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Master Thesis

Indication du port mi-temps nocturne pour le corset de Cheneau-Toulouse Munster dans la scoliose idiopathique juvénile et de l’adolescent

Abstract : 
The results of 12h nighttime Cheneau-Toulouse-Munster (CTM) brace wear on late onset idiopathic scoliosis have not been described.
OBJECTIVE: 
Main objective was to analyze its efficiency for Juvenile and Adolescent Idiopathic Scoliosis during puberty growth. Secondary objectives were to find influencing factors for brace success in order to progress in its indication.

METHOD: 
Pool of 150 consecutive patients treated between 2006 and 2017 was enrolled. Inclusion criteria were evolutive scoliosis defined by Cobb Angle Progression (CAP) > 5° between two successive roentgenograms or cobb Angle >30°, 12h nighttime CTM brace-wear during puberty growth, Risser stages 0, 1 or 2 at the time of the prescription, complete radiological and clinical control 1 year after weaning. Success was defined by no surgery, no CAP>5° for main and secondary curves. Subgroups analyses were performed using mLenke classification and Risser test. Lumbar and thoracolumbar scoliosis were grouped together in Main Lumbar curves. Most of the clinical and radiological predictive factors known were analyzed.

RESULTS : Overall success was 58.7%, with 48% for Main Thoracic Curves and 74% for Main Lumbar Curves (p=0.002).
At Risser stage 0, efficacy was 46.8% whereas it was 69% and 74.2% for Risser stage 1 and 2 (p=0.009). Success was associated with the increase of age, Height, Gibbosity, Compliance and Cobb Angle reduction in-brace. Conversely the increase of Frontal and Sagittal C7 Tilt, Cobb Angle, and Frontal Wedging were correlated to failure. An initial main curve Cobb Angle of 27° was the limit for its indication. After logistic regression, Thoracic Gibbosity and Standing Height were the only independent predictive factors with respectively OR=0.88 IC95%[0.79 ;0.96] p=0.00864 and OR=1.11 IC95%[1.02 ;1.22] p=0.01752.

CONCLUSION
: 12h Nighttime CTM brace-wear finds its best indication for Main Lumbar curves. For this curve pattern, the best results were observed from Risser Stage 1 when frontal C7 Tilt <1cm with 70% of Cobb Angle reduction In-brace. For MT curves the indication should be more restricted. Good results were found from Risser Stage 2, with Cobb Angle < 24° having 50% of Cobb Angle reduction In-brace.
Document type :
Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02339763
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Submitted on : Wednesday, October 30, 2019 - 3:21:48 PM
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Gautier de Chelle. Indication du port mi-temps nocturne pour le corset de Cheneau-Toulouse Munster dans la scoliose idiopathique juvénile et de l’adolescent. Médecine humaine et pathologie. 2018. ⟨dumas-02339763⟩

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