青少年特发性脊柱侧凸患者治疗前后的椎旁表面肌电活动的研究

目的探讨青少年特发性脊柱侧凸的患者在包括手法在内的综合治疗前后的脊柱旁肌电活动特点。方法选择9例确诊的特发性脊柱侧凸的患者,在乳突下、C1、T1、T3、T6、T9、T12、L3、L5位置记录为期24周的综合治疗前后的椎旁的肌电活动。结果在综合治疗前:7例上位凸起的对侧枕下肌电活动过高;6例下位凸起侧的L5/S1段肌电活动过高;6例从C5到L3单侧肌电活动过高。所有患者过高肌电活动发生在两弯曲中的一个的凹侧。综合治疗后:左右枕下SEMG值对称。上位或下位弯曲的SEMG值要么对称,要么在凸侧肌电活动过高。同侧L5/S1的SEMG值与下位弯曲凸侧一样。对治疗前后的SEMG值进行配对T检验,P<0.001。在前两周,患者过高肌电活动抑制很明显。经过7周的治疗,从凹侧至凸侧的过高肌电活动的交换在所有患者都明显并保持到治疗结束。结论综合治疗可以使凹侧的肌电活动过高转变为双侧平衡或凸侧肌电活动过高时,弯曲发展可以被阻止。一旦平衡建立,弯曲的阻止和活动的交换就会贯穿整个治疗过程。     

特发性脊柱侧凸与椎旁肌肌纤维类型的改变

特发性脊柱侧凸是脊柱侧凸中最常见的类型。其病因至今尚不十分明确。椎旁肌肌力的不平衡与特发性脊柱侧凸有密切的关系。特发性脊柱侧凸椎旁肌肌纤维类型与正常人之间有较大差别。病理学上椎旁肌肌纤维的类型变化所带来的功能改变及其与椎旁肌肌力不平衡之间的因果关系，对揭示特发性脊柱侧凸病因有重要意义。     

原发性脊柱感染患者X线透视引导下穿刺活检细菌培养阳性率及影响因素

目的：统计X线透视引导下穿刺活检在原发性脊柱感染患者中的细菌培养阳性率,分析影响穿刺培养阳性的因素。方法：回顾性分析2018年8月～2021年8月因原发性脊柱感染在南方医院脊柱骨科和南方医院增城分院骨科行透视引导下经皮穿刺活检的病例,共纳入179例患者,男性110例,女性69例,平均年龄54.63±13.70岁。按穿刺培养结果分为培养阳性组（n=100）和培养阴性组（n=79）。计算培养阳性率,探讨人口统计资料、抗生素干预、临床特征、实验室检查、影像学数据、穿刺操作、血培养及组织病理学结果对培养阳性的影响,采用Logistic回归分析确定培养阳性相关的影响因素。结果：穿刺活检培养阳性率为56%,100例穿刺培养阳性标本共培养出36种119株微生物,其中培养出单一微生物81例（81%）;主要微生物包括：结核分枝杆菌（n=24）、表皮葡萄球菌（n=16）、金黄色葡萄球菌（n=12）、大肠埃希菌（n=8）、布鲁氏菌（n=8）。Logistic回归分析显示C反应蛋白（C-reactive protein）、穿刺部位、穿刺节段对穿刺培养阳性结果无影响,高血压（OR 0.139;95%CI:0.0...     

特发性脊柱侧凸两侧椎旁肌的影像学差异及其临床意义

目的研究特发性脊柱侧凸两侧椎旁肌的影像学变化,并探讨其与特发性脊柱侧凸病因的关系。方法共分三组:特发性脊柱侧凸组39例,男6例,女33例,平均年龄(14.0±1.1)岁。Cobb角40°～108°,平均55.8°±16.7°。KingⅡ型20例,KingⅢ型19例,顶椎位于T6￣T11。其中Cobb角>50°者18例,Cobb角≤50°者21例。先天性脊柱侧凸组25例,男12例,女13例,平均年龄(13.6±1.6)岁。Cobb角40°～155°,平均78.9°±32.1°,顶椎位于T5～T12。12例非脊柱侧凸病例作为对照组,男4例,女8例,平均年龄(23.2±5.8)岁。脊柱侧凸病例取顶椎区水平位MR像,对照组取上位腰椎非病变区水平位MR像,测量两侧椎旁肌的面积和Balance序列平均信号值。结果特发性脊柱侧凸和先天性脊柱侧凸组顶椎区凹侧椎旁肌平均横截面积明显小于凸侧(P<0.05),MRIBalance序列平均信号值明显高于凸侧(P<0.05)。对照组两侧差异无统计学意义(P>0.05)。特发性脊柱侧凸组中Cobb角>50°的病例顶椎区凹凸侧椎旁肌平均横截面积比值和平均信号比值与Cobb角≤50°的病例相比,差异无统计学意义(P>0.05)。结论特发性脊柱侧凸患者两侧椎旁肌存在影像学差异,这种差异可能系脊柱侧凸的继发性改变,且对判断脊柱侧凸的进展性具有潜在的临床意义。     

