青少年特发性脊柱侧凸的胸椎旋转和椎弓根径线变化CT特点及临床价值

目的：探讨16层螺旋CT图像后处理技术对青少年特发性脊柱侧凸的胸椎旋转和椎弓根径线变化特点及临床价值。方法：收集经临床诊治的青少年特发性脊柱侧凸20例,运用16层螺旋CT扫描及图像后处理技术,进行相关CT数据测量统计。结果：（1）脊柱胸椎侧凸的顶椎及邻近椎体均向凸侧旋转、后份向凹侧旋转,以顶椎旋转最重,且凹侧椎弓根径线小于凸侧,与侧凸程度及方向具有相关性。（2）上、下终椎椎体旋转及椎弓根径线变化则较复杂,其椎体无旋转或向相反方向旋转,椎弓根径线可凸侧小于凹侧,以上终椎明显。结论：16层螺旋CT及图像后处理技术,对显示青少年特发性脊柱侧凸胸椎旋转及椎弓根径线变化特征,可提供临床拟订手术方案的重要影像学依据。     

利用Scoligauge测量脊柱侧凸时躯干倾斜角度的可靠性分析

目的:评价Scoligauge作为脊柱侧凸筛查工具的可靠性。方法:6名具有多年脊柱侧凸筛查经验的医师和治疗师分别利用安装Scoligauge软件的i Phone手机和传统的脊柱测量仪脊柱侧凸测量仪(scoliometer)对27例确诊为特发性脊柱侧凸的青少年患者,男10例,女17例,平均年龄12.8岁,进行躯干倾斜角度的测量,每例患者接受每周1次,共4次测量。通过分析两种测量手段的观测值差异和95%置信区间,以及组内相关系数来评估Scoligauge的测量信度。结果:Scoligauge与脊柱侧凸测量仪测量得到的躯干倾斜角配对绝对差为2.5°±1.4°,差异的95%置信区间为±2.9°。Scoligauge的组内相关系数值为0.915,脊柱侧凸测量仪的组内相关系数值为0.932。结论:Scoligauge与脊柱侧凸测量仪在脊柱侧凸测量上可视为等效工具。     

青少年特发性脊柱侧凸影像学评估研究进展

青少年特发性脊柱侧凸(AIS)是一种复杂的脊柱三维畸形。影像学检查能测量AIS侧凸与旋转角度,预测病情进展,协助康复和手术治疗,包括X线平片、三维立体放射技术、计算机断层技术、磁共振成像技术和三维超声成像技术。本文综述其在AIS评估中的应用参数、信度与效度、优势与劣势。三维影像学成像评估技术将是今后的研究趋势。     

多层螺旋CT多种后处理技术在脊柱侧凸中的应用

脊柱侧凸是儿童及青少年的常见病，治疗不当或不及时危害甚大。多层螺旋CT检查、多平面／曲面重建（MPR／CPR）、三维表面遮盖重建（3D-SSD）及与容积再现（VRT）重建的优化组合可以从任意角度、任意方向和任意平面观察脊柱畸形的病变情况，直观和准确地掌握脊柱侧凸和后凸畸形的程度、范围、区域和具体病变情况，测量内固定椎体椎弓根的直径、方向和角度，从而制定手术计划，证实数字化脊柱的可行性并充分应用于临床，为脊柱侧凸患者的安全、有效、个体化治疗提供影像学依据。     

青少年脊柱侧凸症的支具治疗:应用与评估

目的:探讨青少年脊柱侧凸症的非手术疗法之一支具治疗的应用历史,疗效评估及其副作用。资料来源:应用计算机检索Medline1970-01/2003-12和Embase1970-01/2004-04有关青少年脊柱侧凸症支具治疗的文章,检索词为“Adolescent idiopathic scoliosis,brace,review”,并限定文章语言种类为English。资料选择:根据综述描述及引用文献,选取使用支具治疗青少年脊柱侧凸症的研究报道。纳入标准:符合随机临床试验,有正常组对照或/和支具类型之间的对比评估分析及10个月以上的随访研究。排除标准:明显不符合临床随机实验要求的文章。资料提炼:共检索到42篇支具治疗青少年脊柱侧凸症的综述文献;;从中筛选出24篇文献;;分析评估青少年脊柱侧凸症的支具应用;;排除的文献包括同一内容的实验研究及未做随访的研究文章。资料综合:24个实验包括5432例患者;;均采取各种支具治疗青少年脊柱侧凸症。支具类型包括Boston、Charleston、胸腰骶支具和Milwaukee等。目前对支具的有效性及支具选择方面仍存在不同意见。不恰当的支具治疗可能引起多种并发症;;如皮肤溃疡、心理障碍、背痛、胸廓畸形及影响呼吸功能障碍等。结论:虽然对支具使用和效果评估存在不同意见;;但一般认为规范化的早期支具治疗可以有限的控制青少年脊柱侧凸症的畸形进展。     

