青少年特发性脊柱侧凸胸椎形态学MRI临床价值

[目的]观察青少年特发性脊柱侧凸胸椎形态学的MRI测量及其临床应用价值。[方法]研究对象为2018年1月～2018年12月期间本院接诊的胸椎侧凸患者共30例,根据Cobb角大小分别设为轻度组和中度组;另选取同期体检健康青少年15名设为正常组。为减少干扰因素。采用1.5T磁共振扫描仪扫描研究对象全脊柱矢状面,重建脊柱矢状面图像并测量各个胸椎前后壁与棘突间高度,于横截面对椎体横径长度进行测量,对比分析三组结果。[结果]轻度组和中度组患者椎体前后高度、宽度由T_(1～12)逐渐增加,呈线性分布,且两组椎体高度普遍大于正常组;轻度组和中度组患者椎体前后高度比值、高度横径比值均大于正常组。两组患者胸椎侧凸顶椎区T_(6～9)椎体前方高度、脊椎前后高度比值以及高度横径比值明显大于正常组,差异均存在统计学意义(P0.05)。[结论]青少年特发性脊柱侧凸女性患者胸椎形态学特点显著,与正常胸椎相比更加瘦长,胸椎顶椎区呈现出脊柱生长模式异常,MRI测量在临床诊断中具有重要价值。     

青少年特发性胸椎侧凸患者胸椎横断面上的发育特征及其意义

目的:探讨青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者青春期胸椎横断面上的发育特征及其意义。方法:收集30例AIS患者(A组)和30例相应年龄无脊柱畸形的青少年(N组)的胸椎CT片,每组根据研究对象年龄组成再分为两个亚组,每个亚组均为15例。低龄AIS组(A1组)和高龄AIS组(A2组)平均年龄分别为10.6岁和16.8岁;低龄对照组(N1组)和高龄对照组(N2组)平均年龄分别为10.8岁和17.3岁。在AIS患者侧凸区(T5～T12)及对照组相应椎体横断面CT上分别测量椎体的横径和纵径、椎管的横径和纵径、椎弓根长度和直径、椎板长度和直径。对相同年龄段的AIS和对照组、同一组内的两个亚组以及每个亚组患者左右侧(凹凸侧)的各个相应参数进行比较分析。结果:每组内高龄亚组的椎体均较低龄组增大,但同年龄层的两亚组无明显差异;N组两个亚组间椎管大小无明显差异,而A2组椎管横径明显大于A1组以及N2组。高龄亚组的椎弓根长度、直径及椎板长度和相应低龄亚组相比均无明显差异,但A2组凸侧以及N2组的椎板直径明显大于相应低年龄组。N组内左右侧后弓测量参数无明显差异,A1组和A2组凹侧椎弓根较凸侧长,但差异无显著性。同年龄层两亚组的椎弓根、椎板的直径、长度均无明显差异。结论:在青春期,AIS患者脊椎后弓可能存在膜内成骨异常,而神经中央软骨对AIS脊椎发育没有明显的影响。     

NF-1伴非萎缩型胸椎侧凸与胸弯型AIS及正常青少年矢状面形态的比较研究

[目的]探讨青少年I型神经纤维瘤病(neurofibromatosis type 1,NF-1)伴非萎缩型胸椎侧凸与青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者及正常青少年矢状面脊柱、骨盆形态的差异。[方法]回顾分析2001年1月～2012年12月期间在本院手术治疗且侧凸Cobb角<70°的15例NF-1伴非萎缩型胸椎侧凸青少年患者(NF-1组)。选择与NF-1患者年龄、性别、弯型以及侧凸Cobb角匹配的15例AIS患者(AIS组)进行比较,并以年龄、性别匹配的30名正常青少年作对照(control group,CTL组)。全部研究对象均拍摄站立位全脊柱正侧位X线片并测量以下参数评估矢状面的形态:胸椎后凸角、胸腰段交界角、腰椎前凸角、骨盆入射角、骨盆倾斜角、骶骨倾斜角、脊柱倾斜度和脊柱骶骨角。采用单因素方差分析三组矢状面各参数的异同。[结果]15例NF-1患者中TK不足者及后凸畸形各1例,其余13例均为正常范围(10°～40°),NF-1组平均TK为(25.6±7.6)°,明显大于AIS组的(16.5±5.4)°(P<0.05);NF-1组LL为(-53.8±6.4)°,AIS为(-47.8±4.2)°,两者有显著性差异(P<0.05)。NF-1组与CTL组比较显示各参数均无统计学差异(P>0.05)。[结论]NF-1伴非萎缩型胸椎侧凸患者矢状面形态与正常青少年无明显差异:没有明显的胸椎后凸畸形,也无AIS患者明显胸椎后凸不足表现,提示此类患者术后远期矢状面上的并发症可能与术前的矢状面形态无明显相关性。     

