跳到主要内容
Lê Hoàn Prosthetics & Orthotics

矫形器

青少年特发性脊柱侧弯的支具治疗：证据与指引

支具真的能帮助避免手术吗？汇总BrAIST试验、Cochrane综述、SOSORT指南以及按Cobb角的处理方案。

免费咨询 0985 211 888
青少年特发性脊柱侧弯的支具治疗：证据与指引

青少年特发性脊柱侧弯（AIS）约影响2–3%的青春期儿童。对仍在生长且侧弯足够大的孩子，支具是唯一在多中心随机试验中被证明能降低手术率的非手术治疗。

以下为证据与指南的摘要。含表格和参考文献的完整文章提供越南语和英语版本。

要点

  • 未经治疗，约每10名AIS儿童中有4名侧弯会进展。
  • 最危险的阶段是青春期生长高峰；50°这一界限决定成年后的前景。
  • 对仍在生长（Risser 0–3）、侧弯大于20° ± 5°且有进展风险的儿童建议使用支具（SOSORT 2016）。
  • 夜间支具（CONTRAIS，2024年）：成功率76%，专项运动58%，仅体育活动53%。
  • 运动（Schroth/PSSE）的益处较小，与支具联合使用效果最好，而不是取代支具。

科学证据

  • BrAIST：242名儿童，Cobb角20–40°，Risser 0–2；因支具疗效明显而提前终止。
  • Cochrane 2015：7项研究、662名青少年——支具可防止侧弯进展。
  • 支具内的初始矫正与成功密切相关（Eur Spine J，2019年）。
  • 电子监测使平均佩戴时间每天增加3.47小时（PLOS ONE，2022年）。
  • 诊所病例：15岁，Cobb角38.65°；使用日用和夜用两套支具约14个月后，不戴支具10°，日用支具内0.2°，夜用支具内−2.6°。支具内矫正越大，结局往往越好：van den Bogaart综述（Eur Spine J 2019，26项研究）提供强证据，表明初始支具内矫正不足与治疗失败相关；Emans（Spine 1986，295例）；Katz（JBJS 2010）：每天佩戴超过12小时者82%无进展，少于7小时者为31%。这是关联，不是因果证明。
How to read: each horizontal bar is a group of children; the longer the bar, the higher the success rate. SUCCESS means that when growth ended the Cobb angle was still below 50° (no surgery). Observation only: 48%. Brace worn 0–6 hours/day: 41%. Brace worn 12.9 hours/day or more: 90–93%. Wear time was measured by heat sensors inside the brace, so it is a real measurement rather than self-report; the link between hours worn and success was statistically significant (P < 0.001). Note that this is an analysis by actual wear time, so children who wore it longer may also differ in other ways. Source: Weinstein et al., NEJM 2013;369:1512–1521 (242 children, Cobb 20°–40°, Risser 0–2).
How to read: each horizontal bar is a group of children; the longer the bar, the higher the success rate. SUCCESS means that when growth ended the Cobb angle was still below 50° (no surgery). Observation only: 48%. Brace worn 0–6 hours/day: 41%. Brace worn 12.9 hours/day or more: 90–93%. Wear time was measured by heat sensors inside the brace, so it is a real measurement rather than self-report; the link between hours worn and success was statistically significant (P < 0.001). Note that this is an analysis by actual wear time, so children who wore it longer may also differ in other ways. Source: Weinstein et al., NEJM 2013;369:1512–1521 (242 children, Cobb 20°–40°, Risser 0–2).
How the Cobb angle is assessed and what each range means (source: dungcuchinhhinh.vn)
How the Cobb angle is assessed and what each range means (source: dungcuchinhhinh.vn)
Brace principle: pressure areas and cut-out (relief) areas (source: dungcuchinhhinh.vn)
Brace principle: pressure areas and cut-out (relief) areas (source: dungcuchinhhinh.vn)
Guided scoliosis-specific exercise (source: dungcuchinhhinh.vn)
Guided scoliosis-specific exercise (source: dungcuchinhhinh.vn)
Examples of exercises: quadruped, bar hang/squat, unilateral kneeling, lateral flexion sitting (source: dungcuchinhhinh.vn)
Examples of exercises: quadruped, bar hang/squat, unilateral kneeling, lateral flexion sitting (source: dungcuchinhhinh.vn)
How to read the films: four standing X-rays of the same patient, shown at the same size for easy comparison. The first tile (orange frame) is before treatment (2 August 2022): the orange lines are the Cobb-angle measurement lines, result 38.65°. The other three tiles (green frames) were taken on 24 October 2023, after about 14 months: out of brace (10°), in the night brace (−2.6°, curved to the opposite side) and in the day brace (0.2°); the bright round and elongated objects are the pads and frame of the brace. The large figure under each film is the Cobb angle. The patient-name line printed on the films has been masked; everything else is kept as on the original films. Image source: dungcuchinhhinh.vn.
How to read the films: four standing X-rays of the same patient, shown at the same size for easy comparison. The first tile (orange frame) is before treatment (2 August 2022): the orange lines are the Cobb-angle measurement lines, result 38.65°. The other three tiles (green frames) were taken on 24 October 2023, after about 14 months: out of brace (10°), in the night brace (−2.6°, curved to the opposite side) and in the day brace (0.2°); the bright round and elongated objects are the pads and frame of the brace. The large figure under each film is the Cobb angle. The patient-name line printed on the films has been masked; everything else is kept as on the original films. Image source: dungcuchinhhinh.vn.