青少年脊柱侧凸症的支具治疗：应用与评估

目的：探讨青少年脊柱侧凸症的非手术疗法之一支具治疗的应用历史，疗效评估及其副作用．资料来源：应用计算机检索Medline1970—01／2003—12和Embase 1970—01／2004—04有关青少年脊柱侧凸症支具治疗的文章，检索词为“Adolescent idiopathic scoliosis，brace，review”，并限定文章语言种类为English。资料选择：根据综述描述及引用文献，选取使用支具治疗青少年脊柱侧凸症的研究报道。纳入标准：符合随机临床试验，有正常组对照或／和支具类型之间的对比评估分析及10个月以上的随访研究。排除标准：明显不符合临床随机实验要求的文章。资料提炼：共检索到42篇支具治疗青少年脊柱侧凸症的综述文献，从中筛选出24篇文献，分析评估青少年脊柱侧凸症的支具应用，排除的文献包括同一内容的实验研究及未做随访的研究文章。资料综合：24个实验包括5432例患者，均采取各种支具治疗青少年脊柱侧凸症。支具类型包括Boston、Charleston、胸腰骶支具和Milwaukee等。目前对支具的有效性及支具选择方面仍存在不同意见。不恰当的支具治疗可能引起多种并发症，如皮肤溃疡、心理障碍、背痛、胸廓畸形及影响呼吸功能障碍等。结论：虽然对支具使用和效果评估存在不同意见，但一般认为规范化的早期支具治疗可以有限的控制青少年脊柱侧凸症的畸形进展。     

Mimics软件重建脊柱三维骨骼数据基础上快速成型的脊柱畸形模型

目的：探讨快速成型技术在脊柱侧凸诊断和治疗中的作用。方法：实验于2007-07/09在解放军广州军区广州总医院骨科和南方医科大学临床解剖学研究所进行。选择6例脊柱侧凸病例,男1例,女5例;平均年龄14岁,全部进行脊柱PET-CT扫描,应用Mimics8.1软件进行数字化三维重建,依据三维重建结果进行快速成型,得到与病变完全一致的脊柱实体模型。在脊柱模型上测量各种数据,进行手术操作模拟;术中验证模型与实体的相似性。结果：6例患者术前均应用快速成型模型进行手术设计、内固定植入设计及模拟操作等,术中可将模型带至手术台旁进行参考。所有患者手术顺利,无神经、血管等并发症,术后复查见畸形矫正满意,内固定位置正确。结论：快速成型技术能直观、准确地反映侧凸脊柱的形态,对脊柱侧凸的诊断、手术设计及内固定选择等有较大帮助。     

计算机辅助术前预测青少年特发性脊柱侧凸内置物的长度

背景:青少年特发性脊柱侧凸常需要根据患者脊柱畸形的特点和棒模板的长度对棒长进行估计,但这种方法并不精确。目的:计算机辅助术前预测青少年特发性脊柱侧凸矫形棒的长度,并评价该法的可重复性及准确性。方法:将青少年特发性脊柱侧凸患者术前脊柱的CT资料通过MIMICS软件进行三维重建并模拟手术矫形效果,然后利用系统自带的测量工具以连续的短直线测量矫形棒长。选择7例青少年特发性脊柱侧凸患者,测量术前用计算机辅助预测的棒长、术中传统方法估计的棒长、术后通过前后位X射线平片测量的理想棒长,评价本方法的准确性。结果与结论:重复测量操作,同一操作者连续相邻两次测量结果的变化值为(2.492±2.089)mm,不同操作者测量结果之间t检验,P=0.719;信度分析:r=0.986,P=0.000。计算机辅助预测棒长值较理想值长(4.23±3.84)mm,传统估计棒长较理想值长(9.32±5.23)mm,P=0.021。提示,计算机辅助术前预测青少年特发性脊柱侧凸矫形手术矫形棒长度具有较好的操作者自身的可靠性和不同操作者之间的可重复性。计算机辅助预测矫形棒长度,具有较好的准确性,能够准确预测矫形棒的长度,为指导手术操作提供依据。     

