Observation on the curative effect and analysis of influencing factors of Cheneau brace in the treatment of adolescent idiopathic scoliosis

English Keywords:Adolescent idiopathic scoliosis  Brace treatment  In-brace correction

English Abstract:

  【Abstract】 Objectives: To study the efficacy of Cheneau brace in the treatment of adolescent idiopathic scoliosis and investigate the related factors affecting the outcomes. Methods: Patients diagnosed with adolescent idiopathic scoliosis(AIS) and treated with Cheneau brace from January 2016 to June 2018 were reviewed. 49 patients(46 females and 3 males) were included in the study. The average initial treatment age was 12.6±1.3y(10-15y), the initial Risser sign was 2.2±1.6, and the initial main curve Cobb angle was 32.5°±6.9°(20°-45°). The clinical data including age and daily wearing time and radiological data of full-length X-ray films of spine at the beginning, immediately after bracing and follow-up were evaluated. In-brace correction was calculated using immediate X-ray film after bracing. The outcomes were evaluated as "improved" (reduction of Cobb angle ≥6°), "stable unchanged" (Progression or reduction of Cobb angle within 5°), and "worsened"(Cobb angle ≥6° progression), and the outcomes of "improved" and "stable" were considered as successful. The influencing factors for deformity progress were analyzed, including treatment factor of in-brace correction and patients′ factors, such as deformity magnitude(20°-29°, 30°-39° and 40°-45°), Risser sign (0-4), and curve type (thoracic curve, thoracolumbar/lumbar curve, and double major curve). Meanwhile, the potential factors affecting the in-brace correction rate were also analyzed. Results: Of all the patients, the average treatment duration was 2.0±1.0 years. All children wore braces for more than 18-20 hours per day, with good compliance. The average age of patients in the last follow-up was 14.6±1.4 years, the Risser sign was 4.2±0.6, and the Cobb angle was 28.5°±9.6°. Deformity improved in 31 cases, deformity unchanged in 14 patients, and the successful rate was 91.8%(45/49). Deformity progressed in 4 cases, of which 3 cases were more than 45°. The average In-brace correction was (64.9±23.6)%, which was (69.5±23.2)%, (61.5±23.7)% and (42.5±10.0)% in the improved group, the stable group and the worsened group, respectively. There was a moderate correlation between the initial orthosis rate and the results of each group(correlation coefficient 0.318, P=0.026); Ordinal multinomial logistic regression showed that the brace correction rate had a positive effect on the results, and the difference was statistically significant(P=0.045). By analyzing the patients′ factors for deformity progression, it was found that deformity magnitude and bone maturity were risk factors for deformity progression(P=0.016 and P=0.010). There was no significant difference in the rate of deformity progression among different curve types(P=0.124). However, the 4 cases of progressive deformity all occurred in thoracic region (3 cases of thoracic curve and 1 case of double major curve), no progress occurred in thoracolumbar curve/lumbar curve. Multivariate analysis showed that the lower the degree of deformity, the higher in-brace correction(P=0.001); the curve type and Risser score had no significant effect on in-brace correction. Conclusions: Cheneau brace serves as an effective method for the treatment of adolescent idiopathic scoliosis. In-brace correction rate is an important factor affecting the outcomes, that is the higher the in-brace correction rate, the better the treatment results. Thoracic region curve with severe deformity (>40°) and low level of skeletal maturity(Risser 0) are more likely to progress.