青少年特发性脊柱侧凸与神经源性脊柱侧凸患者椎体和椎间盘的楔形变及其临床意义

目的:观察青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)与神经源性脊柱侧凸(neurological scoliosis,NS)患者的椎体和椎间盘的楔形变情况,探讨其临床意义。方法:对35例AIS患者和31例NS患者(继发于Chiari畸形)应用Cobb法测量胸椎和腰椎每个侧凸范围内顶椎及其上、下各两个椎体和相应椎间盘的楔变角,计算其占整个侧凸角度的百分比(楔变率),得出侧凸范围内5个椎体的平均楔变率和4个椎间盘的平均楔变率。应用SPSS10.0统计软件进行统计分析,组间比较采用单因素方差分析。结果:相同病因、相同侧凸部位、相同Cobb角分组情况下,椎体与椎间盘的楔变率存在显著性差异(P0.05)。相同病因、相同侧凸部位,Cobb角60°组的椎体楔变率和椎间盘楔变率与Cobb角≥60°组比较均无显著性差异(P0.05)。相同侧凸部位、相同Cobb角分组,AIS组椎体和椎间盘的楔变率分别与NS组比较均无显著性差异(P0.05)。结论:AIS与NS患者椎体与椎间盘的相对楔形变方式相同,AIS患者的椎体楔形变可能是继发的。在治疗脊柱侧凸时,即便是较小角度的脊柱侧凸,都应该考虑到其存在椎体和椎间盘的楔形变。     

前路胸腔镜下青少年特发性胸椎侧凸矫形的初步临床结果

目的回顾胸腔镜下青少年特发性脊柱侧凸（adolecent idiopathic scoliosis,AIS）前路矫形的初步临床疗效。方法 2007年8月~2008年11月行胸腔镜下前路矫形患者8例,均为女性Lenkel A-型AIS患者,平均年龄为13.8岁。对手术前后及末次随访时的胸椎侧凸Cobb角、腰椎侧凸Cobb角、顶椎中点与C7中点垂线或骶骨平分线垂直距离（apical vertebral translation,AVT）、顶椎旋转角、胸椎后凸Cobb角及双肩高度差进行分析。结果所有患者术后随访3~12个月,胸椎侧凸Cobb角平均改善率为71%、矫形丢失率为6%;腰椎侧凸Cobb角平均改善率为60%、矫形丢失率为6%;AVT改善率为73%,丢失率为6%。所有患者顶椎旋转角度均无改善;胸椎后凸Cobb角无改变。双肩高度差除1例患者随访时丢失50%,其余改善率均为100%。结论柔韧度好的Lenkel A-型AIS行胸腔镜下前路矫形可获得良好的冠状面矫形,但矢状面矫形及椎体去旋转效果不佳,长期疗效有待继续观察。     

后路间隔置钉治疗Lenke 5型青少年特发性脊柱侧凸

目的 探讨后路矫形侧间隔置钉、支撑侧每隔1或2个节段置钉治疗Lenke 5型青少年特发性脊柱侧凸(AIS)的疗效.方法 回顾性分析2001年6月—2012年12月本院收治的20例Lenke 5型AIS患者的影像学资料.术前、术后1周及末次随访时测量胸椎及腰椎Cobb角、冠状面平衡、矢状面平衡、双肩高度差、顶椎偏移(AV...     