脊柱侧凸椎旁肌肌纤维不对称性分布的研究

目的　对特发性脊柱侧凸两侧椎旁肌肌纤维分布进行比较 ,并探讨其与脊柱侧凸病因学可能存在的关系。方法　本实验分三组 ,特发性脊柱侧凸组 :2 0例 ,平均年龄 15 .3岁 ,平均Cobb角为 5 6 .8° ,顶椎位于T7～12 。其中Cobb角 >5 0° 11例 ,Cobb角≤ 5 0° 9例。先天性脊柱侧凸组 :11例 ,平均年龄 13.9岁 ,平均Cobb角为 6 6 .7° ,顶椎位于T7～12 。对照组 :取 10例非脊柱侧凸病例作为对照。特发性脊柱侧凸和先天性脊柱侧凸组取顶椎区两侧椎旁肌 ,对照组取非病变区两侧椎旁肌 ,进行病理分析。结果　特发性脊柱侧凸和先天性脊柱侧凸组凸侧椎旁肌Ⅰ型肌纤维含量和横截面积均显著大于凹侧 (P <0 .0 5 ) ,对照组两侧无显著差异 (P >0 .0 5 ) ,特发性脊柱侧凸组中Cobb角 >5 0°的病例凸侧Ⅰ型肌纤维含量显著高于Cobb角≤ 5 0°的病例 (P <0 .0 5 )。结论　脊柱侧凸两侧椎旁肌肌纤维分布不对称系继发性改变     

特发性脊柱侧凸双侧椎旁肌褪黑素受体含量的差异性比较研究

目的研究特发性脊柱侧凸椎旁肌中褪黑素受体含量的变化,并探讨其与特发性脊柱侧凸病因学的关系。方法本实验共分3组:特发性脊柱侧凸组:20例,平均Cobb角56°±16°,顶椎位于T6-11。其中Cobb角>50°10例,Cobb角≤50°10例。先天性脊柱侧凸组:12例,平均Cobb角59°±33°,顶椎位于T7-12。对照组:取10例非脊柱侧凸病例作为对照。采用RT-PCR方法检测所有病例两侧椎旁肌中褪黑素受体两种亚型MT1、MT2mRNA的表达量。结果特发性脊柱侧凸和先天性脊柱侧凸组顶椎区凹侧椎旁肌MT2mRNA的表达量明显小于凸侧(P<0·05),MT1mRNA的表达量两侧无显著差异(P>0·05)。特发性脊柱侧凸组中Cobb角>50°的病例顶椎区凹凸侧椎旁肌MT2mRNA表达量的比值与Cobb角≤50°的病例无显著差异(P>0·05)。对照组两侧椎旁肌MT1、MT2mRNA的表达量无显著差异(P>0·05)。结论特发性脊柱侧凸患者两侧椎旁肌MT2mRNA的表达量存在差异,这种差异可能为继发性改变,在特发性脊柱侧凸的发病中不起主要作用。     

