Forskning & artikler

Korsettering af skoliose

Dette studie fra USA blev stoppet før tid, da man allerede havde påvist effekten ved korsettering af skoliose, og dermed ikke kunne forsvare at have kontrolgruppen uden korset:

Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of Bracing in Adolescents with Idiopathic Scoliosis N Engl J Med. 2013 Oct 17;369(16):1512-21.

Udklip fra Resultaterne af studiet omkring bæretid på 12,9 timer/dag eller over for bedst effekt af korsettering:

BRACE DOSE–RESPONSE RELATIONSHIP

The majority of patients assigned to bracing (68%) were treated with a customized Boston-type thora- columbosacral orthosis. Temperature data were available for 116 patients (from both the random- ized and preference cohorts). During the first 6 months, patients wore the brace for a mean (±SD) of 12.1±6.5 hours per day (range, 0 to 23.0). The quartile of duration of brace wear was positively associated with the rate of success (P<0.001). The lowest quartile of wear (mean hours per day, 0 to 6.0) was associated with a success rate (41%) sim- ilar to that in the observation group in the pri- mary analysis (48%), whereas brace wear for an average of at least 12.9 hours per day was associated with success rates of 90 to 93% (Fig. 2).

Conclusion:

Bracing significantly decreased the progression of high-risk curves to the threshold for surgery in patients with adolescent idiopathic scoliosis. The benefit increased with longer hours of brace wear.

Vigtigheden af bæretid i korset er allerede belyst i dette studie fra 1997:

Rowe DE, Bernstein SM et al. A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. J Bone Joint Surg Am. 1997 May;79(5):664-74.

Conclusion:

We found that use of the Milwaukee brace or another thoracolumbosacral orthosis for twenty-three hours per day effectively halted progression of the curve. Bracing for eight or sixteen hours per day was found to be significantly less effective than bracing for twenty-three hours per day 

Studie omkring vigtigheden af korrektion i korsettet samt bæretid for slutresultatet:

Landauer F, Wimmer C, Behensky H. Estimating the final outcome of brace treatment for idiopathic thoracic scoliosis at 6-month follow-up. Pediatr Rehabil. 2003 Jul-Dec;6(3-4):201-7.

Conclusion:

Compliant patients with a high initial correction can expect a final correction of around 7 degrees, while compliant patients with low initial correction may maintain the curve extent. Bad compliance is always associated with curve progression.

Nachemson AL, Peterson LE. Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J Bone Joint Surg Am. 1995 Jun;77(6):815-22.

Conclusion:

According to survivorship analysis, treatment with a brace was associated with a success rate of 74 per cent (95 per cent confidence interval, 52 to 84) at four years; observation only, with a success rate of 34 per cent (95 per cent confidence interval, 16 to 49); and electrical stimulation, with a success rate of 33 per cent (95 per cent confidence interval, 12 to 60)

Cheneau korsetter

Cinella et al. The treatment of adolescent idiopathic scoliosis with Cheneau brace: long term outcome. Scoliosis. 2009; 4(Suppl 2): O44.

Conclusion:

At the end of treatment we observed an improvement in correction around at 23%  from the beginning curves, and after 5 years there was stabilization at approximately 15%). Our results demonstrate that conservative treatment with the Cheneau brace is corrective for the treatment of Idiopathic Scoliosis (IS).

Weiss HR, Werkmann M. Rate of surgery in a sample of patients fulfilling the SRS inclusion criteria treated with a Chêneau brace of actual standard. Stud Health Technol Inform. 2012;176:407–410.

Conclusion:

Rate of surgery can be reduced with the help of Chêneau braces of the latest standard and satisfactory in-brace correction. Brace treatment with the Chêneau brace seems effective and therefore clearly is indicated. Clinical outcomes may be more important for the patient than radiologic outcomes.

Cheneau Gensingen (GBW)

Weiss HR, Tournavitis N, Seibel S, Kleban A. A Prospective Cohort Study of AIS Patients with 40° and More Treated with a Gensingen Brace (GBW): Preliminary Results The Open Orthopaedics Journal 2017;11 (Suppl-9, M8): 1558-1567.

Conclusion:

Conservative brace treatment using the Gensingen brace was successful in 92% of cases of patients with AIS of 40 degrees and higher. This is a significant improvement compared to the results attained in the BrAIST study (72%). Reduction of the ATR shows that postural improvement is also possible.

Weiss HR, Seibel S, Moramarco M, Kleban A. Bracing Scoliosis – the Evolution to CAD/CAM Hard Tissue 2013 November. 2: 5.43.

Conclusion:

Symmetrical braces for scoliosis are outdated. Asymmetric braces allow better in-brace correction compared to symmetric braces.