Effectiveness of braces designed using computer-aided design and manufacturing (CAD/CAM) and finite element simulation compared to CAD/CAM only for the conservative treatment of adolescent idiopathic scoliosis: a prospective randomized controlled trial
Effectiveness of braces designed using computer-aided design and manufacturing (CAD/CAM) and finite element simulation compared to CAD/CAM only for the conservative treatment of adolescent idiopathic scoliosis: a prospective randomized controlled trial
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DOI：
10.1007/s00586-016-4434-3
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发表时间：
2016-10-01
影响因子：
2.8
通讯作者：
Labelle, Hubert
中科院分区：
文献类型：
--
作者：
Cobetto, N.;Aubin, C. E.;Labelle, Hubert
采用随机盲法和对照研究设计，对使用CAD/CAM和FEM设计的支具与仅使用CAD/CAM设计的支具保守治疗AIS的即刻支具内效果进行临床评估。对于19名患者（对照组），使用患者躯干扫描和传统CAD/CAM方法（CtrlBrace）设计支具。对于其他21名患者（试验组），使用有限元建模（FEM）和脊柱、肋骨架和骨盆的3D重建（NewBrace）额外设计支具。模拟并迭代优化NewBrace设计，以最大限度地提高矫正度，最小化接触表面和材料。两组患者的年龄、性别、体重、身高、弯曲类型和严重程度相当。脊柱侧凸研究协会的标准化标准的支具。对于对照组，支撑前主胸椎（MT）和腰椎（L）弯曲的平均Cobb角分别为27 A度和28 A度，而试验组为33 A度和28 A度。CtrlBraces分别将MT和L曲线减少了8A度（29%）和10A度（40%），而NewBraces分别减少了14 A度（43%）和13 A度（46%），模拟的差异低于5A度。新型托槽比对照托槽薄50%，覆盖面少20%。在第一次即刻内托槽评估中，采用CAD/CAM和3D FEM模拟设计的托槽比标准CAD/CAM TLSO更有效，更轻。这些结果表明，AIS中支撑的长期效果可以使用这种新的支撑制造平台来改善。
Clinical assessment of immediate in-brace effect of braces designed using CAD/CAM and FEM vs. only CAD/CAM for conservative treatment of AIS, using a randomized blinded and controlled study design.Forty AIS patients were prospectively recruited and randomized into two groups. For 19 patients (control group), the brace was designed using a scan of patient's torso and a conventional CAD/CAM approach (CtrlBrace). For the 21 other patients (test group), the brace was additionally designed using finite element modeling (FEM) and 3D reconstructions of spine, rib cage and pelvis (NewBrace). The NewBrace design was simulated and iteratively optimized to maximize the correction and minimize the contact surface and material.Both groups had comparable age, sex, weight, height, curve type and severity. Scoliosis Research Society standardized criteria for bracing were followed. Average Cobb angle prior to bracing was 27A degrees and 28A degrees for main thoracic (MT) and lumbar (L) curves, respectively, for the control group, while it was 33A degrees and 28A degrees for the test group. CtrlBraces reduced MT and L curves by 8A degrees (29 %) and 10A degrees (40 %), respectively, compared to 14A degrees (43 %) and 13A degrees (46 %) for NewBraces, which were simulated with a difference inferior to 5A degrees. NewBraces were 50 % thinner and had 20 % less covering surface than CtrlBraces.Braces designed with CAD/CAM and 3D FEM simulation were more efficient and lighter than standard CAD/CAM TLSO's at first immediate in-brace evaluation. These results suggest that long-term effect of bracing in AIS may be improved using this new platform for brace fabrication.NCT02285621.