计算机辅助制作矫形器矫正青少年特发性脊柱侧弯

Computer-aided manufactured orthoses for correction of adolescent idiopathic scoliosis

[目的]探索计算机辅助设计制作(computer-aided design and computer-aided manufacture, CAD/CAM)矫形器对青少年特发性脊柱侧弯患者的疗效。[方法] 2018年1月—2019年12月,本院收治的62例Cobb角25°~50°(主侧弯)的青少年特发性脊柱侧弯患者随机分为两组。其中,31例采用CAM制作矫形器治疗,31例采用石膏模制作矫形器治疗。比较两组临床和影像资料。[结果]本组共62例患者,其中60例完成随访,平均随访时间(24.90±4.26)个月。穿戴矫形器期间所有患者未出现皮肤磨破、呼吸困难等并发症。随时间推移,两组患者坐高和SF-36评分显著增加(P<0.05),两组身高均增加,但CAM组差异有统计学意义(P<0.05),石膏组差异无统计学意义(P>0.05)。相应时间点,两组间身高、坐高和垂线偏移距的差异均无统计学意义(P>0.05),但是,治疗1年和末次随访时CAM组的SF-36评分显著优于石膏组(P<0.05)。影像方面,随时间推移,两组的侧弯Cobb角度显著减少(P<0.05)。相应时间点,两组间Cobb角、C;-CSVL和AVT的差异均无统计学意义(P>0.05)。[结论] CAM与石膏模制作矫形器均可有效治疗青少年特发性脊柱侧弯,相比之下,CAM制作的矫形器适配性更好。

[Objective] To explore the clinical outcomes of computer-aided design and computer-aided manufacture(CAD/CAM) orthoses for correction of adolescent idiopathic scoliosis(AIS). [Methods] From January 2018 to December 2019, a total of 62 patients who suffered from AIS with scoliotic Cobb angle of 25°~50° were randomly divided into two groups. Among them, 31 patients were treated with CAM orthoses, while the other 31 patients were treated with plaster mold manufactured orthoses. The clinical and imaging data were compared between the two groups. [Results] Of the 62 patients, 60 patients were followed up for(24.90±4.26) months on an average. No complications such as skin abrasion and dyspnea occurred in any patients during the wearing period of orthosis. The sitting height and SF-36scores increased significantly(P<0.05). The body height increased in both groups, but the difference in CAM group was statistically significant(P<0.05), while not statistically significant in plaster group(P>0.05). At any corresponding time points, there were no significant differences in height, sitting height and vertical offset between the two groups(P>0.05). However, the CAM group had significantly better SF-36 score than the plaster group at 1 year after treatment and the latest follow-up(P<0.05). Radiographically, the scoliotic Cobb angle decreased significantly over time in both groups(P<0.05). At any corresponding time points, there were no significant differences in Cobb angle, C7-CSVL and AVT between the two groups(P>0.05). [Conclusion] Both CAM and plaster mold manufactured orthoses are effective treatments for correction of adolescent idiopathic scoliosis. By comparison, the CAM orthoses are considerably superior to the plaster mold manufactured orthoses in term of fitness to patients.