Abstract：
OBJECTIVE: Adolescent idiopathic scoliosis (AIS) is characterized by coronal scoliosis and often a sagittal hypokyphosis. The effect of bracing on the sagittal profile is not well understood. The aim of this study is to assess the effect of night-time bracing on the sagittal profile in patients with AIS.
METHODS: We retrospectively included AIS patients with a main curve of 25-45° treated with a night-time brace in our institution between 2005 and 2018. Patients with estimated growth potential based on either Risser stage, hand X-rays, or menarchal status were included. Coronal and sagittal radiographic parameters were recorded at both brace- initiation and -termination. Patients were followed until surgery or one year after brace termination. Results were compared to a published cohort of full-time braced patients.
RESULTS: One hundred forty-six patients were included. Maximum thoracic kyphosis (TK) increased 2.5° (± 9.7) (p = 0.003), corresponding to a 3.5-fold relative risk increase post bracing in TK compared to a full-time brace cohort. Twenty-seven percent (n = 36) of the patients were hypokyphotic (T4/T12 < 20°) at brace initiation compared with 19% (n = 26) at brace termination (p = 0.134). All other sagittal parameters remained the same at follow-up. We found no association between progression in the coronal plane and change in sagittal parameters.
CONCLUSIONS: This is the first study to indicate that night-time bracing of AIS does not induce hypokyphosis. We found a small increase in TK, with a substantially lower risk of developing flat back deformity compared to full-time bracing. The coronal curve progression was not coupled to a change in TK.
METHODS: We retrospectively included AIS patients with a main curve of 25-45° treated with a night-time brace in our institution between 2005 and 2018. Patients with estimated growth potential based on either Risser stage, hand X-rays, or menarchal status were included. Coronal and sagittal radiographic parameters were recorded at both brace- initiation and -termination. Patients were followed until surgery or one year after brace termination. Results were compared to a published cohort of full-time braced patients.
RESULTS: One hundred forty-six patients were included. Maximum thoracic kyphosis (TK) increased 2.5° (± 9.7) (p = 0.003), corresponding to a 3.5-fold relative risk increase post bracing in TK compared to a full-time brace cohort. Twenty-seven percent (n = 36) of the patients were hypokyphotic (T4/T12 < 20°) at brace initiation compared with 19% (n = 26) at brace termination (p = 0.134). All other sagittal parameters remained the same at follow-up. We found no association between progression in the coronal plane and change in sagittal parameters.
CONCLUSIONS: This is the first study to indicate that night-time bracing of AIS does not induce hypokyphosis. We found a small increase in TK, with a substantially lower risk of developing flat back deformity compared to full-time bracing. The coronal curve progression was not coupled to a change in TK.
摘要：
目的：青少年特发性脊柱侧凸（AIS）的特征是冠状脊柱侧凸，通常是矢状位后凸。支撑对矢状轮廓的影响尚不清楚。这项研究的目的是评估夜间支撑对AIS患者矢状面的影响。
方法：我们回顾性地纳入了2005年至2018年间在我们机构接受夜间支撑治疗的主要曲线为25-45°的AIS患者。根据Risser分期估计生长潜力的患者，手部X光片,或月经状态包括在内。冠状和矢状的放射摄影参数在腕部起始和终止时都被记录。随访患者直至手术或支架终止后一年。将结果与已发表的全职支架患者队列进行比较。
结果：纳入了146例患者。最大胸椎后凸(TK)增大2.5°(±9.7)(p=0.003),与全职支撑队列相比，TK支撑后相对风险增加3.5倍。27％（n=36）的患者在支具开始时出现后凸低（T4/T12<20°），而支具结束时（p=0.134）为19％（n=26）。所有其他矢状参数在随访时保持相同。我们发现冠状面的进展与矢状参数的变化之间没有关联。
结论：这是第一项表明夜间支撑AIS不会引起后凸畸形的研究。我们发现传统知识略有增加，与全职支撑相比，发生平坦背部畸形的风险大大降低。冠状曲线的进展与TK的变化无关。
方法：我们回顾性地纳入了2005年至2018年间在我们机构接受夜间支撑治疗的主要曲线为25-45°的AIS患者。根据Risser分期估计生长潜力的患者，手部X光片,或月经状态包括在内。冠状和矢状的放射摄影参数在腕部起始和终止时都被记录。随访患者直至手术或支架终止后一年。将结果与已发表的全职支架患者队列进行比较。
结果：纳入了146例患者。最大胸椎后凸(TK)增大2.5°(±9.7)(p=0.003),与全职支撑队列相比，TK支撑后相对风险增加3.5倍。27％（n=36）的患者在支具开始时出现后凸低（T4/T12<20°），而支具结束时（p=0.134）为19％（n=26）。所有其他矢状参数在随访时保持相同。我们发现冠状面的进展与矢状参数的变化之间没有关联。
结论：这是第一项表明夜间支撑AIS不会引起后凸畸形的研究。我们发现传统知识略有增加，与全职支撑相比，发生平坦背部畸形的风险大大降低。冠状曲线的进展与TK的变化无关。
