Milwaukee和Boston支具治疗青少年特发性脊柱侧凸的疗效分析

Efficacy analysis for adolescent idiopathic scoliosis treated with Milwaukee or Boston orthosis

目的 评估Milwaukee和Boston支具不同佩戴方式对于治疗青少年脊柱侧凸疗效.方法 回顾总结2004年2月至2009年3月间对85例骨骼发育未成熟的青少年特发性脊柱侧凸患儿的诊治.支具治疗的57例患儿,分别接受颈胸腰骶支具（ CTLSO） -Milwaukee支具（28例）和胸腰骶矫形支具（TLSO） -Boston支具（29例）并辅以体操矫正.其中30例规律佩戴,每天21 ～23 h;27例间断佩戴,每天6 ～ 15 h；另28例未佩戴相应支具.每3～6个月定期观察患儿Cobb角和Risser征,复查时均摄佩带和卸下支具站立位全脊柱正侧位X线片及外观大体像.结果 73例获得2～5年的临床随访,时间（26.3±33.7）个月.Milwaukee支具组：规律佩戴支具类有效率达91.67％（11/12）,间断佩戴支具类有效率达56.25％（9/16）,未佩戴支具类有效率为20％（4/20）.经比较Milwaukee支具规律类优于支具间断类和无支具类（P＜0.05）.Boston支具组：规律佩戴支具类有效率达88.89％（16/18）,间断佩戴支具类有效率达54.55％（6/11）,未佩戴支具类有效率为25％（2/8）.经比较Boston支具规律类优于支具间断类和无支具类（P＜0.05）.文中支具和患儿选择不同,因此未对两种支具临床疗效对比.结论 两种支具均应坚持正确规律的佩戴,两种支具组规律类疗效优于各支具组间断类和无支具类,对于符合支具治疗指征的AIS患儿疗效确切.

Objective To evaluate the efficacy about the different wearing manner with Milwaukee and Boston for the treatment of adolescent idiopathic scoliosis （AIS）.Methods Retrospectively summarization and analysis was performed in 85 adolescent patients with idiopathic scoliosis who were treated from February 2004 to March 2009.The skeletal growth of them had not completed.There were 57 cases who received brace treatment.In them,28 were treated with （CTLSO） Milwaukee brace,and the rest were treated with （TLSO） Boston brace and orthopedic gymnastics.The 30 cases wear regularly used for 21 to 23hours per day,and 27 cases could consist on wearing only 6 to 15 hours per day.The other 28 cases of 85AIS cases were only treated with orthopedic gymnastics instead of orthosis treatment.All patients were periodically observed with lateral side （X）-ray photograph at standing position and photograph,and Cobb angle and Risser sign were measured every 3 to 6 months.Since 2008 all adolescent idiopathic scoliosis patients treated with orthosis were requested to fill with simplified Chinese SRS-22.Results 73 cases adolescent idiopathic scoliosis patients were followed up for 2 ～5 years [ mean（26.3 ± 33.7）months ].Milwaukee orthosis group showed the regular wearing group had 91.67 % （ 11/12） effective rate and the intermittent wearing group had 56.25% （9/16） effective rate and the group without wearing orthosis only had 20% （4/20）effective rate.The group regularly wearing Milwaukee brace had superior effect than the other two groups （P 〈 0.05 ）.Boston orthosis group showed the regular wearing group had 88.89% （16/18） effective rate and the intermittent wearing group had 54.55% （6/11 ） effective rate and the group without wearing brace with 25% （2/8） effective rate.The group regularly wearing Boston brace had better effect than the other two groups （ P 〈 0.05 ）.Due to the different choice of AIS patients and orthosis,the effective rate of the Milwaukee and Boston orthosis was not compared.Conclusions The adolescent idiopathic scoliosis patients should insist on regularly wearing brace regardless of the Milwaukee or Boston orthosis （ this article suggest that the wearing time should not less than 21 ～ 23 h/d）.The group regularly wearing with the Milwaukee or Boston orthosis had better effect than the intermittent group or the group without wearing brace.It＇s a good treatment for the AIS patients who have with the indication of orthosis treatment.