不同摄片方法预测青少年特发性脊柱侧凸三维矫形融合术效果的比较

背景:站立侧屈、仰卧侧屈、侧方按压、俯卧推压和牵引下摄X射线片对预测哈氏法和卢氏法手术的矫正效果确实有效,但均不能更好地预测目前应用的三维椎弓根钉棒矫形系统的矫正效果。目的:评估术前支点弯曲位、重力悬吊牵引位和仰卧侧屈位X射线平片在预测青少年特发性脊柱侧凸三维矫形融合术效果的价值。设计:对比观察。单位:解放军第二一一医院骨科(全军骨科中心)。对象:选择2003-01/2005-12解放军第二一一医院骨科就诊的63例青少年特发性脊柱侧凸患者,男18例,女45例,年龄10￣21岁。均经临床检查及X射线平片诊断为青少年特发性脊柱侧凸;Cobb角≥40°;患者均对检测项目知情同意。方法:术前对63例青少年特发性脊柱侧凸患者的79个结构性侧凸摄站立位全脊柱正侧位片、支点弯曲位片、重力悬吊牵引位片和仰卧侧屈位片,术后1周时摄站立位全脊柱正侧位片。主要观察指标:青少年特发性脊柱侧凸术前支点弯曲位Cobb角与术后实际Cobb角。结果:患者63例均进入结果分析。术前支点弯曲位Cobb角与术后站立位比较,差异无显著性意义(P>0.05);而术前重力悬吊牵引位和仰卧侧屈位Cobb角与术后站立位比较,差异有显著性意义(P<0.05)。结论:支点弯曲位X射线平片比重力悬吊牵引位和仰卧侧屈位X射线平片能更准确地预测术后矫正效果,而重力悬吊牵引位与仰卧侧屈位摄片的预测结果相似。     

青少年特发性脊柱侧凸的康复

青少年特发性脊柱侧凸（adolescentidiopathicscoliosis，AIS）是在青春前期或骨骼成熟前发生的一种脊柱畸形，影响青少年健康发育，发病率约为1％-1．17％，其中女性多于男性，比例约为9：1。有的脊柱侧凸有明确致病原因，如先天性脊柱侧凸，继发于骨骼、肌肉、神经系统疾患的侧凸；但更多的是原因不明的脊柱侧凸，即特发性（原发性）脊柱侧凸。脊柱侧凸如得不到及时发现与处理，其中部分患者侧凸情况会逐渐加重，形成严重的畸形。严重的脊柱侧凸不仅会造成身体外观异常、脊柱运动功能障碍或因骨盆倾斜而跛行，而且还可因胸廓畸形造成心、肺功能障碍。少数严重的脊柱侧凸可造成脊髓受压而致下肢瘫痪及排便功能障碍。因此，AIS的早期诊断、早期治疗与康复极为重要。     

Horizontal postrotatory nystagmus response in female subjects with adolescent idiopathic scoliosis.

Quantitative and qualitative assessment of vestibular function was made in 18 female subjects with adolescent idiopathic scoliosis and a control group of 25 female subjects without scoliosis. The Southern California Postrotary Nystagmus Test, which examines postrotatory nystagmus response, was used to assess the vestibular function of subjects in both groups. The results indicated that subjects with adolescent idiopathic scoliosis had a significantly decreased duration of postrotatory nystagmus as well as irregularities in nystagmus form. The recommendation was made that a neurological examination, including assessment of vestibular function, be incorporated into screening methods for scoliosis.     

青少年脊柱侧凸患者术前应用综合呼吸操的效果观察

目的：观察在青少年脊柱侧凸患者中术前实施综合性呼吸操锻炼的临床效果方法：选取46例伴有不同程度肺功能障碍的青少年脊柱侧弯患者作为研究对象,对其自入院后第一天即开始实施综合性呼吸操锻炼,观察术前肺功能的变化情况及术后肺部并发症的发生情况。结果：锻炼后患者肺活量（VC）、肺容量（TLC）、用力肺活量（FVC）、最大通气量（MVV）,等肺功能指标较锻炼前有明显改善,差异具有统计学意义（P〈20．05）;术后血氧饱和度〉95％;无肺部并发症发生。结论：入院后即进行综合性呼吸操锻炼能在近期有效改善患者肺功能,提高患者对脊柱矫形手术的耐受力,对预防和减少术后肺部感染以及呼吸功能不全的发生有积极作用。     