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。     

特发性脊柱侧凸患者椎旁肌中胶原的表达及意义

目的:通过比较特发性脊柱侧凸(idiopathic scoliosis,IS)、先天性脊柱侧凸(congenital scoliosis,CS)顶椎凹凸侧椎旁肌和无脊柱侧凸患者椎旁肌的组织形态学改变及胶原蛋白表达的变化,探讨椎旁肌在IS发展中的作用机制。方法:分别取IS患者(A组)、CS患者(B组)顶椎凹凸两侧及无脊柱侧凸患者(对照组,C组)的椎旁肌,光镜和电镜下观察其组织学形态学改变;应用Masson三色染色法显示胶原蛋白的表达,图像分析系统测量各组胶原的阳性表达面积百分比;对各组结果采用SPSS13.0软件进行统计学处理。应用免疫组织化学方法对Ⅰ型和Ⅲ型胶原染色,观察其在各组的表达情况。结果:光镜和电镜下均显示A、B组凹侧椎旁肌形态明显异常,胶原表达增强、分布紊乱;A、B组凸侧椎旁肌及C组未见明显异常。A、B组凹侧椎旁肌中阳性胶原面积的百分比分别为0.255±0.036和0.253±0.023,明显高于凸侧(A、B组分别为0.057±0.006和0.055±0.002)及C组(0.056±0.004),差异有显著性(P<0.05)。免疫组织化学染色示A、B两组凹侧椎旁肌中Ⅰ型、Ⅲ型胶原表达无明显差异,而在凸侧椎旁肌中以Ⅰ型胶原阳性者为主。结论:IS患者凹侧椎旁肌形态明显异常,胶原表达增强且分布紊乱,其变化可能为IS的继发性改变。     

特发性脊柱侧凸患者两侧椎旁肌横截面积的CT测量

目的:观察特发性脊柱侧凸(IS)患者凸、凹侧椎旁肌横截面积是否存在差异,探讨椎旁肌改变与脊柱侧凸的关系.方法:IS患者31例,女20例,男11例,年龄12～18岁,Cobb角范围28°～76°,平均53°±12°,在CT片上测量上终椎、顶椎、下终椎双侧椎旁肌横截面积.同龄非脊柱畸形患者(对照组)20例,女8例,男12例,年龄5～15岁,在CT片上测量T8、T10双侧椎旁肌横截面积.比较两组双侧椎旁肌的横截面积.结果:IS患者上终椎、顶椎、下终椎凸侧椎旁肌横截面积均大于凹侧,差异有统计学意义(P<0.05);凸/凹侧椎旁肌横截面积比值顶椎>上终椎>下终椎;Cobb角>50°和<50°患者顶椎水平凸,凹侧椎旁肌横截面积比值无统计学意义(P>0.05),顶椎水平凸/凹侧椎旁肌横截面积比值与Cobb角无显著相关性.对照组双侧椎旁肌横截面积差异无统计学意义(P>0.05),左/右侧椎旁肌横截面积比值亦无统计学意义(P>0.05).结论:特发性脊柱侧凸患者双侧椎旁肌发育不对称,凸侧椎旁肌横截面积大于凹侧,且在顶椎水平差异最大,但顶椎水平椎旁肌横截面积凸,凹侧比值与Cobb角无明显相关性.     

调节青少年特发性脊柱侧凸患者椎旁肌改变的关键微RNA

目的探寻调节青少年特发性脊柱侧凸(AIS)患者椎旁肌改变的关键微RNA(miRNA)。方法对3例女性AIS患者凹侧与凸侧椎旁肌组织进行RNA高通量测序,获得差异表达miRNA。使用27例AIS手术患者的椎旁肌组织采用实时荧光定量PCR法验证测序的质量和差异,并将miRNA的相对差异表达量与患者临床参数进行相关性分析。结果 AIS患者凹侧与凸侧椎旁肌组织存在18个差异表达miRNA。实时荧光定量PCR法检测结果显示,miR-516、miR-517、mi R-495的表达差异具有统计学意义(P 0.05)。两侧椎旁肌miR-516相对表达量差值与患者发病年龄呈负相关(r=-0.452),miR-517相对表达量差值与侧凸Cobb角呈负相关(r=-0.378)。结论 AIS患者两侧椎旁肌miR-516、miR-517、miR-495存在不对称表达,其中miR-516、miR-517的不对称表达与发病年龄和侧凸角度相关。     

A preliminary study on electromyographic analysis of the paraspinal musculature in idiopathic scoliosis

The paraspinal muscles have been implicated as a major causative factor in the progression of idiopathic scoliosis. Therefore, the objectives of this preliminary study were to measure the electromyographic activity (EMG) of the paraspinal muscles to determine its relationship to progression of the scoliotic curve. Idiopathic scoliotic patients were selected and identified afterwards on curve progression. The EMG activity on both sides of the spine was measured in a set of standardized postures using bipolar surface electrodes at the apex and two end vertebrae of the scoliotic curve. An EMG ratio involving measurements of the EMG activity on the convex and concave sides of the scoliotic curve was used to evaluate the paraspinal muscles. Enhanced EMG ratios at the apex of the scoliotic curve were found in both groups during sitting and standing. The most interesting finding was that children with progression of the curve also showed enhanced EMG ratios at the lower end vertebra of the curve. The EMG ratios between the groups were significantly different from each other at the apex and end vertebrae for several test conditions. Overlap in the EMG-ratio ranges made differentiation difficult for prediction of the progression of the individual scoliosis patient. However, the EMG ratio at the lower end vertebra of the scoliotic curve is significantly higher than 1 in all test conditions in the group of children with subsequent progression of the curve, whereas it is always normal in the non-progressive group. Therefore, EMG of the paraspinal muscles might be of value for prediction of progression in idiopathic scoliosis.     