Chiari畸形伴胸椎侧凸患者两侧肋骨长度差异及其与剃刀背畸形的相关性

目的:评估Chiari畸形伴胸椎侧凸患者两侧肋骨长度的差异及其与剃刀背畸形的相关性,探讨两侧肋骨生长的差异性是否为继发性改变。方法:选取Chiari畸形伴脊柱侧凸(scoliosis secondary to Chiarimalformation,SSCM)患者38例(SSCM组),年龄9~17岁(12.3±3.6岁),身高155.4±10.8cm,Cobb角26°~108°(44.9°±23.5°);顶椎位于T7~T9。另选58例青少年特发性脊柱侧凸(AIS)患者作为对照,均为右胸弯,年龄10~18岁(13.7±2.6岁),身高157.6±11.5cm,Cobb角28°~102°(43.9°±17.2°),顶椎位于T7~T9。剃刀背畸形角(ribhump,RH)均使用Scoliometer测量,采用螺旋CT三维重建的方法(volume viewer workstation)测量所有患者凹凸侧12对肋骨的长度,比较两组患者顶椎区、上下端椎及非侧凸区两侧肋骨的长度,分析顶椎区肋骨的对称性及其与Cobb角和RH的相关性。结果:SSCM组患者顶椎区(顶椎、顶椎上一椎体及顶椎下一椎体)凹侧肋骨长度显著大于凸侧(P<0.01),而上下端椎及非侧凸区两侧肋骨长度无显著性差异(P>0.05),RH为12.7°±4.0°;AIS组患者顶椎区(顶椎上一椎体、顶椎及顶椎下一椎体)凹侧肋骨长度也显著大于凸侧(P<0.01),其程度与Chiari畸形组无显著性差异(P>0.05),RH为11.9°±3.5°。顶椎区肋骨的不对称性与Cobb角大小呈显著性正相关关系(SSCM组:r=0.562,P=0.001;AIS组:r=0.463,P=0.003);与RH亦呈显著相关性(SSCM组:r=0.373,P=0.01;AIS组:r=0.328,P=0.02)。结论:SSCM患者主胸弯顶椎区两侧肋骨长度不对称,且不对称程度和剃刀背畸形相关,其不对称性特征与AIS患者一致,其可能是脊柱侧凸在生长期发病后的继发性改变。     

青少年特发性脊柱侧凸的选择性融合

手术治疗青少年特发性脊柱侧凸（adolescentidiopathicscoliosis,AIS）的目的是矫正脊柱畸形、稳定侧凸、重建或保持脊柱的平衡。临床上通常根据冠状面的Cobb角、骨骼发育情况、矢状面变化、椎体旋转程度以及侧凸的自然史来判断是否需手术治疗。一般认为,对处于生长期、Cobb角＞５０°、非手术治疗无效、疼痛、胸椎前凸及伴有明显外观畸形的患儿应选择手术治疗。自１９１４年首例采用脊椎融合术治疗侧凸以来,确定AIS手术合适的融合节段一直是众多学者争论的焦点;AIS手术是否成功有赖于对融合节段的正确选择,选择不当易引起脊柱侧…     

脊柱侧凸椎旁肌肌纤维群化现象的研究

目的对椎旁肌肌纤维群化现象与青少年特发性脊柱侧凸(adolescent id iopath ic scoliosis,AIS)的发生、发展之间的关系进行研究。方法本实验分三组,AIS组:20例,平均年龄15.3岁,平均Cobb角56.8°。顶椎位于T7~12。其中Cobb角>50°11例,Cobb角≤50°9例。先天性脊柱侧凸(congen ital scoliosis,CS)组:11例,平均年龄13.9岁,平均Cobb角66.7,°顶椎位于T7~12。对照组:取10例非脊柱侧凸病例作为对照。AIS和CS组取顶椎区两侧椎旁肌,对照组取非病变区两侧椎旁肌行病理分析。结果AIS和CS组均存在凸侧椎旁肌Ⅰ型肌纤维群化现象,对照组未观察到肌纤维群化现象。CS组的肌纤维群化程度显著高于AIS组(P<0.05),AIS组中Cobb角>50°的患者肌纤维群化程度显著高于Cobb角≤50°的患者(P<0.05)。结论脊柱侧凸凸侧椎旁肌Ⅰ型肌纤维群化现象系继发性改变,且与侧凸的严重性呈正相关。     

