,差异均无统计学意义（P>0.05）。④peakVO2%pred与肺功能各指标、年龄均无相关性（P均>0.05）,与BMI呈负相关（r=-0.326,P=0.027）。 结论 肺功能正常的AIS患者普遍存在运动耐力下降;胸弯同胸腰弯患者相较,peak VE下降;胸弯+胸腰弯者同单胸弯、单胸腰弯者相较,VO2AT/kg下降;运动耐力同侧凸程度、肺功能、年龄无关,而与BMI相关。     

Abnormal cerebral cortical thinning pattern in adolescent girls with idiopathic scoliosis

Adolescent idiopathic scoliosis (AIS) is a 3-D spinal deformity with uncertain etiology; abnormalities in brain development represent one of the possible explanatory concepts for its pathogenesis. The objective of this study is to investigate the brain maturation by thickness of cerebral cortex among female adolescents with and without idiopathic scoliosis. Fifty AIS patients with a typical right-thoracic curve pattern were compared with 40 age-matched healthy controls. Based on the T1-weighted magnetic resonance images, the thickness of cortical gray-matter was calculated using a well-validated surface measurement method. Focusing on adolescent participants within the age range with the frequent occurrences of AIS cases (i.e., 12 to 17 years), we observed that the cortical thickness declined significantly in almost all cortical lobes in normal subjects (Spearman correlation < − 0.4; P ≤ 0.05) except temporal lobe in LH, while in AIS patients this decline was weakly correlated with age (Spearman correlation > − 0.4) and largely insignificant (P ≥ 0.05). Quadratic regression results expressed the detailed difference in the age-related cortical changing pattern between the two groups. In addition, focal cortical thickness was significantly different in AIS patients compared with healthy controls in areas involved in motor and vestibular functions as well as object recognition. The findings from this study imply a different thinning pattern of the cerebral cortex during adolescence in patients with AIS; this may be primary (i.e. etiopathogenetic) or secondary (i.e. adaptation) to the development of scoliosis.     

The influence of thoracolumbosacral orthoses on standing balance in patients with adolescent idiopathic scoliosis: a pilot study

Background and aim: The objective of this study was to assess the effect of thoracolumbosacral orthoses (TLSOs) on antero-posterior (AP) sway, medio-lateral (ML) sway and displacement of the center of pressure (COP) during a longitudinal study in patients with adolescent idiopathic scoliosis (AIS). Methods: Eight females aged between 12 and 14.5 years participated in this study. Evaluations were performed prior to the TLSO intervention as a baseline condition, after 1 month, and after 4 months of orthosis use by assessing balance when standing statically on different surfaces. Results: When standing on both lower limbs on a solid surface there were significant differences in ML sway with the eyes both open and closed, and also in A/P sway but only when standing on a solid surface with the eyes open and also when standing on a foam surface with the eyes closed with TLSO use. When standing on the dominant leg, ML sway significantly improved, but AP sway only improved with a foam base surface with the eyes open. Conclusion: This study demonstrated positive effects of wearing a TLSO in improving quiet standing balance and standing on the dominant lower extremity in subjects with AIS after 4 months of brace use.

• Implications for Rehabilitation

• Due to a change in body shape such as that caused by scoliosis, human posture changes and spinal deformities affect the position of the center of support, and thus balance ability may change.

• AIS subjects have poor standing stability compared to a healthy matched control group.

• Brace wearing had positive effect in improving quiet standing balance and standing on the dominant lower extremity in subjects with AIS undergoing brace treatment after 4 months of TLSO use.

     

Altered physiology of mesenchymal stem cells in the pathogenesis of adolescent idiopathic scoliosis

Adolescent idiopathic scoliosis is the most common spinal deformity during puberty, especially in females. It is characterized by aberrant skeletal growth and generalized reduced bone density, which is associated with impaired bone mineral metabolism. Despite recent progress in multidisciplinary research to support various hypotheses, the pathogenesis of Adolescent idiopathic scoliosis is still not clearly understood. One of the hypothesis is to study the role of mesenchymal stem cells due to its involvement in the above-mentioned bone metabolic abnormalities. In this review, we will summarize reported literatures on the role of mesenchymal stem cells, particularly in the pathogenesis of Adolescent idiopathic scoliosis. In addition, we will describe the research on mesenchymal stem cells of Adolescent idiopathic scoliosis performed using bioinformatics tools.     