Muscle spindles in the paraspinal musculature of patients with adolescent idiopathic scoliosis

Electromyographic studies have determined that muscle imbalance and asymmetry of stretch receptors in the paraspinal muscle of patients with idiopathic scoliosis may have a large role to play in the development and production of the deformity. This project consisted of a detailed histologic and histochemical analysis of the distribution of muscle spindles in paraspinal musculature of patients suffering from idiopathic scoliosis, using the reduced form of nicotinamide-adenine dinucleotide (NADH), adenosine triphosphatase (ATPase), and Tri-chrome stain techniques. Muscle biopsy samples were taken at operation for spinal instrumentation from each of 13 patients (mean age: 16.2 years; 3 males, 10 females) with all but one female exhibiting right thoracic curves. The samples were collected from two specific sites (superficial and deep) on both sides of the vertebral column at the level of the apex of the primary curve and two vertebral levels above and below the apex. From the results there appear to be few muscle spindles in the scoliotic muscle of this region. All of the patients from whom muscle samples were taken possessed at least one sample with a muscle spindle. However, each patient had very few samples which contained a minimum of one muscle spindle (mean: 20.3%; SD: 12.6). It is clear that further examination is necessary, particularly in the area of comparison with 'normal' standards when these standards become available.     

表面肌电图在中医脊柱平衡法治疗青少年特发性脊柱侧凸症中的应用

目的：评价表面肌电图（sEMG）检测在非手术治疗青少年特发性脊柱侧凸症（AIS）中的应用价值。方法：对2011年10月至2012年5月采用中医脊枉平衡法治疗的33例青少年特发性脊柱侧凸症患者临床资料进行总结分析。其中男14例,女19例,年龄（15．40±3．01）岁,Cobb角13°-40°,病程均在3个月以上。X线检查：“C”形侧弯21例,“S”形侧弯9例。观察指标为治疗前、治疗后6个月的Cobb角、平均肌电值（AEMG）比值和治疗的安全性。结果：30例患者完成全部的治疗和检测,完成率为90．9％（30／33）。整个临床治疗和检测过程中,未发现对生命体征产生不良影响,无骨折、脱位、晕厥、针口感染及病情加重情况发生。AEMG比值与Cobb角呈正相关（P=0．003）。有效治疗后,患者AEMG比值减小（P〈0．01）,表明肌力的差异性改善。结论：侧凸椎旁肌sEMG检测可以作为评定AIS凸凹侧肌电活动差异的客观检查之一,通过动态检测,可以作为疗效评价和进展风险评估的客观指标,初步表现出较好的,临床应用价值。     

青少年特发性脊柱侧凸患者脊柱柔韧性的影响因素

目的:探讨青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者脊柱柔韧性的可能影响因素.方法:选取2006年12月～2008年4月在我院脊柱外科手术治疗的204例AIS患者,男性36例,女性168例,平均年龄15.0岁;平均Cobb角50.1°;平均Risser征3.4度;主弯跨度平均6.8个椎体;主弯顶椎旋转度平均2.0度.摄站立位全脊柱正侧位及仰卧左右侧屈位X线片,计算主弯柔韧性.采用相关分析研究各临床指标与主弯柔韧性的相关性.结果:女性AIS患者的脊柱柔韧性明显高于男性(P<0.05);胸腰弯组和腰弯组AIS患者的脊柱柔韧性显著大于胸弯组(P<0.05),胸腰弯和腰弯组之间无显著性差异(P>0.05).女性AIS患者中的年龄及主弯Cobb角(站立位与侧屈位)均与脊柱柔韧性显著负相关(P<0.05),且胸弯女性AIS患者的月经初潮至手术时间及顶椎旋转度也与脊柱柔韧性显著负相关(P<0.05).男性胸弯AIS患者中侧屈位主弯Cobb角、胸腰弯/腰弯组中主弯Cobb角(站立位与侧屈位)均与脊柱柔韧性显著负相关(P<0.05).主弯跨度及Risser征与脊柱柔韧性均无明显相关性(P>0.05).结论:女性AIS患者脊住柔韧性受年龄、月经初潮至手术时间、主弯Cobb角(站立位与侧屈位)、弯型及顶椎旋转度等因素影响;男性AIS患者的脊柱侧凸柔韧性主要受主弯Cobb角及弯型影响.     

