矫形支具在先天性脊柱侧凸治疗中的应用

目的]研究密尔沃基(Milwaukee)支具、改良色努(Cheneau)支具及波士顿(Boston)支具在先天性脊柱侧凸治疗中的临床疗效,评价影响支具治疗先天性脊柱侧凸效果的相关因素.方法]对本院自2004年1月～2011年12月使用支具治疗并得到随访的先天性脊柱侧凸(单侧弯)患儿63例进行研究,其中男19例,女44例,年龄2～15岁,平均8.7岁,平均随访2年.分别记录患者治疗前、治疗后6个月、治疗后1年、治疗后2年的Cobb角、顶椎旋转度(AVR)、躯干位移(TS)等指标,分析并评价适合支具治疗的先天性脊柱侧凸的类型.结果]治疗前脊柱侧凸的Cobb角平均34.18° (34.18°±14.89°),随访2年后的Cobb角28.13°(28.13°±13.10°),与治疗前比较有显著性差异(P＜0.05).治疗前及治疗后每个患儿的AVR无进展(P＞0.05).治疗前患儿的TS为33.35 mm (33.35±12.82) mm],治疗过程中逐渐减小,治疗后为25.18mm (25.18±13.96) mm],与治疗前比较有统计学意义(P＜0.05).患儿经支具治疗后无代偿性弯曲.结论]支具在先天性脊柱侧凸治疗中是有疗效的,可在一定程度内控制畸形的发展,帮助选择手术时间,使脊柱在矫正术前得到尽可能多的生长和发育,并降低手术难度.

The application of orthopedic brace in congenital scoliosis

Objective] By studying the clinical efficacy of Milwaukee,improved-Cheneau and Boston brace in congenital scoliosis,we got some related knowledge of the brace therapy.Method]Sixty-three cases of congenital scoliosis(single curve)were treated by Milwaukee,improved-Cheneau and Boston brace from January 2004 to December 2011,nineteen males and forty-four females by the age of between 2 years and 15 years(mean age 8.7 years).Mean follow-up period was 2 years.The clinical and radiological data including Cobb angle,apex vertebral rotation and trunk shift were recorded to evaluate the therapeutic effects.Result]After two years of brace therapy,the Cobb’s angle decreased from 34.18°(34.18°±14.89°) to 28.13°(28.13°±13.10°),with siginificant difference(P<0.05).There was no progression in apex vertebral rotation(P>0.05).Trunk shift decreased from 33.35 mm(33.35±12.82 mm)to 25.18 mm(25.18±13.96 mm)(P<0.05),with statasic difference.There was no compensatory bending after brace therapy.Conclusion]Brace therapy is proved to be a safe and effective method in congenital scoliosis.Brace therapy can prevent the development effectively and choose the operation opportunity or decrease the difficulty of the operation.Brace therapy can prevent the development effectively and provide a rigt time for the operation,which helped the spine get more growth and decreased the difficulty of operation.