青少年特发性脊柱侧凸患者的静态平衡功能研究

目的:研究青少年特发性脊柱侧凸(AIS)患者的静态平衡功能。方法:随机选取46例青少年特发性脊柱侧凸患者为AIS组,选取14例健康正常青少年为对照组,用Tetrax静态平衡仪测定所有研究对象在8种姿势下的静态平衡功能。结果:不同姿势下AIS组的体重分配系数、傅立叶协调系数与对照组相比差异无显著性意义。AIS组不同姿势下的稳定性指数均高于对照组,差异有显著性意义(P=0.000)。AIS组的跌倒指数平均为50.3±31.9,对照组的跌倒指数平均为13.3±8.3,AIS组潜在跌倒风险明显高于对照组,差异有显著性意义(P=0.000)。结论:青少年特发性脊柱侧凸患者稳定性降低,具有中等跌倒风险。     

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。     

Inter- and intratester reliability values of ultrasound imaging measurements of diaphragm movement in the thoracic and thoracolumbar curves in adolescent idiopathic scoliosis

Purpose: The purpose of this study was to determine intertester and intratester reliability of ultrasound measurements of bilateral diaphragm excursions in the thoracic and thoracolumbar spinal curves of 31 females with adolescent idiopathic scoliosis (AIS) (mean age = 14.1 ± 1.8 years). Method: Subjects were tested during tidal breathing using real-time ultrasound imaging with a 3.5 MHz curvilinear transducer. Results: There were no significant differences in intratester and intertester reliability values in bilateral diaphragmatic excursions measured at the thoracolumbar spinal curve, whereas significant differences were observed in measurements taken at the thoracic spinal curve (p < 0.05). Overall, the intertester and intratester reliabilities of the thoracic and thoracolumbar curves in AIS ranged from 0.764 to 0.998. Conclusions: These findings suggest that ultrasound imaging is highly reliable between and within testers and is useful to precisely discriminate pathological diaphragm movement in idiopathic thoracic scoliosis and idiopathic thoracolumbar scoliosis.     

足姿指数评价青少年特发性脊柱侧弯患者足部位置的信度北大核心CSCD

目的 探究足姿指数(FPI-6)评价我国青少年特发性脊柱侧弯(AIS)患者足姿的信度。方法 2021年7月至2022年4月,从广东省第二中医院门诊及不定向招募AIS患者35例,两名评定者于同一天采用FPI-6进行足姿评定;1周后,其中一名评定者对35例患者再次进行评定。计算评定者间和重测组内相关系数,绘制Bland-Altman图,各项目评分与总分间行Spearman相关分析。结果 除距骨头触诊和距骨关节区隆起外,其他项目评定者间和重测组内相关系数均> 0.75,足姿分类无显著性差异(χ~2=4.000, P> 0.05)。各项目分与总分间相关系数均> 0.3 (P <0.01)。结论 FPI-6对轻度AIS患者足姿评估有较好信度。     

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。     

Neurophysiological basis of rehabilitation of adolescent idiopathic scoliosis

Background. Knowledge on mechanisms of neurophysiological control of trunk movement and posture could help in the development of rehabilitation programs and brace treatment in adolescent idiopathic scoliosis (AIS).

Aims. Reviewing up-to-date research on neurophysiology of movement and posture control with the aim of providing basis for new researches in the field of AIS rehabilitation and background understanding for clinicians engaged in management of AIS.

Methods. Review of literature.

Results. We considered several neurophysiological issues relevant for AIS rehabilitation, namely, the peculiar organization of patterns of trunk muscle recruitment, the structure of the neural hardware subserving axial and arm muscle control, and the relevance of cognitive systems allowing mapping of spatial coordinates and building of body schema.

Discussion and conclusion. We made clear the reason why trunk control is generally carried out by means of very fast, feedforward or feedback driven patterns of muscle activation which are deeply rooted in our neural control system and very difficult to modify by training. We hypothesized that augmented sensory feedback and strength exercises could be an important stage in a rehabilitation program aimed at hindering, or possibly reversing, scoliosis progression. In this context we considered bracing not only as a corrective biomechanical device but also as a tool for continuous sensory stimulation that could help awareness of body misalignment. Future research aimed at developing strategies of trunk postural control learning is essential in the rehabilitation of adolescent idiopathic scoliosis.     

Neurophysiological basis of rehabilitation of adolescent idiopathic scoliosis

Background. Knowledge on mechanisms of neurophysiological control of trunk movement and posture could help in the development of rehabilitation programs and brace treatment in adolescent idiopathic scoliosis (AIS).

Aims. Reviewing up-to-date research on neurophysiology of movement and posture control with the aim of providing basis for new researches in the field of AIS rehabilitation and background understanding for clinicians engaged in management of AIS.

