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Die Compliance als Prognosefaktor bei der konservativen Behandlung idiopathischer Skoliosen

Compliance as a prognostic factor in the treatment of idiopathic scoliosis

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Zusammenfassung

Hintergrund

Ziel der Untersuchung war die Analyse des Einflusses der Korsettcompliance auf das Behandlungsergebnis bei idiopathischer Skoliose.

Material und Methode

Bei 90 Jugendlichen wurde mit Dresdner Skolioseorthese (DSO) ganztags behandelt. Nach einem Beobachtungszeitraum von im Mittel 4,3 Jahren erfolgte die retrospektive Analyse der Compliance mit Fragebogen und Gespräch.

Ergebnisse

Die Primärkorrektur in Orthese betrug lumbal 36% und thorakal 25%. 59,4% der Patienten waren compliant und hatten damit eine Erfolgsrate von 89% (konstanter Winkel nach Cobb bzw. Verbesserung). Beim Zusammentreffen von Compliance und einer Primärkorrektur von >30% erreichten thorakale Skoliosen eine Korrektur um 8,3° und lumbale Skoliosen um 12,4°. In der Noncompliancegruppe wurden bei 11 von insgesamt 39 Patienten Operationsindikationen gestellt, während dies in der Compliancegruppe nur bei 4 von 57 Patienten der Fall war.

Schlussfolgerung

Die Compliance ist neben der Primärkorrektur der Orthese der entscheidende prädiktive Faktor der Korsettbehandlung idiopathischer Skoliosen. Es erhebt sich die Frage nach psychologischen Einflussfaktoren auf die Compliance.

Abstract

Background

The purpose of this study was to assess the compliance of brace treatment and the correlation with outcomes in patients with idiopathic scoliosis.

Methods

Ninety adolescent patients completed treatment with the Dresden scoliosis orthosis. After a mean follow-up time of 4.3 years, their level of compliance was retrospectively assessed and correlated with the radiographic results.

Results

The amount of primary correction was 36% in the lumbar spine and 25% in the thoracic spine. Of the patients, 59.4% were compliant (daily duration of brace treatment >20 h). The success rate in this group (improved or constant Cobb angles during therapy) was 89%. With good compliance and primary correction of more than 30%, the average Cobb angle at follow-up had improved by 8.3° in the thoracic spine and by 12.4° in the lumbar spine compared with the initial Cobb angle. Eleven of 39 patients in the noncompliant group but only four of 57 compliant patients underwent surgery.

Conclusion

Compliance with orthosis therapy and the amount of primary correction are together the most important factors for predicting the final outcome of brace treatment in idiopathic scoliosis. Influencing factors on compliance must be further analyzed.

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Authors and Affiliations

  1. Wirbelsäulenbereich, Klinik für Orthopädie, Universitätsklinikum Carl Gustav Carus der TU Dresden , Fetscherstraße 74, 01307, Dresden, Deutschland

    J. Seifert & K.P. Günther

  2. OTM, Orthopädie- und Rehatechnik Dresden GmbH, Dresden, Deutschland

    A. Selle

  3. Asklepios Orthopädische Klinik, Hohwald, Deutschland

    C. Flieger

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  1. J. Seifert
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  2. A. Selle
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  3. C. Flieger
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  4. K.P. Günther
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Correspondence to J. Seifert.

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Seifert, J., Selle, A., Flieger, C. et al. Die Compliance als Prognosefaktor bei der konservativen Behandlung idiopathischer Skoliosen. Orthopäde 38, 151–158 (2009). https://doi.org/10.1007/s00132-008-1367-5

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  • DOI: https://doi.org/10.1007/s00132-008-1367-5

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