矫形器
病例:39°侧弯经约29个月支具治疗降至5.8°
一名15岁(Risser 3)单一腰段侧弯患者治疗前、首次佩戴及脱日用支具后的最终X光片,并与各项研究比较。
诊所的真实病例:15岁(Risser 3),单一腰段侧弯(顶椎L1)Cobb角38.65°,使用日用和夜用两套支具。展示治疗前、首次佩戴及最终的X光片。
单个病例不能取代科学证据,下文将其与研究对照。
要点
- 治疗前(2022年8月2日):38.65°。
- 首次佩戴(2022年12月18日):相对于38.65°,日用9.8°(−75%),夜用0.8°(−98%)。
- 最终(2024年12月30日):不戴支具5.8°(−85%),夜用支具内−4.5°,已脱日用支具。
- 患者(女)每天佩戴支具约22小时且从未中断;每日锻炼仅为引体悬吊和负重拉(每次数百次,负荷约为体重的三分之一)。对比:BrAIST阈值为每天12.9小时,Brown 2026平均为11.7小时。
- 这是一个病例,不代表所有儿童。初诊时Risser 3:超出BrAIST(0–2)范围,但在SOSORT指征(0–3)之内。
- 不同的百分比不能直接比较:研究中的90–93%、82%、76%是取得良好结局的患者比例;本病例的85%是单个患者Cobb角的降低幅度(38.65° → 5.8°)。
科学证据
- 支具内矫正(PubMed):全天支具平均22–55%(按样本量加权平均约47%,n = 474),胸腰段侧弯73%,Providence夜间支具96–98%(仰卧位拍片)。本病例:日用75%,夜用98%。
- Emans(Spine 1986,295例):停戴支具后改善超过15°者仅4%。本病例:32.9°。
- Brown 2026(50名):矫正≥45%者成功率88%(标准:角度变化≤5°),<45%者为41%。
- BrAIST(NEJM 2013):每天≥12.9小时成功率90–93%,0–6小时为41%;标准:生长结束时角度<50°。
实用建议
- 按处方时长佩戴并配合训练。
- 首次佩戴时用X光片确认支具内矫正,复查拍片至少间隔3个月。
- 脱支具须遵医嘱。
如果孩子有脊柱侧弯征象,请携带X光片前来咨询:+84 985 211 888。
参考文献
- Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013;369(16):1512–1521.
- Negrini S, Donzelli S, Aulisa AG, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018;13:3.
- Katz DE, Herring JA, Browne RH, Kelly DM, Birch JG. Brace wear control of curve progression in adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2010;92(6):1343–1352. PMID 20516309.
- van den Bogaart M, van Royen BJ, Haanstra TM, de Kleuver M, Faraj SSA. Predictive factors for brace treatment outcome in adolescent idiopathic scoliosis: a best-evidence synthesis. Eur Spine J. 2019;28(3):511–525. PMID 30607519.
- Emans JB, Kaelin A, Bancel P, Hall JE, Miller ME. The Boston bracing system for idiopathic scoliosis: follow-up results in 295 patients. Spine. 1986;11(8):792–801. PMID 3810295.
- Brown MW, et al. A 14% rate of surgery in modern Rigo Chêneau bracing for adolescent idiopathic scoliosis: in-brace correction and brace wear contribute to treatment success. J Pediatr Orthop. 2026. PMID 42592965.
- Dolan LA, et al. BrAIST-Calc: prediction of individualized benefit from bracing for adolescent idiopathic scoliosis. Spine. 2024. PMID 37994691.
- Charalampidis A, Diarbakerli E, Dufvenberg M, et al. Nighttime bracing or exercise in moderate-grade adolescent idiopathic scoliosis: a randomized clinical trial (CONTRAIS). JAMA Netw Open. 2024;7(1):e2352492. PMID 38285447.
- Charalampidis A, et al. Effectiveness of nighttime vs full-time bracing… a secondary analysis of the CONTRAIS trial. Acta Orthop. 2025;96:437–442. PMID 40485598.
- Peeters CMM, et al. Predictive factors on initial in-brace correction in idiopathic scoliosis: a systematic review. Spine. 2022. PMID 35500086.
- Zheng Q, et al. Can computer-aided design and computer-aided manufacturing integrating with/without biomechanical simulation improve the effectiveness of spinal braces on adolescent idiopathic scoliosis? Children (Basel). 2023. PMID 37371158.
- Lou EH, et al. How quantity and quality of brace wear affect the brace treatment outcomes for AIS. Eur Spine J. 2016. PMID 26386869.
- Bonsignore-Opp L, et al. Three-dimensional Rigo Cheneau-style brace for adolescent idiopathic scoliosis: higher in-brace correction and lower rates of curve progression. Spine Deform. 2025. PMID 40778973.
- Davis L, et al. A comparative analysis of patients with adolescent idiopathic scoliosis treated with Rigo Cheneau, Boston-style, and Providence braces: a preliminary report. J Pediatr Orthop. 2026. PMID 41287368.
- D’Amato CR, et al. Nighttime bracing with the Providence brace in adolescent girls with idiopathic scoliosis. Spine. 2001;26(18):2006–2012. PMID 11547201.
- Cheng JC, Castelein RM, Chu WC, et al. Adolescent idiopathic scoliosis. Nat Rev Dis Primers. 2015;1:15030. PMID 27188385.
- Hình ảnh và số liệu ca bệnh / Case images and data: dungcuchinhhinh.vn (website của Lê Hoàn Prosthetics & Orthotics).
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