Methods. Review of literature.

Results. We considered several neurophysiological issues relevant for AIS rehabilitation, namely, the peculiar organization of patterns of trunk muscle recruitment, the structure of the neural hardware subserving axial and arm muscle control, and the relevance of cognitive systems allowing mapping of spatial coordinates and building of body schema.

Discussion and conclusion. We made clear the reason why trunk control is generally carried out by means of very fast, feedforward or feedback driven patterns of muscle activation which are deeply rooted in our neural control system and very difficult to modify by training. We hypothesized that augmented sensory feedback and strength exercises could be an important stage in a rehabilitation program aimed at hindering, or possibly reversing, scoliosis progression. In this context we considered bracing not only as a corrective biomechanical device but also as a tool for continuous sensory stimulation that could help awareness of body misalignment. Future research aimed at developing strategies of trunk postural control learning is essential in the rehabilitation of adolescent idiopathic scoliosis.     

核心肌力训练对轻中度青少年特发性脊柱侧弯患儿肌群肌力改善及Cobb角的影响

目的 探讨核心肌力训练对轻中度青少年特发性脊柱侧弯(AIS)患儿肌群肌力改善及Cobb角的影响.方法 选取2018年1月—2019年12月于医院接受治疗的青少年特发性脊柱侧弯(AIS)患儿98例,按照组间基本特征匹配的原则分为对照组与观察组,各49例.对照组采用常规支具治疗与护理,观察组在此基础上采用核心肌力训练干预,...     

青少年特发性脊柱侧凸患者术后麻痹性肠梗阻发生现状及影响因素分析

目的探讨青少年特发性脊柱侧凸(AIS)患者术后麻痹性肠梗阻(PI)的发生情况及影响因素,为临床护理干预措施的制订提供参考及依据。方法采用便利抽样法,于2019年1月—2020年6月选取在北京协和医院脊柱中心住院的93例AIS患者作为研究对象,收集患者一般资料、疾病及手术相关资料等,并记录术后PI发生情况。采用二项Logistic回归分析AIS患者术后PI发生的影响因素。结果41.9%(39/93)的患者发生术后PI,伴随厌食、腹胀、恶心、呕吐和腹痛的发生率分别为66.7%(26/39)、61.5%(24/39)、59.0%(23/39)、30.8%(12/39)和20.5%(8/39)。二项Logistic回归显示,直腿抬高运动(OR=3.582,P=0.023)、术后首次进食时间(OR=1.209,P=0.027)、质子泵抑制剂(OR=6.820,P=0.002)、截骨术(OR=5.516,P=0.007)是AIS患者术后PI发生的影响因素。结论AIS患者术后PI发生率较高,伴随症状主要表现为厌食、腹胀和恶心;直腿抬高运动、术后首次进食时间、质子泵抑制剂、截骨术是AIS患者术后PI发生的影响因素。     

青少年特发性脊柱侧凸康复治疗卫生经济学初步研究

目的:对青少年特发性脊柱侧凸患者康复治疗进行成本-效果分析.方法:24例青少年特发性脊柱侧凸患者分为康复治疗组和手术治疗组.康复治疗组12例,采取运动疗法、关节松动、支具治疗;手术治疗组12例,采取手术治疗.治疗前后均应用中文版脊柱侧凸研究学会患者问卷(SRS-22)进行生存质量调查,并在治疗6个月后进行费用调查.结果:治疗6个月后,康复治疗组患者SRS-22问卷自我形象、心理健康维度得分高于治疗前,康复治疗组患者自我形象、对治疗的满意程度维度得分高于手术治疗组(P＜0.05).康复治疗组自我形象维度得分每增加1分所需要的总直接医疗费用为人民币14561.07元,手术治疗组每增加1分所需要的总直接医疗费用为人民币74776.44元.结论:康复治疗是青少年特发性脊柱侧凸经济有效的治疗方案.     

Does adolescent idiopathic scoliosis relate to vestibular disorders? A systematic review

Adolescent idiopathic scoliosis (AIS) is a tridimensional deformity of the spinal column. This frequent disease, which has no clearly identified pathogenic mechanism, can have serious consequences. It has been hypothesized that unilateral and isolated vestibular disorders could be the origin of AIS. The objective of this work is to verify this hypothesis and to establish a pathophysiological model.MethodWe performed a Pubmed-NCBI search, for the period 1966–2013, crossing the keyword scoliosis with the following keywords: vestibular, labyrinthine, postural control.ResultsThis search retrieved 66 articles. Twenty controlled studies were considered for study. Their analysis showed discordant results. This review cannot confirm a link between isolated vestibular disorder and occurrence of development of scoliosis.ConclusionsThere is not enough evidence to show a link between unilateral, isolated, vestibular dysfunction and AIS. From these findings, we propose a more global pathophysiological concept, which involves a trouble of the orthostatic postural control, with disturbance in the multisensory integration of vestibular, visual and somesthesic inputs. AIS could be the consequence of a reorientation of the longitudinal body axis in accordance with an erroneous central representation of verticality. An assessment of the sense of verticality would allow evaluate this hypothesis.     