青少年Chiari畸形Ⅰ型合并脊髓空洞患者颈椎管矢状面锥度研究

目的:分析青少年Chiari畸形Ⅰ型(Chiari malformation type Ⅰ,CMⅠ)合并脊髓空洞患者颈椎管矢状面锥度大小.方法:2007年10月～2013年10月在我科入院治疗且以胸椎侧凸为主首诊的青少年CM Ⅰ合并脊髓空洞患者共61例,男28例,女33例,年龄10～18岁,平均13.7±2.1岁,胸椎侧凸Cobb角42°～78°,平均51.5°±16.5°;以胸椎侧凸为主的AIS患者共75例,男35例,女40例,年龄11～18岁,平均14.8±1.8岁,胸椎侧凸Cobb角40°～69°,平均47.4°±15.3°.选取正常青少年志愿者60例作为正常对照组,男28例,女32例,年龄11～18岁,平均15.6±2.6岁.3组研究对象年龄与性别分布、CM Ⅰ组与AIS组胸椎侧凸Cobb角均无统计学差异(P＞0.05).在MR T2加权像正中矢状位扫描层面上测量颈椎管前后径,绘制散点图及趋势线,趋势线的斜率计为C1～C7椎管矢状面锥度.应用方差分析,比较3组研究对象颈椎管矢状面锥度的大小,并分析不同年龄分组(≤14岁与＞14岁)和性别分组间颈椎管矢状面锥度的差异.结果:CM Ⅰ组、AIS组和正常对照组颈椎管平均矢状面锥度分别为-0.58±0.42mm/节段(-1.38～0.98mm/节段),-0.28±0.15mm/节段(-0.02～-0.70mm/节段)和-0.29±0.28mm/节段(-0.79～0.33mm/节段),CM Ⅰ组颈椎管矢状面锥度显著大于AIS组(P＜0.05)和止常对照组(P＜0.05),而AIS组与正常对照组比较无统计学差异(P＞0.05).3组颈椎管矢状面锥度在年龄、性别分组间均无统计学差异(P＞0.05).结论:与AIS患者和正常青少年相比,青少年CM Ⅰ合并脊髓空洞患者具有较大的颈椎管矢状面锥度,表明其颈椎管矢状面发育存在异常.     

The position of the aorta relative to the spine: a comparison of patients with and without idiopathic scoliosis

BACKGROUND: There is little information documenting the relationship of the aorta to the thoracic scoliotic spine. Recent studies have suggested that the ends of screws placed during an anterior spinal arthrodesis, and pedicle screws used for the treatment of right thoracic scoliosis, may be in proximity to the aorta. The purpose of this study was to analyze the anatomical relationship between the aorta and the spine in a comparison of patients with idiopathic right thoracic scoliosis and patients with a normal spine. METHODS: Thirty-six patients with adolescent idiopathic scoliosis with a right thoracic curve and forty-three with a normal straight spine were studied. Radiographs were analyzed to determine the Cobb angle, the apex of the curve, and the apical vertebral rotation for the patients with scoliosis. Axial magnetic resonance images from the fourth thoracic vertebra to the third lumbar vertebra at the midvertebral body level were used to measure the distance from the aorta to the closest point of the vertebral body cortex, the distance from the posterior edge of the aorta to the spinal canal, and the aorta-vertebral angle. RESULTS: No differences were found between the groups with respect to age or sex distribution. For the scoliosis and normal groups, boys had greater average vertebral body width and depth for all levels than did girls (p < 0.05). For the scoliosis group, the most common apical vertebra was the eighth thoracic vertebra, the average coronal curve measurement was 55.2 degrees, and the average apical rotation was 17.3 degrees. The average distance from the aortic wall to the vertebral body cortex at the apex of the curve was greater in the patients with scoliosis (4.0 mm) than at similar levels in the normal group (2.5 mm) (p < 0.05). The distance from the posterior aspect of the aorta to the anterior aspect of the spinal canal was less in the scoliosis group (11.1 mm) than in the normal group (19.2 mm) for the fifth to the twelfth thoracic level (p < 0.05). The aorta was positioned more laterally and posteriorly adjacent to the vertebral body at the fifth to the twelfth thoracic level in patients with scoliosis compared with that in normal patients as reflected in a smaller aorta-vertebral angle (p < 0.05). With an increasing coronal Cobb angle in the thoracic curve and apical vertebral rotation, the aorta was positioned more laterally and posteriorly (p < 0.05). CONCLUSION: In patients with right thoracic idiopathic scoliosis, the aorta is positioned more laterally and posteriorly relative to the vertebral body compared with that in patients without spinal deformity.     