产前超声诊断在胎儿椎体结构畸形中的预测现状研究

背景及目的:椎体畸形是临床较为罕见的畸形发育疾病,是指椎体在胚胎形成的过程中发生障碍,导致椎体发育异常或者畸形。先天性椎体畸形可引起脊柱前凸、侧凸、后凸以及脊柱缩短等脊柱形态异常以及胸廓畸形,影响患儿的生活质量甚至危及生命,给活产儿个人、家庭、社会均带来较为沉重的负担。随着医学影像技术的飞速发展,临床对于椎体畸形的检查方法日渐多样化和高科技化,二维超声和三维超声作为产前超声检查必不可少的影像学检查手段,为胎儿椎体畸形的诊断提供了依据,并在临床中得到了广泛的应用。结果及结论:本文主要对产前超声诊断在胎儿椎体结构畸形中的预测现状进行研究和综述,发现产前超声诊断在半椎体畸形、蝴蝶椎畸形以及椎体融合畸形等方面具有一定的诊断价值,可为临床后续疾病的治疗提供依据。     

A Kohonen neural network description of scoliosis fused regions and their corresponding Lenke classification

Purpose  

Surgical instrumentation for adolescent idiopathic scoliosis (AIS) is a complex procedure where selection of the appropriate curve segment to fuse, i.e., fusion region, is a challenging decision in scoliosis surgery. Currently, the Lenke classification model is used for fusion region evaluation and surgical planning. Retrospective evaluation of Lenke classification and fusion region results was performed.     

Asymmetric biomechanical characteristics of the paravertebral muscle in adolescent idiopathic scoliosis

BackgroundWe sought to assess the biomechanical properties of the paravertebral muscles in adolescent idiopathic scoliosis patients with Lenke Type 1, 2, or 3 (Lenke 1-3) curves.MethodsThe MyotonPro® and shear wave elasticity imaging system were used to assess the biomechanical features of the thoracic paravertebral muscles on concave and convex side in adolescent idiopathic scoliosis patients with Lenke 1-3 curves. The Cobb angle of the main curve was measured using the anteroposterior whole spine radiograph in the standing position.FindingsA total of 40 adolescent idiopathic scoliosis patients with a mean Cobb angle of 66.49° (SD 32.8°) were included in this study. Muscle tone, stiffness and Deborah number on the concave side was significantly greater than that on the convex side. Relaxation time was significantly longer on the convex side than on the concave side. No statistically significant difference in muscle elasticity was observed between the concave side and the convex side (P > 0.05). Pearson correlation analysis demonstrated that stiffness on the concave side was moderately positively correlated with the Cobb angle (P < 0.05, r = 0.582); the Deborah number on both sides and the relaxation time on the concave side showed a moderate negative correlation with the Cobb angle (P < 0.05, r = −0.632; r = −0.432; r = −0.611).InterpretationConcave paravertebral muscle tone and stiffness were greater than those on convex side in adolescent idiopathic scoliosis patients. The asymmetric biomechanical characteristics of paravertebral muscles are closely related to the severity of scoliosis.     

肿瘤血管生成及其在乳腺肿瘤影像学中的应用研究

乳腺癌是女性常见的恶性肿瘤之一,早期诊断对其治疗和预后尤为关键,而肿瘤血管在肿瘤的发生、发展的各阶段中起着重要的作用。随着医学影像技术的发展,肿瘤血管的生成在肿瘤诊疗过程中的应用已成为影像学领域的研究热门,影像学诊断方法采用“肿瘤血管的生成”这一信息来提高乳腺肿瘤检测和鉴别诊断的准确率。目前检测乳腺肿瘤的常用影像学方法有超声、增强核磁、近红外线及动态光学等,本文就新生血管生成和其影像检测方法的应用作简要综述。     

An inquiry into chiropractors' intention to treat adolescent idiopathic scoliosis: a telephone survey

BACKGROUND: The primary aim of this study was to (1) determine the clinical management approach of practicing chiropractors with regard to patients with adolescent idiopathic scoliosis and (2) measure the response rate of a telephone survey. METHODS: A survey instrument was developed and pretested, and a case-specific clinical vignette was generated for a hypothetical typical 12-year-old girl with adolescent idiopathic scoliosis. The instrument addressed 3 domains: the specific management of idiopathic scoliosis, elements guiding the general selection of treatment recommendations, and demographics of respondents. The sample frame consisted of 62,000 US chiropractors, of whom 165 were randomly selected for the survey sample. Interviews were conducted by telephone through use of the tested survey instrument. RESULTS: The response rate was 69% (114/165). Of the 51 nonrespondents, 15 did not have a listed business telephone number and 24 were not in active practice. The response rate of those who met the inclusion criteria (practicing chiropractor with a listed telephone number) was 90% (114/126). The gender, chiropractic college, and years in practice of respondents in this survey were similar to those of respondents in 3 other national surveys. In general, the respondents would provide 6 months of "intensive" chiropractic therapy, then follow the patient for 4 years (near skeletal maturity). Eighty-two percent of respondents named diversified technique as their primary adjustive treatment, 87% would use exercise, and 30% would use electric muscle stimulation as an adjunct to manual therapy. CONCLUSION: Most surveyed chiropractors would use similar methods (frequency and length of treatment, manipulation technique, and exercise) in the treatment of patients with adolescent idiopathic scoliosis. A high response rate to a national survey can be achieved through use of telephone contact.     

