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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。

病例:39°侧弯经约29个月支具治疗降至5.8°

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°)。
38.65° → 9.8° / 0.8° → 5.8° / −4.5°
38.65° → 9.8° / 0.8° → 5.8° / −4.5°

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

  1. 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.
  2. 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.
  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.
  4. 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.
  5. 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.
  6. 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.
  7. Dolan LA, et al. BrAIST-Calc: prediction of individualized benefit from bracing for adolescent idiopathic scoliosis. Spine. 2024. PMID 37994691.
  8. 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.
  9. 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.
  10. Peeters CMM, et al. Predictive factors on initial in-brace correction in idiopathic scoliosis: a systematic review. Spine. 2022. PMID 35500086.
  11. 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.
  12. Lou EH, et al. How quantity and quality of brace wear affect the brace treatment outcomes for AIS. Eur Spine J. 2016. PMID 26386869.
  13. 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.
  14. 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.
  15. 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.
  16. Cheng JC, Castelein RM, Chu WC, et al. Adolescent idiopathic scoliosis. Nat Rev Dis Primers. 2015;1:15030. PMID 27188385.
  17. Hình ảnh và số liệu ca bệnh / Case images and data: dungcuchinhhinh.vn (website của Lê Hoàn Prosthetics & Orthotics).

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