Thoracolumbar Orthoses

Thoracolumbar orthoses (TLOs) are used mainly to treat fractures between T10 and L2, because their mobility is not restricted by the ribs, unlike fractures between T2 and T9. Thoracolumbar orthoses (TLOs) digunakan terutama untuk merawat fractures antara T10 dan L2, karena mobilitas mereka tidak dibatasi oleh ribs, tidak seperti fractures antara T2 dan T9. Immobilization at T10-L2 helps to prevent further collapse. Immobilization di T10-L2 membantu mencegah lebih lanjut runtuh.

CASH brace

The cruciform anterior spinal hyperextension (CASH) brace (see Image 8 ) features anterior sternal and pubic pads to produce force opposed by the posterior pad and strap around the thoracolumbar region. Tulang belakang yang cruciform anterior hyperextension (KAS) brace (lihat Gambar 8) fitur anterior sternal dan berkenaan dgn pinggang pads untuk menghasilkan kekuatan yang bertentangan oleh burit pad dan tali di sekitar wilayah thoracolumbar. Sternal and pelvic pads attach to the anterior, metal, cross-shaped bar, which can be bent to reduce excess pressure on the chest and pelvis. Sternal dan panggul pads melampirkan ke depan, logam, salib berbentuk bar, yang bertekad untuk mengurangi kelebihan tekanan pada dada dan panggul. The brace is easy to don and doff, but it is difficult to adjust. Kurawal yang mudah dan mengangkat don, tetapi sulit untuk menyesuaikan. It provides greater breast and axillary pressure relief than does the Jewett hyperextension brace (described below). Memberikan yang lebih besar dan dada yg berhubungan dgn ketiak tekanan timbul dari berapa Jewett hyperextension kurawal (dijelaskan di bawah). Two round upper chest pads can be used instead of the sternal pad to decrease discomfort around the breast area. Dua putaran atas dada pads dapat digunakan sebagai pengganti sternal pad untuk menurunkan kegelisahan di sekitar daerah payudara. The average cost of a CASH brace is approximately $460. Biaya rata-rata dari CASH kurawal adalah sekitar $ 460.

Indications for the use of a CASH brace include the following: Indikasi untuk penggunaan CASH kurawal yang meliputi:

* Flexion immobilization to treat thoracic and lumbar vertebral body fractures Lengkungan immobilization untuk merawat yg berkenaan dgn dada dan pinggang yg berhubung dgn tulang belakang tubuh fractures
* Reduction of kyphosis in patients with osteoporosis Pengurangan kyphosis di pasien dengan osteoporosis

Motion restrictions provided by the CASH brace include the following: Motion larangan yang diberikan oleh KAS brace meliputi:

* Limits flexion and extension at T6-L1 Batas lengkungan dan perpanjangan di T6-L1
* Ineffective in limiting lateral bending and rotation of the upper lumbar spine Sehingga tidak efektif dalam lipatan lateral dan rotasi di atas lumbar tulang belakang

Contraindications to the use of a CASH brace include the following: Contraindications penggunaan alat pembaca CASH brace meliputi:

* Three-column spinal fractures involving anterior, middle, and posterior spinal structures Tiga kolom tulang belakang fractures melibatkan anterior, tengah, dan belakang struktur tulang belakang
* Compression fractures caused by osteoporosis Compression fractures disebabkan oleh osteoporosis


Jewett hyperextension brace

The Jewett hyperextension brace (see Image 7 ) uses a 3-point pressure system with 1 posterior and 2 anterior pads. Jewett yang hyperextension brace (lihat gambar 7) menggunakan 3-point tekanan sistem dengan 1 dan 2 posterior anterior pads. The anterior pads place pressure over the sternum and pubic symphysis. The anterior pads tempat tekanan pada tulang dada dan berkenaan dgn pinggang symphysis. The posterior pad places opposing pressure in the midthoracic region. Burit pad tempat yang menentang tekanan di wilayah midthoracic. The posterior pad keeps the spine in an extended position, and its lightweight design makes it more comfortable than the CASH brace. Burit pad yang menyimpan tulang belakang dalam posisi yang diperpanjang, dan ringan rancangan yang lebih nyaman dibandingkan dengan CASH brace. Pelvic and sternal pads can be adjusted from the lateral axillary bar, where they attach. Panggul dan sternal pads dapat disesuaikan dari sisi yg berhubungan dgn ketiak bar, di mana mereka pasang. The pads can cause discomfort from pressure applied to a small surface area. Pads yang dapat menimbulkan kegelisahan dari tekanan diterapkan ke permukaan daerah kecil. No abdominal support is provided with this device. Tidak ada dukungan abdominal disediakan dengan perangkat ini. When the patient is seated, the sternal pad should be half an inch inferior to the sternal notch, and the pubic pad should be half an inch superior to the pubic symphysis. Apabila pasien duduk, maka harus pad sternal setengah inci rendah ke sternal kumai, dan berkenaan dgn pinggang pad harus setengah inci unggul ke berkenaan dgn pinggang symphysis. The Jewett brace costs approximately $460 and is not custom-molded. Jewett the brace biaya sekitar $ 460 dan tidak custom molded.