Sagittal configuration of the spine and growth of the posterior elements in early scoliosis

The early changes of the sagittal alignment of the spine and the asymmetry between the posterior and anterior elements were determined on the basis of 134 lateral and 167 anteroposterior radiographs obtained from a control group and from patients with early scoliosis. The radiographs were allocated into four groups according to the degree of the Cobb angle. In thoracic curves with a Cobb angle of more than 8°, the kyphosis and the vertebral sagittal wedge angle decreased in comparison with the control group. The sagittal-wedge angle of the disc did not change significantly with increasing Cobb angle. The pedicle height in relation to the vertebral height, considered to represent the growth of the posterior element in relation to the growth of the anterior element, was not significantly different in the scoliotic groups as compared with the control group. The results indicate that changes of the sagittal configuration of the spine occur early in idiopathic scoliosis and that they are associated with disturbed growth of the vertebral body but not of the posterior elements. These findings seem to reflect a simulataneous deformation in the coronal and sagittal planes rather than a single growth disturbance in any specific plane.     

Relative anterior spinal overgrowth in adolescent idiopathic scoliosis. Results of disproportionate endochondral-membranous bone growth

We undertook a comparative study of magnetic resonance imaging (MRI) vertebral morphometry of thoracic vertebrae of girls with adolescent idiopathic thoracic scoliosis (AIS) and age and gender-matched normal subjects, in order to investigate abnormal differential growth of the anterior and posterior elements of the thoracic vertebrae in patients with scoliosis. Previous studies have suggested that disproportionate growth of the anterior and posterior columns may contribute to the development of AIS. Whole spine MRI was undertaken on 83 girls with AIS between the age of 12 and 14 years, and Cobb's angles of between 20 degrees and 90 degrees, and 22 age-matched controls. Multiple measurements of each thoracic vertebra were obtained from the best sagittal and axial MRI cuts. Compared with the controls, the scoliotic spines had longer vertebral bodies between T1 and T12 in the anterior column and shorter pedicles with a larger interpedicular distance in the posterior column. The differential growth between the anterior and the posterior elements of each thoracic vertebra in the patients with AIS was significantly different from that in the controls (p < 0.01). There was also a significant positive correlation between the scoliosis severity score and the ratio of differential growth between the anterior and posterior columns for each thoracic vertebra (p < 0.01). Compared with age-matched controls, the longitudinal growth of the vertebral bodies in patients with AIS is disproportionate and faster and mainly occurs by endochondral ossification. In contrast, the circumferential growth by membranous ossification is slower in both the vertebral bodies and pedicles.     