Influence of asymmetric mobilisation of the trunk on the Cobb angle and rotation in idiopathic scoliosisin children and adolescents

Background. The aim of the study was the radiological evaluation of the treatment of the idiopathic scoliosis utilising asymmetric trunk mobilisation in the strictly symmetric initial position. Material and methods. Presented study was based upon 136 cases (13 boys aged from 6 to 16 years and 123 girls aged from 6 to 18 years) treated due to the idiopathic scoliosis (from November 1999 to February 2001). Among 48 children suffering from double-major scoliosis 6 cases were infant scoliosis, 20 juvenile and 22 adolescent. Among 88 single scoliosis 6 were infant, 33 juvenile and 49 adolescent. Radiological examination was conducted always in the repeatable technical conditions. Radiograms were evaluated by the same physician. Radiological analysis of the scoliosis included value of the Cobb angle, angle of axial rotation. Results. In double-major scoliosis observed during one year period, in the thoracic segment Cobb angle decreased in 31,3%, increased in 39,5% and in 29,2% was unchanged. Axial rotation angle in 16,7% of cases decreased, in 35,4% increased and remained the same in 47,9%. In the lumbar segment Cobb angle decreased in 35,4%, increased in 39,6%, remained in 25%. Angle of axial rotation decreased in 23% of cases, increased in 29% and persisted in 48%. In single scoliosis Cobb angle decreased in 38,6%, increased in 35,3% and in 26,1% was unchanged. Axial rotation angle in 21,6% of cases decreased, in 29,5% increased and remained the same in 48,9%. Conclusion. Asymmetric mobilisation of the trunk in strictly symmetric initial positions is a method of choice in the conservative treatment of the idiopathic scoliosis.     

热塑矫形器及其材料在青少年特发性脊柱侧凸治疗中的应用

背景:矫形器治疗是目前公认的适于未发育成熟轻中度特发性脊柱侧凸患者惟一有效的非手术治疗方法.目的:回顾性分析热塑矫形器治疗青少年特发性脊柱侧凸临床疗效.方法:1997-04/2004-03在海南省人民医院康复医学部矫形科收治特发性脊柱侧凸患者113例.佩戴热塑矫形器(brace)从开始2.0-3.0 /d,逐渐增加22 h/d.复查时cobb's角减少大于30%,则佩戴时间减至20 h/d,Risser征Ⅳ度或月经初潮1年后佩戴时间减至4 h/d.同时每天完成1 h矫正体操,包括腰背肌锻练:5点式(即头、双肘及双足支撑)和3点式(即头、双足支撑)锻练.随访2年后复测cobb's角,监测cobb's角变化.结果与结论:全部病例随访2年,有效98例(86.7%);治疗无效15例(13.3%),出现脊柱侧凸进展加重.脊柱侧凸cobb's角在20°-30°者68例,有效63例(92.6%).31°-45°者45例,有效35例(77.8%).未发现材料方面的特殊不良反应.结果证明,热塑矫形器结合矫正体操综合治疗特发性脊柱侧凸疗效明显,可减少∞bb's角度,改善侧凸,防止或延缓特发性脊柱侧凸进展.     

超声成像技术在骨折诊断中的应用与发展

随着高频超声分辨率的不断提高,其在骨折诊断中的应用受到关注。超声成像作为可能诊断手段之一,已用于肋骨、掌骨、软骨、鼻骨等部位骨折诊断。在一些X线难以发现的隐匿性骨折中,超声成像通过多方位扫查可观察骨折部位、大小、断端移位以及周围组织水肿或血肿,为临床诊断提供重要依据。高频超声具有便携、无创、无辐射等优势,因此在骨折诊断中拥有广泛的应用前景。本文通过回顾文献对超声成像技术在骨折诊断中的应用和发展进行综述。