Three dimensional analysis of brace biomechanical efficacy for patients with AIS

Purpose

Corrective three dimensional (3D) effect of different braces is debatable. We evaluated differences in in-brace radiographic correction comparing a custom thoracic-lumbo-sacral-orthosis (TLSO) (T) brace to a Chêneau type TLSO (C) brace using 3D EOS reconstruction technology. Our primary research question was the 3D effect of brace on the spine and in particularly the apical vertebra rotation (AVR).

Methods

This was a retrospective comparative analysis of patients with adolescent idiopathic scoliosis who had orthogonal AP and lateral X-rays with and without brace. A 3D image of the spine was reconstructed. Coronal, sagittal and axial spine parameters were measured before bracing and then on the first post-brace X-ray. Brace efficacy in controlling coronal, sagittal and axial parameters was evaluated.

Results

Eighteen patients treated with the C brace and ten patients treated with the T brace were included. No difference was found regarding patients’ age, gender, magnitude of Cobb angle, sagittal parameters or AVR at inclusion. Following bracing, AVR was significantly reduced by the C brace compared to the T brace [average correction of 8.2° vs. 4.9° (P = 0.02)]. Coronal and sagittal correction did not differ significantly between the two groups.

Conclusions

By utilizing a novel 3D reconstruction technology, we were able to demonstrate that braces differ in their immediate effects on the spine. Although clinical relevance should be evaluated in a future trial we feel that the ability to measure treatment effects in 3D, and especially the transverse plane, is an important tool when evaluating different treatments.     

A review of methods for quantitative evaluation of axial vertebral rotation

Quantitative evaluation of axial vertebral rotation is essential for the determination of reference values in normal and pathological conditions and for understanding the mechanisms of the progression of spinal deformities. However, routine quantitative evaluation of axial vertebral rotation is difficult and error-prone due to the limitations of the observer, characteristics of the observed vertebral anatomy and specific imaging properties. The scope of this paper is to review the existing methods for quantitative evaluation of axial vertebral rotation from medical images along with all relevant publications, which may provide a valuable resource for studying the existing methods or developing new methods and evaluation strategies. The reviewed methods are divided into the methods for evaluation of axial vertebral rotation in 2D images and the methods for evaluation of axial vertebral rotation in 3D images. Key evaluation issues and future considerations, supported by the results of the overview, are also discussed.     

Effect of Pelvic Tilt and Rotation on Cup Orientation in Both Supine and Standing Positions

Background

The purpose of this study is to analyze the effect of pelvic tilt and rotation on radiographic measurement of cup orientation.

3D打印髋关节旋转中心定位器在全髋关节置换术中的辅助作用

目的探讨3D打印髋关节旋转中心定位器在全髋关节置换术中的辅助作用。方法回顾性分析2015年8月至2017年12月期间郑州市骨科医院关节Ⅰ科采用单侧人工全髋关节置换术治疗的14例股骨头缺血性坏死或股骨颈骨折患者资料。男8例,女6例;年龄为37~65岁,平均51.8岁。运用3D打印髋关节旋转中心定位器辅助进行全髋关节置换术。术后测量臼杯的外展角、前倾角及髋关节旋转中心,记录患者手术后髋关节旋转中心O2(患侧)与解剖旋转中心O1(健侧)的符合情况、末次随访时髋关节功能及并发症发生情况。结果14例患者术后获6~24个月(平均18个月)随访。髋关节旋转中心O2与解剖旋转中心O1的纵坐标分别为(19.36±3.61)、(18.33±3.41)mm,横坐标分别为(39.93±2.97)、(39.99±3.16)mm,差异均无统计学意义(P>0.05),旋转中心符合。术后患侧外展角与髋臼前倾角均在正常范围内:外展39.3°±3.2°,前倾14.6°±1.2°。末次随访时14例患者的髋关节Harris评分由术前(42.3±3.2)分提高至(94.3±4.7)分,差异有统计学意义(t=2.873,P=0.002);优13例,良1例。随访期间X线片示假体位置良好,无髋臼及股骨假体松动,未见异位骨化形成。结论3D打印髋关节旋转中心定位器应用于人工全髋关节置换术,可有效协助髋关节旋转中心的重建,精准植入髋臼假体。     

