TRATAMIENTO DE LA ESCOLIOSIS IDIOPÁTICA CON CORSÉ PRODUCIDO CON TECNOLOGÍA 3D

FREITAS JÚNIOR, HAROLDO OLIVEIRA DE; FRANÇA, LUIZ CLAUDIO DE MOURA; CASTILHO, ANDRÉ MOREIRA; RESENDE, ROGÉRIO LÚCIO CHAVES DE; TAVARES, PAULA CAROLINA MARTINS; LEAL, JEFFERSON SOARES

doi:10.1590/S1808-185120212003250497

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ORIGINAL ARTICLE, DEFORMITIES • Coluna/Columna 20 (3) • Jul-Sep 2021 • https://doi.org/10.1590/S1808-185120212003250497 copiar

TRATAMIENTO DE LA ESCOLIOSIS IDIOPÁTICA CON CORSÉ PRODUCIDO CON TECNOLOGÍA 3D

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo

Evaluar la capacidad de corrección inmediata del corsé de Wood-Chêneau-Rigo (WCR), producido con recursos tecnológicos digitales e ingeniería robótica, en curvas primarias y secundarias de la escoliosis idiopática del adolescente (EIA).

Métodos

Se realizó un estudio retrospectivo de 138 pacientes con diagnóstico de EIA que adquirieron el corsé WCR entre 2019 y 2021 en un laboratorio de producción de ortesis y prótesis ortopédicas. Estos individuos fueron sometidos a un análisis independiente de los parámetros radiográficos por un solo investigador, siendo el resultado principal la medición estandarizada de las curvas principal y secundaria por el método de Cobb. Las radiografías analizadas se tomaron en bipedestación antes e inmediatamente después de la adaptación del corsé al paciente. La capacidad de corrección se calculó por la razón entre la diferencia entre las curvas de antes y de después del uso del corsé y la curva de antes del corsé.

Resultados

La corrección promedio de la curva primaria con el WCR fue del 48,4% y de la curva secundaria fue del 41,0%. El nivel de corrección de la curva primaria fue significativamente más grande en pacientes con una curva principal con vértice de la convexidad en la región toracolumbar (p = 0,004), principalmente toracolumbar a la izquierda (p = 0,010); curvas con magnitud entre 10º y 24,9º (p < 0,001) y curvas simples (p < 0,001).

Conclusiones

El uso corsé WCR, producido con modernos recursos tecnológicos, fue efectivo en la corrección inmediata de la EIA. Se necesitan estudios a largo plazo sobre esta nueva modalidad de tratamiento conservador de la escoliosis. Nivel de evidencia III; Estudio retrospectivo.

Escoliosis; Tratamiento Conservador; Análisis de Varianza

Variable	Characterization
1. Sex:	Male or female
2. Age:	Age in years on the date of brace manufacture
3. Side of the curve:	According to the location of the convexity of the main curve: right or left
4. Apex of the main curve:	Vertebra or disc farthest from the midline that belongs to the convexity of the main curve. After defining the apex of the main curve, the Scoliosis Research Society (SRS) topographical classification⁸ was used: thoracic (T2 to disc T11-T12), thoracolumbar (between T12 and L1), lumbar (disc L1-L2 to disc L4-L5)
5. Location of the curves:	Defined according to the SRS topographical classification⁸ and the side of the curve, subdivided into right thoracic, left thoracic, right thoracolumbar, left thoracolumbar, right lumbar, and left lumbar
6. Type of curve:	According to the number of structured curves: simple (one curve), double (two curves), and triple (three curves)
7. Risser:	Risser sign grade of the iliac crest in the AP radiological incidence. Grades 0, 1, 2, 3, 4 and 5. Risser classification grouping: Group A (Risser sign 0, 1 or 2) and Group B (Risser sign 3, 4 or 5)
8. Magnitude:	Magnitude of the curves measured using the Cobb method. Stratification of magnitude: Group 1 (curve ≤ 24.9º), Group 2 (25º to 40º), and Group 3 (> 40º).

Characteristics		n	%
Sex	Female	110	79.7
Sex	Male	28	20.3
Side of main convexity	Right	75	54.4
Side of main convexity	Left	63	45.7
Apex of main convexity	Thoracic	62	44.9
	Thoracolumbar	41	29.7
	Lumbar	35	25.4
Location of the curve	Right thoracic	59	42.8
	Left thoracic	3	2.2
	Right thoracolumbar	9	6.5
	Left thoracolumbar	32	23.2
	Right lumbar	7	5.1
	Left lumbar	28	20.3
Type of curve	Simple curve	50	36.2
Type of curve	Double curve	88	63.8
Grouping by Risser classification	A	86	62.3
Grouping by Risser classification	B	52	37.7
Magnitude	Group 1	29	21.0
	Group 2	61	44.2
	Group 3	48	34.8

