| Background:At present,China pays increasing attention to adolescent spinal health,in recent years,with the increase of academic pressure of adolescent students,the decrease of outdoor activities and physical exercise,the incidence of scoliosis is on the rise,becoming the third most common disease affecting the health of children and adolescents in China after obesity and myopia.Juvenile idiopathic scoliosis(AIS)occurs mostly in adolescent women,and most patients present with mild deformity.The Society on Scoliosis Orthopaedic and Rehabilitation Treatment(SOSORT)states that observational follow-up or exercise intervention can be performed for patients with mild scoliosis(Cobb angle 10°-25°).In orthopedic clinical treatment,scoliosis is generally divided into thoracic curvature,lumbar curvature,thoracolumbar curve and bibend.Among them,some scholars believe that lumbar scoliosis is the origin of the entire scoliosis.Therefore,it is important to develop individualized therapies for patients with lumbar major curvature AIS.A large number of studies by scholars at home and abroad have proved that physiotherapy Scoliosis Specific Exercises(PSSE)is an effective method for treating AIS patients,but the overall treatment plan is relatively general,and the exercise methods in the study are suitable for various scoliosis types,and the research on the exercise strategy of AIS patients with different scoliosis types is lacking.Therefore,the development of individualized therapy regimens for patients with lumbar main curvature AIS still needs more research to further prove.Objective:To observe the efficacy of individualized treatment regimens for patients with lumbar main curvature AIS,and to explore the effect of healthy life management programs on the quality of daily life of AIS patients.Methods:In this study,40 patients with 10-25° lumbar main curvature AIS were admitted to the Department of Rehabilitation of Tianjin Hospital of Tianjin,all of whom met the diagnostic criteria for adolescent idiopathic scoliosis,and the subjects were divided into experimental group(individualized protocol group,n=20)and control group(healthy life management group,n=20)according to the wishes of patients and their families.The duration of the intervention was 24 weeks,and the following indicators were evaluated before and after the intervention:trunk rotation angle,imaging parameters(coronal Cobb angle,pelvic tilt,lumbar lordosis,T1 pelvic angle,vertebral rotation angle),spine-related functions(lumbar back muscle endurance,lumbar range of motion),SRS-22 questionnaire.Statistical methods:SPSS 27.0 statistical software was used for analysis.The measurement data following the normal distribution were expressed by the mean soil standard deviation,and the independent sample t-test was used to compare the differential changes of the experimental data between the groups,and the paired t-test was used to compare the differential changes of the experimental data in the group.Metric data that do not follow the normal distribution are expressed as medians,and nonparametric tests are used to test the differential changes in the data.The chi-square test was used for the counting data,in which the rank sum test of two samples was used for comparison of grade data.Statistically significant,expressed as P<0.05;Significant differences are indicated by P<0.01.Results:1.Changes in trunk rotation angle(ATR):there was no significant difference between the two groups before the intervention(P>0.05),and there was a significant difference between the groups after the intervention(P<0.05);the comparison before and after the intervention in the control group was statistically significant(P<0.05),and the comparison results before and after the intervention in the experimental group had a significant difference(P<0.01).After the intervention,ATR increased by 1.06°in the control group and decreased by 2.5° in the experimental group.2.Changes in imaging parameters:(1)Changes in coronal Cobb angle:there was no significant difference between the two groups before the intervention(P>0.05),and after 24 weeks of intervention,there was a significant difference between the experimental group and the control group(P<0.01);compared with the control group before and after the intervention,there was no statistical significance(P>0.05),and compared with the pre-intervention,the results of the experimental group after 24 weeks of intervention had a significant difference(P<0.01).Compared with before the intervention,the Cobb angle of the control group increased by 0.88°,and the number of patients with improvement and progression accounted for 1 case,and the number of Cobb angles in the remaining patients was stable.The improvement rate of patients in the control group was 6.25%,the stabilization rate was 87.5%,and the progression rate was 6.25%.The Cobb angle in the experimental group decreased by 4.28°.Among them,6 patients had a decrease in Cobb angle of more than 5°,and 12 patients had a change of Cobb angle within 5°,and the improvement rate and stability rate were 33.3%and 66.7%,respectively.