A Quantitative Evaluation Of Corrective Action In AIS Patients :based On 3D-spinal Ultrasonography And Surface Electrography

Background and ObjectiveAdolescent idiopathic scoliosis(AIS)is the most common spinal deformity in adolescent scoliosis.High quality evidence validate the effectiveness of surgery and bracing in the treatment of AIS,but surgical and bracing treatments have certain limitations and some adverse consequences.Physiotherapeutic scoliosis specific exercises(PSSE)is the most important method of exercise therapy and has been used extensively in southern and eastern Europe,but the benefits of these exercises for different AIS patients have not been established.This study aims to accurately observe the spine shape and paraspinal muscle activation state when patients performed orthopedic actions.In this way,the orthopedic effect of orthopedic actions on different patients can be judged,and the results can be provided for accurate treatment of AIS by PSSE.MethodsFrom November 2018 to September 2019,18 AIS patients were recruited at the Guangdong Provincial Youth Scoliosis Sports Rehabilitation and Orthotic Devices Engineering Technology Development Centre.Eighteen patients with mild to moderate AIS were divided into two groups,including eight cases with main thoracic curvature with compensatory lumbar curvature(group A),and ten cases with main lumbar curvature with compensatory thoracic curvature(group B).All subjects performed natural standing posture and 7 orthopaedic movements.The spinal morphology and paravertebral muscle electromyography on both sides of the scoliosis were observed with the aid of 3D Ultrasound Scanning and surface electromyography.The root mean square(RMS)values were calculated for 5 seconds to evaluate the degree of paravertebral muscle contraction during exercise.Results(1)The surface EMG results in the natural standing position showed that the RMS of the main thoracic curvature paravertebral muscle in group A was greater on the convex side [18.35(95% CI:16.06-20.64)] than on the concave side [11.84(95%CI:10.26-13.42)],and the compensated lumbar curvature paravertebral muscle on the concave side [35.04(95% CI:30.20-39.88)] than on the convex side [ 12.37(95%CI:9.11-15.64)];whereas in group B,the RMS of the main lumbar curvature paravertebral muscle was greater on the convex side [35.58(95% CI:32.65-38.50)]than on the concave side [15.01(95% CI:9.81-20.21)] and on the concave side of the compensated thoracic curvature [18.03(95% CI:11.42-24.63)] than the convex side[10.66(95%CI:9.42～11.89)].(2)Three-dimensional ultrasound results showed that,compared with the natural standing position,for subjects in Group A,Schroth strengthening exercise,pole standing exercise,muscle-cylinder exercise,left-sided bridge,and left Sidelying left Apical Expansion reduced chest curvature by 12.4°(95% CI:8.5°～16.2°),14.3°(95% CI:9.4° ～19.1 °),11.2°(95% CI :4.4°～18.0°),17.4°(95%CI:12.8 °～21.9°),7.0°(95%CI:0.5°～13.6°),Schroth strengthening exercise,pole standing exercise,muscle-cylinder exercise,left-sided bridge,right Sidelying right Apical Expansion reduced lumbar curvature by 16.8°(95%CI:11.2 ～22.5°),15.9°(95%CI: 9.9°～22.0°),17.5°(95% CI: 9.9°～25.2°),13.3°(95% CI: 9.6°～16.9°),17.8°(95% CI: 11.0°～24.6°),paired p<0.05 for all t-tests.For subjects in group B,Schroth strengthening exercise,pole standing exercise,muscle-cylinder exercise,left-sided bridge and left Sidelying left Apical Expansion reduced the chest curvature by 11.9°(95% CI: 7.8°～16.1°),12.1°(95% CI: 7.2°～17.1°),12.2°(95% CI: 8.7°～15.7°),14.6°(95% CI:10.9°～18.2°),15.3°(95% CI:10.5°～ 20.1°),and Schroth strengthening exercise,pole standing exercise,muscle-cylinder exercise,left-sided bridge,and right Sidelying right Apical Expansion reduced lumbar curvature by 17.9°(95% CI:13.3°～ 22.6°),14.7°(95% CI:8.5°～20.9°),22.3°(95% CI: 15.0°～29.5°),12.3°(95% CI: 8.7°～16.0°)and 6.7°(95% CI: 1.0°～12.4°)respectively,p<0.05 for all paired t-tests.(3)The EMG results showed that,compared to the natural standing position,the left side bridge decreased the RMS ratio of the paravertebral muscles on the convex side of the thoracic bend by 0.90(95% CI: 0.65～1.15)and the left side bridge increased the RMS ratio of the paravertebral muscles on the convex side of the lumbar bend by 0.39(95% CI: 0.15～0.62)for subjects in Group A.Paired t-tests were p<0.05.For group B subjects,Schroth strengthening,pole stance,muscle column,right side bridge,and left side lying with right arm extension increased the RMS ratio of the paravertebral muscles on the convex side of the thoracic curvature by 0.60(95%CI: 0.16～1.05),3.33(95% CI: 2.46～4.20),2.35(95% CI: 1.93～2.77),and 0.92(95% CI:1.92～2.77),respectively.(95% CI: 0.64～1.19),1.15(95% CI: 0.79～1.51),Schroth strengthening,muscle cylinder,right-sided bridge,and left-sided proneural apical expansion reduced the paravertebral muscle electromyographic ratio on the convex side of the lumbar bend by 1.25(95% CI: 0.52～1.98),0.94(95% CI: 0.21 ～1.67),2.40(95% CI: 1.80～3.00)and 1.75(95% CI: 1.27～2.23)respectively,p<0.05 by paired t-test.Conclusion(1)The electromyographic imbalance between the two sides of the spine in patients with AIS in the natural standing position is not related to the segment of lateral convexity,but to the nature of the lateral convexity,i.e.the electromyographic activity of the paravertebral muscles on the convex side of the structural main bend is greater than on the concave side,and the electromyographic activity of the paravertebral muscles on the concave side of the compensatory bend is greater than on the convex side.(2)In patients with hyperbolic AIS with right thoracic convexity and left lumbar convexity,the best corrective manoeuvre for patients with the main thoracic bend with compensatory lumbar bend scoliosis type is the left side bridge;for patients with the main lumbar bend with compensatory thoracic bend scoliosis type the best corrective manoeuvre is Schroth strengthening exercise with muscle cylinders.