脊柱侧凸上,下终椎和顶椎椎骨旋转的研究

对25例特发性脊柱侧凸患者采用侧卧位CT扫描正位定像法，测量上终推、顶推和下终椎椎骨旋转角度与Cobb’s角的关系、棘突轴心线与两侧椎弓根轴心线所夹角的关系、椎骨旋转与棘突移位分级的关系。结果显示，上终推椎体旋转角度与Cobb’s角无相关性（P＞0．2）；顶推和下终推与Cobb’s角均有相关性（P＜0.01）；上终椎、顶推和下终难的凹侧和凸侧椎弓根轴心线与棘突轴心线所夹角度有显著差异，凹侧明显增大，凸侧明显减少；椎体旋转与棘突移位分级之间无相关性。     

Clinical Relevance of Cervical Kinematic Quality Parameters in Planar Movement

Comprehending cervical spinal motion underlies the understanding of the mechanisms of cervical disorders. We aimed to better define the clinical relevance of cervical spine kinematics, focusing on quality parameters describing cervical spine planar motion. The most common study focuses were kinematic quality parameters after cervical arthroplasty and in normal subjects, patients with cervical degeneration, and patients with cervical deformities. Kinematic quality parameters are important for cervical degeneration prevention, being detected sooner than differences on imaging examinations and being significantly related to the degree of cervical degeneration. Kinematic quality parameters are effective for evaluating the changes of cervical motion pattern after cervical fusion and non‐fusion, assessing operative and adjacent segments in the early stages, and predicting adjacent segment degeneration. However, owing to current research limitations, and controversy about the changes of kinematic quality parameters after different surgical procedures, current assessments are limited to cervical spine flexion and extension. Different osteotomy methods of cervical deformity have different effects on cervical motion patterns and quality parameters. Choosing the most effective surgical method remains a challenge and kinematic quality parameters in cervical deformity are important future research topics. This review highlights the instantaneous center of rotation, the center of rotation, and the instantaneous axis of rotation as being important kinematic quality parameters of cervical spinal motion. These can be used to detect abnormal cervical mobility, to diagnose cervical degeneration, to design disc protheses, and to evaluate surgical effects earlier than other methods. Owing to limitations of research methods there is variation in the way parameters are defined by various researchers. No uniform standard exists for defining degenerative motion quality parameters in normal asymptomatic, degenerative, and postoperative patients. Therefore, further study is required. New study techniques and defining kinematic quality parameters in normal subjects will clarify the definitions of these parameters, enhancing their future clinical usefulness.     

Can Anatomic Measurements of Stem Anteversion Angle Be Considered as the Functional Anteversion Angle?

Background

Stem anteversion angle is important in the combined anteversion theory to avoid implant impingement after total hip arthroplasty (THA). However, anatomic measurements of stem anteversion angle may not represent functional anteversion of the femur if the femur undergoes axial rotation. Herein, the femoral rotational angle (FRA) was measured in supine and standing positions before and after THA to evaluate the difference between anatomic and functional measurements.

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.     

面颈部旋转皮瓣在面颊部瘢痕治疗中的应用

目的：探讨面颊部瘢痕切除术后创面修复的较好方法。方法：应用面颈部旋转皮瓣对11例面颊部瘢痕切除术后创面进行修复。结果：11例瘢痕切除术后创面均得到修复，所修复创面的皮肤颜色和质地与周围皮肤一致，供皮瓣区术后瘢痕不明显。结论：该方法对于面颊部一定大小面积内的瘢痕切除后创面的修复是一种较好的方法。     

Outcome of Surgical Management of Sacrococcygeal Pilonidal Sinus Disease with Rotation Flap in 52 Patients—A Retrospective Study