Characteristics	n	Mean	Standard deviation	Minimum	1st Quartile	Median	3rd Quartile	Maximum
Age at the beginning of the study	138	13.0	1.6	10.0	12.0	13.0	14.0	16.0
Risser Classification	138	1.8	1.8	0.0	0.0	2.0	4.0	5.0
Degrees (º) of the primary curve before the WCR	138	35.3	11.4	10.6	26.9	34.8	43.1	64.8
Degrees (º) of the primary curve after the WCR	138	19.2	11.2	0.3	9.7	19.4	26.9	49.4
Percentage (%) of primary curve correction	138	48.4	23.1	0.0	32.3	46.3	65.5	97.4
Degrees (º) of the secondary curve before the WCR	88	27.2	9.9	7.5	20.8	26.9	32.4	50.3
Degrees (º) of the secondary curve after the WCR	88	16.4	9.1	0.0	9.5	16.7	20.7	37.5
Percentage (%) of secondary curve correction	88	41.0	23.4	1.9	22.3	37.6	54.1	100.0

Characteristics		Percentage (%) of correction of the primary curve				p value	Percentage (%) of correction of the secondary curve				p value
Characteristics		Mean	Standard Deviation	Median	Q1-Q3	p value	Mean	Standard Deviation	Median	Q1-Q3	p value
Sex	F	48.8	21.7	47.3	35.5-61.6	0.496	39.7	22.6	36.8	23.3-52.3	0.313
Sex	M	47.0	28.3	43.2	25.3-75.0	0.496	46.0	26.8	47.3	21.3-61.7	0.313
Side of the main convexity	R	44.9	20.1	45.6	31.5-55.4	0.082	41.4	23.3	38.2	22.6-54.6	0.782
Side of the main convexity	L	52.6	25.8	48.7	35.5-74.2	0.082	40.3	23.8	37.3	22.8-51.9	0.782
Apex of the main convexity	T	44.3	20.3	45.2	29.0-55.2	0.004**	41.9	23.9	38.6	26.1-53.8	0.887
	TCL	58.6	25.1	61.6	38.2-77.2		42.9	27.8	33.2	28.3-67.1
	L	43.8	22.2	41.6	27.9-58.0		38.5	20.4	37.4	20.4-53.3
Location of the curve	RT	45.0	20.4	45.6	31.3-55.4	0.010**	42.0	24.2	39.0	25.5-54.6	0.914
	LT	30.8	12.5	24.3	23.6-34.7		37.3	-	37.3	37.3-37.3
	RTCL	47.6	17.9	47.6	32.6-51.1		29.6	6.1	32.9	27.7-33.1
	LTCL	61.7	26.2	65.7	46.7-79.1		45.7	29.9	36.0	28.6-73.5
	RL	41.0	22.2	35.9	24.3-55.8		44.2	23.2	53.9	20.0-55.9
	LL	44.5	22.6	42.6	32.6-58.2		37.3	20.1	36.7	21.2-49.6
Grouping by Risser classification	A	49.8	23.5	45.8	34.3-67.3	0.531	43.0	23.7	38.8	24.8-54.9	0.331
Grouping by Risser classification	B	46.1	22.5	47.6	32.1-60.5	0.531	38.1	23.1	33.2	20.4-51.4	0.331
Magnitude	G1	60.4	27.9	67.5	38.5-77.8	< 0.001**	53.3	23.7	61.7	28.9-67.1	0.080
	G2	51.8	21.5	50.0	35.9-68.4		44.1	26.4	39.3	24.2-58.2
	G3	36.9	16.2	39.9	22.5-47.6		34.9	18.4	33.2	21.4-43.4
Type of curve	SC	58.8	23.9	61.3	46.1-76.6	< 0.001*	-	-	-	-	-
Type of curve	DC	42.6	20.6	41.2	30.4-51.4	< 0.001*	-	-	-	-	-

Characteristics	Percentage of correction of the primary curve					Percentage of correction of the secondary curve
Characteristics	Beta	Standard error	p value	CI 95%		Beta	Standard error	p value	CI 95%
Age at start of WCR use	-0.3	1.2	0.793	-2.7	2.1	-1.0	1.5	0.510	-4.1	2.1
Risser classification	-0.8	1.1	0.453	-3.0	1.4	-1.7	1.4	0.234	-4.5	1.1

Characteristics	Percentage of correction of the primary curve
Characteristics	Beta	Standard error	CI 95%		p value	Adjusted R²
(Constant)	64.0	4.1	55.9	72.0	< 0.001	0.184
Magnitude
Group 1	reference
Group 2	-4.7	4.9	-14.4	5.0	0.340
Group 3	-17.8	5.3	-28.3	-7.3	0.001
Type of curve
Simple curve	reference
Double curve	-11.4	4.0	-19.3	-3.5	0.005

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[1] Correspondence: Haroldo Oliveira De Freitas Júnior. Rua Padre Rolim 815, sala 107. Bairro Santa Efigênia. Belo Horizonte, MG, Brazil. CEP: 30.130-090. haroldodefreitasjunior@gmail.com