(2)Changes in pelvic tilt angle(PO):there was no significant comparison between the control group and the experimental group before the intervention(P>0.05),after the intervention,there was a significant difference between the control group and the experimental group(P<0.01),there was no significant comparison within the control group(P>0.05),and the comparison results within the experimental group had a significant difference(P<0.01).After 24 weeks of intervention,pelvic tilt decreased by 1.23° in the experimental group.(3)Changes in T1 pelvic angle(TPA):the difference between the two groups before and after intervention was not statistically significant(P>0.05);the difference between the control group and the experimental group before the intervention was not statistically significant(P>0.05),and after 24 weeks of treatment,the difference between the control group and the experimental group was statistically significant(P<0.05).Before the intervention,the distribution of TPA values in the experimental group did not change significantly compared with the control group,while after the intervention,the distribution of TPA values in the experimental group was more concentrated than that in the control group,and the median value was close to the normal value of TPA of 11.9°.(4)Changes in lumbar lordosis(LL):before the intervention,the difference between the two groups was not statistically significant(P>0.05),and the difference between the two groups after the intervention was statistically significant(P<0.05);the difference between the control group before and after the intervention was not statistically significant(P>0.05),and compared with the pre-intervention,the experimental group had a significant difference after the intervention(P<0.01).(5)Changes in vertebral body rotation(Nash-Moe):The number of vertebral body rotation cases in the two groups was not statistically significant before the intervention(P>0.05),and after the end of 24 weeks of intervention,the control group decreased by 1 case of grade Ⅰ.,3 cases of grade Ⅱ.,6 cases of grade Ⅲ.and 2 cases of grade Ⅳ.decreased,and the difference before and after was not statistically significant(P>0.05).In the experimental group,the vertebral body rotation increased by 1 case,the Ⅰ.decreased by 1 case,the Ⅱ.increased by 4 cases,the Ⅲ.decreased by 1 case,and the Ⅳ.decreased by 3 cases,and the before and after comparison was statistically significant(P<0.05).3.Changes in spine-related functions:(1)Changes in lumbar back muscle endurance:there was no significant difference between the control group and the experimental group before the intervention(P>0.05),and there was a significant difference between the two groups after the intervention(P<0.01);the control group was statistically significant before and after the intervention,and compared with before the intervention,the change of lumbar back muscle endurance in the experimental group after 24 weeks of treatment had a significant difference(P<0.01).After 24 weeks of intervention,the experimental group’s lumbar muscle endurance test increased by 27.78 seconds.(2)Changes in lumbar range of motion:the indicators of the control group were not statistically significant before and after the intervention,and the lumbar spine forward flexion,posterior extension,left flexion and right flexion were significantly different before and after the intervention in the experimental group(P<0.01);after the intervention,there was a significant significance between the control group and the experimental group between the lumbar forward flexion and the left flexion(P<0.05).4.Changes in SRS-22 questionnaire scores:There were no significant scores in the first two groups(P>0.05).After 24 weeks of intervention,the SRS-22 questionnaire in both groups showed no statistically significant scores on pain,mental health,self-image,and functional activity(P>0.05).The within-group comparison showed that the mental health and self-image of the two groups were statistically significant before and after the intervention(P<0.05),and the changes in the control group were more significant(P<0.01).Pain and functional activity were not statistically significant within the group(P>0.05).In addition,patients had better satisfaction with treatment after the intervention(P=0.02<0.05).Conclusions:1.The individualized therapy scheme can improve the patient’s lumbar bulge deformity,make the imaging parameters show a trend of improvement,improve the endurance of the lumbar back muscles,increase the range of motion of the lumbar spine forward flexion,posterior extension,left flexion and right flexion,and patients have better treatment satisfaction.Individualized therapy has a good effect on patients with lumbar main curvature AIS.2.Individualized therapy and healthy life management programs can improve the mental health and self-image of AIS patients.However,improvements in healthy living management programmes have been more pronounced. |
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