Indications for the use of a Jewett brace include the following: Indikasi untuk penggunaan yang Jewett brace meliputi:

* Symptomatic relief of compression fractures not caused by to osteoporosis Merupakan gejala yang timbul compression fractures disebabkan oleh tidak untuk osteoporosis
* Immobilization after surgical stabilization of thoracolumbar fractures Immobilization setelah bedah stabilisasi dari thoracolumbar fractures

Motion restrictions provided by the Jewett brace include the following: Motion larangan yang diberikan oleh Jewett brace meliputi:

* Limits flexion and extension between T6-L1 Lengkung dan perpanjangan batas antara T6-L1
* Ineffective in limiting lateral bending and rotation of the upper lumbar spine Sehingga tidak efektif dalam lipatan lateral dan rotasi di atas lumbar tulang belakang

Contraindications for the use of a Jewett brace include the following: Contraindications untuk penggunaan yang Jewett brace meliputi:

* Three-column spinal fractures involving anterior, middle, and posterior spinal structures Tiga kolom tulang belakang fractures melibatkan anterior, tengah, dan belakang struktur tulang belakang
* Compression fractures above T6, because segmental motion increases above the sternal pad T6 compression fractures di atas, karena berupa ruas gerakan naik di atas sternal pad
* Compression fractures caused by osteoporosis Compression fractures disebabkan oleh osteoporosis

One important consideration in the use of the Jewett brace is that it is more effective than the CASH brace. Salah satu pertimbangan penting dalam menggunakan alat Jewett adalah lebih efektif dibandingkan dengan CASH brace. The Korsain brace is a modification of the Jewett brace, with added abdominal support for increased rigidity. Korsain kurawal yang merupakan modifikasi dari Jewett brace, abdominal ditambahkan dengan dukungan untuk peningkatan kekerasan. The cost of the Korsain brace is similar to that of the Jewett brace. Biaya yang Korsain brace mirip dengan yang Jewett brace.

Indications for the Korsain brace include the following: Indikasi untuk Korsain brace meliputi:

* Symptomatic relief of compression fractures not caused by osteoporosis Merupakan gejala yang timbul compression fractures tidak disebabkan oleh osteoporosis
* Immobilization after surgical stabilization of thoracolumbar fractures Immobilization setelah bedah stabilisasi dari thoracolumbar fractures
* Flexion immobilization to treat thoracic and lumbar vertebral body fractures Lengkungan immobilization untuk merawat yg berkenaan dgn dada dan pinggang yg berhubung dgn tulang belakang tubuh fractures


Motion restrictions and contraindications associated with the Korsain brace are similar to those of the Jewett brace. Motion contraindications dan pembatasan yang terkait dengan Korsain brace mirip dengan mereka yang Jewett brace.(Lihat Jewett brace gerakan larangan.)

Knight-Taylor brace Knight-Taylor brace

The Knight-Taylor brace features a corset-type front with lateral and posterior uprights and shoulder straps to help reduce lateral bending, flexion, and extension. Knight-yang memiliki Taylor brace korset depan dengan jenis-lateral dan posterior uprights dan bahu straps untuk membantu mengurangi lateral lipatan, lengkung, dan ekstensi. The shoulder straps may cause discomfort in some patients. Tersinggung straps dapat menimbulkan kegelisahan di beberapa pasien. The brace can be prefabricated and made with polyvinyl chloride or aluminum. Kurawal yang dapat dibuat dengan prafabrik dan polyvinyl chloride atau aluminium. The posterior portion of the brace has added cross supports below the inferior angle of the scapula and features a pelvic band fitted at the sacrococcygeal junction. Di bagian belakang penahan telah menambahkan mendukung lintas di bawah rendah dari sudut tulang belikat dan dilengkapi dengan panggul band dipasang di persimpangan sacrococcygeal. The anterior corset is made of canvas and provides intracavitary pressure. Korset anterior yang dibuat dari kanvas dan memberikan tekanan intracavitary. The anterior corset is laced to the lateral uprights. The anterior korset adalah laced ke lateral uprights. The average cost of the Knight-Taylor brace is approximately $540. Biaya rata-rata dari Knight-Taylor brace adalah sekitar $ 540.

Use of the brace is indicated when flexion immobilization is required to treat thoracic and lumbar vertebral body fractures. Menggunakan alat ditunjukkan ketika lengkung immobilization diperlukan untuk merawat yg berkenaan dgn dada dan pinggang yg berhubung dgn tulang belakang tubuh fractures.

Motion restrictions associated with the Knight-Taylor brace include the following: Motion larangan yang terkait dengan Knight-Taylor brace meliputi:

* Limits flexion, extension, and lateral bending
* Poor rotation control

Thoracolumbosacral orthosis

A custom-molded plastic body jacket, or thoracolumbosacral orthosis (TLSO), is fabricated from polypropylene or plastic. It offers the best control in all planes of motion and increases intracavitary pressure. This orthosis has a lightweight design and is easy to don and doff. The material is easy to clean and comfortable to wear. This brace sometimes is referred to as the clamshell. 7

The TLSO provides efficient force transmission, with pressure distributed over a wide surface area; it is therefore ideal for use in patients with neurologic injuries. The brace may have a tendency to ride up on the patient when he/she is in a supine position. Plastic retains heat, but an undershirt will help to absorb perspiration and protect the skin. Frequent checks to ensure proper fit will aid in preventing pressure ulcers. Velcro straps are used to tighten the brace. The average cost of a TLSO made with polyform material is $1250-$1700.

Indications for the TLSO include the following:

* Immobilization for compression fractures from osteoporosis
* Immobilization after surgical stabilization for spinal fractures
* Bracing for idiopathic scoliosis
* Immobilization for unstable spinal disorders at T3-L3

Motion restrictions for the TLSO include the following:

* Limits sidebending
* Limits flexion and extension
* Limits rotation to some extent

Clinical information on the custom-molded TLSO suggests that it is more effective in the prevention of idiopathic scoliosis curve progression than are the Milwaukee brace and the Charleston bending brace (described below). A retrospective cohort study found that the mean curve progression with a TLSO was less than 2°, while curve progression with the Charleston and Milwaukee braces was greater than 6°. 8 According to the report, fewer than 18% of patients treated with a TLSO brace required surgery for scoliosis, compared with 23% of patients treated with a Milwaukee brace and 31% of patients treated with a Charleston brace.