Background  Surgical treatment of sacrococcygeal pilonidal sinus disease (SPSD) consists of radical excision of the entire tract and treatment of the resultant raw area. Here, the authors have reviewed the results of the rotation flap for closure of the SPSD. Aim  This study aims to evaluate the outcomes following SPSD excision and rotation flap closure. Materials and Methods  All patients were treated for SPSD with excision and closure using a rotation flap from January 2010 to September 2018. Cases having a follow-up of at least 6 months post surgery were evaluated. Result  A total of 52 patients were included in the study; 42 cases were of primary disease while 10 were of recurrent disease. The patients’ follow-up records on the 3rd day, 10th day, 1 month, and 6 months were evaluated. None of the patients showed any signs of recurrence on follow-ups. One patient developed a hematoma on the third day post surgery which was treated conservatively. One patient developed a seroma in the perianal region on the fifth postoperative day which required aspiration. Both these patients healed well subsequently. Conclusion  Rotation flap is a (simple and reliable) treatment option for closure of postexcision SPSD defect. It not only takes the tension away from suture line, but also pushes the gluteal fat from the sides into the midline, obliterating the deep crevice of the natal cleft which is believed to be one of the important factors in the causation of SPSD, thus minimizing recurrence.     

The external rotation immobilisation does not reduce recurrence rates or improve quality of life after primary anterior shoulder dislocation: A systematic review and meta-analysis

PurposeConducting a systematic review and meta-analysis of prospective randomised controlled trials directly comparing (1) the rates of recurrence and (2) patient-based quality-of-life assessments after the external rotation (ER) or internal rotation (IR) immobilisation after primary anterior shoulder dislocation.MethodsPubMed, EMBASE, the Cochrane Library and ISI Web of Science were searched up to January 2013, using the Boolean operators as follows: (bankart lesion OR shoulder anterior dislocation) AND ((external rotation AND internal rotation) OR immobilisation). All prospective randomised controlled trials directly comparing recurrence rate and patient-based quality-of-life assessments between the ER and IR immobilisations were retrieved. No limitation of the language or publication year existed in our analysis.ResultsSeven of 896 studies involving 663 patients were included, 338 in the ER group and 325 in the IR group. No significant difference was observed in the recurrence rate at all ages (risk ratio (RR) = 0.65; 95% confidence interval, 0.41–1.03; p = 0.067), at the age stratum of ≤30 years (RR = 0.70; 95% confidence interval, 0.38–1.29; p = 0.250) and >30 years (RR = 0.86; 95% confidence interval, 0.38–1.97; p = 0.722). Four trials adopted quality-of-life assessments, using the Constant–Murlay functional scoring system, the Rowe scoring system, the Western Ontario Shoulder Instability index (WOSI), the Disabilities of arm, shoulder and hand (DASH) and the American Shoulder and Elbow Surgeons evaluation form (ASES). Only one trial demonstrated borderline statistical significance (p = 0.05) and probable superiority of the ER group based on the ASES. No significant difference was observed in other three trials.ConclusionBased on the results of our analysis, the ER immobilisation could not reduce the rates of recurrence after primary anterior shoulder dislocation or improve the quality of life compared with the IR immobilisation. More rigorous and adequately powered prospective randomised controlled trials with long-term follow-ups are required to elucidate a more objective outcome.     

Rib deformity in scoliosis

Rib deformity in scoliosis is of interest because it may help in the diagnosis, and also, in some pronounced cases, it may need correction by costoplasty. There are, however, debates about its use in diagnosis, because some authors think that rib deformity is not closely related to either the magnitude or the extent of rotation of the curve. In order to define the relation between rib deformity and scoliosis, 11 patients were recruited who were to undergo scoliosis surgery and thoracoplasty, and anteroposterior (AP) T1-S1 standing radiographs, computerized tomography (CT) scans, and three-dimensional (3D) reconstructions were obtained. From the radiographs, the most rotated vertebra, the Cobb angle, the apex and the type of the curve were determined. From the CT scans and 3D reconstructions, the exact level of the rib deformity measured was matched with the corresponding vertebral level. In this way, the most rotated vertebra and the most prominent part of the rib cage deformity were identified. The most rotated vertebra was found to be at the same level in both radiographs and CT scans in only five patients. In the rest of the patients, CT scans showed it either one level higher or lower than it appeared on the radiograph. The most prominent part of the rib cage deformity was at the same level as the most rotated vertebra in two patients, and in the rest of the patients it was one, two or three vertebral levels lower. There was no association between the Cobb angle, vertebral rotation and rib deformity. A CT scan is necessary preoperatively in patients who will undergo a costoplasty, to determine the exact levels of the prominence. However, a scanogram or a 3D reconstruction is required for exactly matching the most prominent part of the rib cage deformity to the corresponding vertebral level.     