Morphometric analysis of thoracic and lumbar vertebrae in idiopathic scoliosis

STUDY DESIGN: Prospective study on the morphometry of 337 pedicles in 29 patients with idiopathic scoliosis. OBJECTIVES: To analyze by means of computed tomographic scans the vertebral morphometry in idiopathic scoliosis treated by pedicle screw instrumentation. SUMMARY OF BACKGROUND DATA: Although several studies exist on the vertebrae's morphometry in normal spines, little is known concerning the morphometry of scoliotic vertebrae. METHODS: The pedicles' morphometry between T5 and L4 was analyzed by computed tomographic scans in 29 surgically treated patients with idiopathic right thoracic scoliosis. Measurements included chord length, endosteal transverse pedicle width, transverse pedicle angle, and pedicle length. RESULTS: The endosteal transverse pedicle width was significantly smaller (P < 0.05) on the concavity in the apical region of the thoracic spine and measured between 2.5 and 4.2 mm in the middle thoracic spine (T5-T9) and between 4.2 and 5.9 mm in the lower thoracic spine (T10-T12). In the lumbar spine, the width varied between 4.8 and 9.5 mm without significant differences between the concave and convex sides (P > 0.05). The chord length was shortest at T5, measuring 37 mm and increased gradually to 50 mm at L3 with significantly larger dimensions in male patients and on the concavity of the apical region in the thoracic spine (P < 0.05). The pedicle length varied minimally, with a range of between 20 and 22 mm, and was relatively consistent throughout the thoracic and lumbar spine. The transverse pedicle angle varied between 6 degrees in the lower thoracic spine and 12 degrees in the upper thoracic and lower lumbar spine. CONCLUSION: The morphometry in scoliotic vertebrae is substantially different from that of vertebrae in normal spines, with an asymmetrical intravertebral deformity shown in scoliotic vertebrae. Pedicle screw instrumentation on the concavity in the apical region of thoracic curves appears critical because of the small endosteal pedicle width.     

Structural vertebral changes in the horizontal plane in idiopathic scoliosis and the long-term corrective effect of spine instrumentation

Summary The rotation and structural changes of the apex vertebra in the horizontal plane as well as of the thoracic cage deformity were quantified by measurements on computed tomography (CT) scans from patients with right convex thoracic idiopathic scoliosis (IS). The CT scans were obtained from 12 patients with moderate scoliosis (mean Cobb angle 25.8°, r 13°–30°) and from 33 with severe scoliosis (mean Cobb angle 46.2°, r 35°–71°). In addition, CT scans of thoracic vertebrae from 15 patients without scoliosis were used as reference material. Ten of the scoliotic cases had had Cotrel-Dubousset instrumentation (CDI) and posterior fusion and had entered a longitudinal study on the effect of operative correction on the re-modelling of the apical vertebra. An increasingly asymmetrical vertebral body, transverse process angle, pedicle width and canal width were found in the groups with scoliosis as compared with the reference material. Vertebral rotation and rib hump index were significantly larger in patients with early and advanced scoliosis than in normal subjects. The modelling angle of the vertebral body, the transverse process angle index and the vertebral rotation in relation to the middle axis of the thoracic cage were significantly greater in patients with severe than with moderate scoliosis. The results of this longitudinal study suggest that the structural changes of the apical vertebra regress 2 years or more after CD instrumentation.     

Idiopathic scoliosis: the relation between the vertebral canal and the vertebral bodies

STUDY DESIGN: The axial length of the vertebral canal and the anterior aspect of the vertebrae were measured in 36 skeletons, 15 with probable idiopathic scoliosis. OBJECTIVES: To compare the discrepancy in length of the vertebral canal and the anterior spinal column in skeletons having probable idiopathic scoliosis with the degree of deformity. SUMMARY AND BACKGROUND DATA: In idiopathic scoliosis, the vertebral bodies rotate toward the convexity of the curve, whereas the vertebral canal tends to retain a midline position. The vertebral canal therefore will be relatively short. The degree of shortening has not been described previously, nor its relation with the degree of deformity. METHODS: The axial length of the vertebral canal and the anterior aspect of the vertebral bodies were measured in 36 skeletons: 8 with normal spines, 13 with kyphosis, and 15 with probable idiopathic scoliosis. The relative shortening in the scoliotic spines was correlated with the Cobb angle and the degree of rotation. RESULTS: No significant difference in length was found between the vertebral canal and the vertebral column in the normal spines. The kyphotic spines had canals significantly longer than the vertebral length (P<0.025). All but one of the scoliotic spines had short vertebral canals (P<0.01). The degree of discrepancy was related to the Cobb angle (r = -0.50; P< 0.05), and particularly to the degree of rotation (r = -0.88; P< 0.001). CONCLUSIONS: The findings have surgical and etiologic implications. The results are consistent with a conceivable hypothesis that in some patients with idiopathic scoliosis, there may be impaired growth in the length of the spinal cord, the posterior elements are tethered, and as the vertebral bodies continue to grow, they become lordotic and then rotate.     