青少年特发性脊柱侧凸与伏案时长的相关性研究及其足底压力分析

目的:探讨青少年特发性脊柱侧凸(AIS)的发展与伏案时长的相关性及足底压力测试在AIS患者康复诊疗中的应用可行性。方法:选取17例AIS患者为观察组,另选取17名同年龄健康人为对照组。问卷调查观察组伏案时间等信息数据,分析观察组内不同伏案时长与侧凸角度的相关性;使用三维步态分析系统测量受试者的静态足底压力、峰值压力(PP)和触地面积(CA)。结果:伏案总时长>5h较1～3h和3～5h的脊柱侧凸角度均明显增大(均P<0. 05);连续伏案2～3h较1～2h的脊柱侧凸角度明显增大(P<0. 05),且连续伏案>3h较1～2h和2～3h的脊柱侧凸角度均显著显增大(均P<0. 05)。观察组在步行周期中足弓、第1跖骨头、第2～5趾骨处较对照组PP值均更大(P<0. 01,0. 05),且在足弓和足跖的CA均较对照组更大(P<0. 01,0. 05),而足跟和足趾的CA均小于对照组(均P<0. 01)。观察组"C"型凸侧足底M2区及前足压力均显著大于凹侧(均P<0. 05)。结论:伏案时长会对AIS患者脊柱侧凸角度造成一定影响,脊柱侧凸角度大...     

3MPR-IA/IB在青少年特发性脊柱侧凸骨髓间质干细胞中的异常表达及意义

目的：从骨髓间质干细胞（MSCs）水平探讨BMPR-IA/IB表达与青少年特发性脊柱侧凸（AIS）发病可能相关的分子机制。方法：30例12-18岁志愿者分为2组：AIS组20例，同年龄正常对照组10例。髂前上棘处穿刺抽取10mL骨髓，肝素抗凝。密度梯度离心法分离MSCs，体外培养并传至P3代行表型鉴定，采用RT-PCR法、Western-blotting法、免疫荧光法检测2组MSCs中BMPR-IA/IB的表达情况。结果：BMPR-IA/IB不论是核酸水平还是蛋白水平的表达，在AIS组均要显著高于正常对照组（P〈0．01）。结论：BMPs信号通路中重要的膜表面分子BMPR-IA/IB在MSCs水平表达的异常可能与AIS发病的分子机制相关。     

青少年特发性脊柱侧弯病人生活质量及其影响因素的研究进展

青少年特发性脊柱侧弯是青少年常见的一种疾病,严重影响青少年的生活质量.作者总结了其生活质量的评估工具,应用这几种工具评估结果认为,目前我国AIS病人的生活质量较正常人群低,与文化差异、种族差异、性别以及治疗方法的选择有关.     

青少年特发性脊柱侧凸患者静态站立及步行时生物力学变化的Meta分析

目的 将青少年特发性脊柱侧凸(AIS)患者与健康人进行比较,明确AIS患者在静态站立及步行时存在的生物力学特征的偏差。方法 检索PubMed、Web of Science、EMBASE、Cochrane Library、中国知网、中国生物医学文献数据库、万方、维普数据库,检索时间均为自建库至2021年8月,纳入文献为AIS生物力学特征相关横断面研究,2名研究员独立提取数据并进行文献质量评价,采用RevMan 5.4软件进行分析。结果 共纳入23项研究,1 092例研究对象。所纳入文献具有中等到高等的方法学质量。静态站立时,AIS患者足底压力中心的椭圆面积(ES=0.69, 95%CI 0.35～1.02, P <0.001)、前后向转移速度(ES=0.59, 95%CI0.29～0.89, P <0.001)、内外向转移速度(ES=0.47, 95%CI 0.12～0.83, P <0.05)均大于正常对照组,而骨盆冠状面倾斜情况(ES=0.10, 95%CI-0.16～0.36, P> 0.05)与正常对照组相比无显著性差异。步行中,AIS患者膝关节矢状面活动...