Lenke 1AL型青少年特发性脊柱侧凸腰椎代偿弯中顶椎旋转度的影响因素分析

[目的]通过分析Lenke 1型AIS患者冠状位及矢状位的术前影像学资料,探讨影响代偿性腰弯顶椎旋转畸形的影像学参数.[方法]回顾性分析2004～2011年58例以右胸弯为主弯的Lenke 1AL型AIS患者术前站立正、侧位X线像,测量冠状面及矢状面Cobb角,L4椎体倾斜度,骨盆旋转度,胸弯与腰弯的顶椎旋转度及腰弯顶椎节段所在节段等指标并进行相关分析.[结果]腰弯顶椎旋转度与冠状位腰弯Cobb角度(P＜0.001),胸弯Cobb角度(P=0.012),L4椎体倾斜度(P ＜0.001)及骨盆旋转度(P=0.003)存在明显的相关关系,而控制腰弯Cobb角后胸弯顶椎旋转度(P=0.014)代替了胸弯Cobb角的相关性.[结论]Lenke 1AL型AIS代偿性腰弯顶椎旋转度受到冠状面及上下节段水平面轴向旋转畸形的影响,而与矢状面之间的关系无统计学意义.     

超声引导下Vacora旋切术在乳腺多发良性疾病中的应用

目的探讨超声引导下真空辅助旋切系统(Vacora旋切系统)在乳腺多发(一侧乳腺病灶≥3个)良性病灶治疗中的应用价值。方法 2009年2月~2010年6月应用真空辅助旋切系统(美国巴德公司Vacora系统)对17例经B超检查发现直径≤3 cm的79个良性乳房肿瘤进行实时超声引导旋切,术后2 d,2个月及6个月对患者行超声随访,并将手术区超声图像与术前病灶图像进行对比分析,观察有无血肿,肿瘤残留及美容效果。结果所有乳腺多发病灶均准确并完整切除,经病理诊断均为良性。17例随访1~16个月,平均7.6月,1例术后14 d复查可见血肿形成,术后2个月血肿完全消失;1例术后3个月复查发现残留,继续跟踪随访;所有患者皮肤切口愈合良好,无明显切口瘢痕。结论超声引导下Vacora旋切系统对乳腺多发良性病灶切除效果好,具有美观、微创、安全、并发症少等优点。     

An analysis of symmetry of torque strength of the forearm under resisted forearm rotation in normal subjects

PURPOSE: To establish normative pronation and supination torque values in right-handed adults without evidence of upper-extremity dysfunction or impairment in the forearm positions of neutral, pronation, and supination. METHODS: Fifty-one normal right-handed participants ages 22 to 45 years were enrolled and tested in this study using a custom device that incorporated a torque cell and a grip system that produced a digital recording of the peak torque during maximal resisted pronation and supination in positions of neutral forearm rotation, 60 degrees pronation, and 60 degrees supination. RESULTS: The greatest peak torque strength for both male and female participants was found during resisted pronation in the supinated position. The peak torque values averaged 11.9 +/- 3.7 N.m on the right side and 10.4 +/- 3.3 N.m on the left side for men, and 6.0 +/- 1.4 N.m on the right side and 5.0 +/- 1.2 N.m on the left side for women. The weakest torque strengths were resisted pronation in the pronated position and resisted supination in the supinated position. CONCLUSIONS: Torque strength measurements are reliable and should be collected when treating patients with forearm dysfunction. Maximal torque follows the same pattern related to hand dominance as grip strength. Men generate average torque strengths that are approximately twice the magnitude of those generated by women.