Observations on the growth of the adolescent spine

We have measured the increase in height and width of the vertebral bodies and expressed them as percentages of the total growth in children aged 10 to 17 years. The first group, 10 boys and 10 girls, each had a single thoracic adolescent idiopathic scoliosis while the second group, 10 girls, each had a single lumbar adolescent idiopathic scoliosis. No significant differences were found between the growth increments and spinal dimensions of the vertebral bodies involved in the scoliotic curve and those vertebrae outside the curve in the same patient. The vertebrae were more slender in girls than in boys.     

Cobb angle versus spinous process angle in adolescent idiopathic scoliosis. The relationship of the anterior and posterior deformities

The standard clinical measurement for adolescent idiopathic scoliosis is the Cobb angle, measured from the end-plates of the end vertebral bodies in a standing radiograph. This measurement of anterior column structures describes the anterior spinal deformity. The posterior spinal deformity can be described by the "spinous process angle," measured from a curve joining the tips of the spinous processes. A computer model, and a radiographic study of Cobb angle, spinous process angle and vertebral rotation show that adolescent idiopathic scoliosis results in larger angulations of the anterior elements than posterior elements. This helps to explain some of the inherent limitations of posterior instrumentation, including Cotrel-Dubousset instrumentation, and of noninvasive posterior surface measurement systems.     

Segmental vertebral rotation in early scoliosis

Summary In order to investigate the development of the vertebral axial rotation in patients with early scoliosis, the vertebral rotation angle (VRA) was quantified on the basis of 132 anteroposterior radiographs obtained from patients with diagnosed or suspected scoliosis. The rotation was measured in the apical vertebra and in the two suprajacent and two subjacent vertebrae. The radiographic material was divided into a control reference group and three scoliotic groups with varying Cobb angle from 4° up to 30°. In the reference group a slight vertebral rotation was significantly more often seen to the right. In the scoliotic groups, the rotation was most pronounced in the apical segments. The mean VRA toward the convex side was significantly increased in the vertebrae just suprajacent to the apex in curves with a Cobb angle of 8°–15° and in the cranial four vetebrae in curves with a Cobb angle of 16°–30°. Atypical vertebral rotation to the opposite side of the major curve was observed in 12.8% of the cases. There was a significant positive correlation between the VRA and the Cobb angle. These results show that a slight VRA to the right is a common feature in the normal spine, and that the VRA increases with progressive lateral deviation of the spine. It is concluded that the coronal plane deformity in early idiopathic scoliosis is accompanied and probably coupled to vertebral rotation in the horizontal plane.     

后路凸凹侧双棒同步矫形在青少年特发性脊柱侧凸矫治中的应用

目的 探讨后路凸凹双侧矫形棒同步矫形技术在青少年特发性脊柱侧凸(AIS)外科矫治中的应用价值及疗效.方法 2006年2月至2008年8月采用后路凸凹侧双棒同步矫形技术治疗AIS 48例,其中男性16例,女性32例;年龄11～24岁,平均17.1岁.Lenke分型:Ⅰ型17例、Ⅱ型9例、Ⅲ型14例、Ⅳ型8例.行选择性胸弯融合27例,非选择性融合21例.观测手术前后冠状Cobb角、顶椎偏距、顶椎旋转、躯干偏移、尾端融合椎旋转、倾斜角、椎间角、矢状面平衡变化,评价侧凸矫正效果及脊柱平衡状况.结果 术后随访12～27个月,平均15.1个月.选择性融合患者末次随访胸、腰弯Cobb角平均矫正率分别为(76±11)%、(72±9)%.非选择性融合术患者末次随访胸、腰弯Cobb角平均矫正率分别为(74±15)%、(69±9)%.所有病例尾侧保留脊柱活动节段平均4.4个.1例因术中定位错误发生近端交界性后凸行翻修术.其余病例末次随访无脊柱失代偿,无假关节形成、神经损伤等并发症.结论 应用后路凸凹双侧矫形棒同步矫形治疗AIS,有助于提高矫形效果,重建和维持脊柱平衡,减少尾侧融合节段.