实用建议

  • 留意早期征象：双肩不等高、肩胛骨突出、腰线不对称、弯腰时出现肋骨隆起。
  • 在孩子仍在生长时就诊并拍摄X光片。
  • 支具需个体化制作，检查支具内矫正，并随生长调整。
  • 关注佩戴时长（每天≥12.9小时）、皮肤状况和孩子的情绪；复查X光通常间隔不少于6个月。

Lê Hoàn YouTube 频道视频

Áo Nẹp Chỉnh Hình
Áo Nẹp Chỉnh Hình

YouTube · Chân Tay Giả – Lê Hoàn

如果您的孩子有脊柱侧弯征象或已被开具支具，请携带X光片前来面诊：+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, Minozzi S, Bettany-Saltikov J, et al. Braces for idiopathic scoliosis in adolescents. Cochrane Database Syst Rev. 2015;(6):CD006850.
  3. Romano M, Minozzi S, Bettany-Saltikov J, et al. Therapeutic exercises for idiopathic scoliosis in adolescents. Cochrane Database Syst Rev. 2024;2:CD007837.
  4. 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.
  5. Yang S, Cai F, Xie R, et al. Adolescent idiopathic scoliosis non-surgical interventions: a systematic review and network meta-analysis of Cobb angle and SRS-22 outcomes. Front Pediatr. 2026;14:1908709.
  6. Po EYP, Yang M, Takemura N, et al. Global prevalence of adolescent idiopathic scoliosis between 1975 and 2025: a systematic review and meta-analysis. Spine. 2026.
  7. Kuru T, Yeldan İ, Dereli EE, et al. The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled clinical trial. Clin Rehabil. 2016;30(2):181–190.
  8. Wang S, Zhao J, Hu X, et al. Psychosocial burden of adolescent idiopathic scoliosis: a systematic review and meta-synthesis of patient and caregiver perspectives. Health Expect. 2026.
  9. The effects of exercise on patients with moderate adolescent idiopathic scoliosis: a systematic review and meta-analysis. Orthop Rev. 2025. PMID: 40476023.
  10. Physiotherapy management of adolescent idiopathic scoliosis (Invited Topical Review). J Physiother. 2025.
  11. Di Felice F, Zaina F, Donzelli S, Negrini S. The natural history of idiopathic scoliosis during growth: a meta-analysis. Am J Phys Med Rehabil. 2018;97(5):346–356.
  12. Puberty changes the natural history of idiopathic scoliosis: three prediction models for future radiographic curve severity from 1563 consecutive patients. Eur Spine J. 2024.
  13. Prediction of future curve angle using prior radiographs in previously untreated idiopathic scoliosis: natural history from age 6 to after the end of growth (SOSORT 2022 award winner). Eur Spine J. 2023.
  14. Karol LA, Virostek D, Felton K, Jo C, Butler L. The effect of the Risser stage on bracing outcome in adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2016;98(15):1253–1259.
  15. Hình ảnh minh họa / Illustrations: dungcuchinhhinh.vn (website của Lê Hoàn Prosthetics & Orthotics)
  16. Cheng JC, Castelein RM, Chu WC, et al. Adolescent idiopathic scoliosis. Nat Rev Dis Primers. 2015;1:15030. PMID 27188385.
  17. Weinstein SL, Dolan LA, Spratt KF, et al. Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA. 2003;289(5):559–567. PMID 12578488.
  18. Lonstein JE, Carlson JM. The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg Am. 1984;66(7):1061–1071. PMID 6480635.
  19. Dolan LA, Weinstein SL. Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review. Spine. 2007;32(19 Suppl):S91–S100. PMID 17728687.
  20. Karavidas N. Bracing in the treatment of adolescent idiopathic scoliosis: evidence to date. Adolesc Health Med Ther. 2019;10:153–172. PMID 31632169.
  21. Kuroki H, Inomata N, Hamanaka H, et al. Efficacy of the Osaka Medical College (OMC) brace in the treatment of adolescent idiopathic scoliosis following Scoliosis Research Society brace studies criteria. Scoliosis. 2015;10:12 (Japan). PMID 25932040.
  22. Kuroki H. Brace treatment for adolescent idiopathic scoliosis. J Clin Med. 2018;7(6):136 (Japan). PMID 29867010.
  23. 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.
  24. 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.
  25. 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.
  26. Almansour H, Pepke W, Bruckner T, Diebo BG, Akbar M. Three-dimensional analysis of initial brace correction in the setting of adolescent idiopathic scoliosis. J Clin Med. 2019;8(11):1804. PMID 31661811.

相关解决方案

关于脊柱侧弯的常见问题解答

关于脊柱侧弯的常见问题解答

解答家长最常问的支具治疗问题：何时需要一个或两个支具、为什么要定期更换，以及脊柱变直后为什么仍需继续佩戴。

关于脊柱侧弯的常见问题解答
如何用矫形支具治疗脊柱侧弯

如何用矫形支具治疗脊柱侧弯

概述脊柱侧弯的成因、预警信号和健康风险，并说明为什么支具结合物理治疗是当前最安全、最有效的治疗方式。

如何用矫形支具治疗脊柱侧弯
扁平足定制矫形鞋垫概述

扁平足定制矫形鞋垫概述

介绍使用定制矫形鞋垫治疗扁平足的成因、益处与治疗流程，并说明费用以及这种方法真正适用的情形。

扁平足定制矫形鞋垫概述

您或家人需要咨询吗？

预约河内到院评估，或发送资料进行远程咨询。我们会在24小时内回复。

预约咨询