Gait analysis in patients with idiopathic scoliosis

Introduction The goal of this study was to observe scoliotic subjects during level walking to identify asymmetries—which may be related to a neurological dysfunction or the spinal deformity itself—and to correlate these to the severity of the scoliotic curve.Methods We assessed the gait pattern of ten females (median age 14.4) with idiopathic scoliosis characterised by a left-lumbar and a right-thoracic curve component. Gait analysis consisted of 3D kinematic (VICON) and kinetic (Kistler force plates) measurements. The 3D-segment positions of the head, trunk and pelvis, as well as the individual joint angles of the upper and lower extremities, were computed during walking and static standing. Calculation of pertinent kinetic and kinematic parameters allowed statistical comparison.Results All subjects walked at a normal velocity (median: 1.22 m/s; range:1.08–1.30 m/s; height-adjusted velocity: 0.75 m/s; range: 0.62–0.88 m/s). The timing of the individual gait phases was normal and symmetrical for the whole group. Sagittal plane hip, knee and ankle motion followed a physiological pattern. Significant asymmetry was observed in the trunks rotational behaviour in the transverse plane. During gait, the pelvis and the head rotated symmetrically to the line of progression, whereas trunk rotation was asymmetric, with increased relative forward rotation of the right upper body in relation to the pelvis. This produced a torsional offset to the line of progression. Minimal torsion (at right heel strike) measured: median 1.0° (range: 5.1°–8.3°), and maximal torsion (at left heel strike) measured 11.4° (range 6.9°–17.9°). The magnitude of the torsional offset during gait correlated to the severity of the thoracic deformity and to the standing posture, whereas the range of the rotational movement was not affected by the severity of the deformity. The ground reaction forces revealed a significant asymmetry of [Msz], the free rotational moment around the vertical axis going through the point of equivalent force application. On the right side, the initial endo-rotational moment was lower, followed by a higher exo-rotational moment than on the left. All the other force parameters (vertical, medio–lateral, anterior–posterior), did not show a significant side difference for the whole group. The use of a brace stiffened torsional motion. However the torsional offset and the asymmetry of the free rotational moment remained unchanged.Conclusion The most significant and marked asymmetry was seen in the transverse plane, denoted as a torsional offset of the upper trunk in relation to the symmetrically rotating pelvis. This motion pattern was reflected by a ground-reaction-force asymmetry of the free rotational moment. Further studies are needed to investigate whether this behaviour is solely an expression of the structural deformity or whether it could enhance the progression of the torsional deformity.No financial assistance was provided for this work     

特发性脊柱侧凸King、Lenke和PUMC临床分型的应用比较

目的比较特发性脊柱侧凸King、Lenke和PUMC分型的全面性及其对手术的指导价值。方法回顾性分析在巴塞罗那SantJoanDeDéu医院接受手术治疗的特发性脊柱侧凸患者145例的临床及影像学资料。所有病例均进行King、Lenke和PUMC分型,比较手术原则与三种分型方法的符合率及术后失代偿的发生情况。结果King分型能对全部病例中的122例进行分型,有23例无法应用King分型;而Lenke分型和PUMC分型均能对全部病例进行分型。145例患者中,手术原则符合King分型者99例(68.3%),符合Lenke分型者120例(82.8%),符合PUMC分型者107例(73.8%)。95例患者随访3～96个月,平均29.6个月。其中手术原则符合King分型、Lenke分型和PUMC分型融合范围而于术后与随访时发生冠状面躯干失平衡(失代偿)的发生率分别为26.3%(26/99)和13.2%(9/68)、30.8%(37/120)和12.5%(10/80)、14.0%(15/107)和2.7%(2/74),符合PUMC分型而发生冠状面躯干失平衡的发生率与符合King分型、Lenke分型者比较差异均有统计学意义(P<0.05)。上胸弯和主胸弯的柔韧性与胸腰弯和腰弯比较差异有统计学意义(P<0.05)。结论特发性脊柱侧凸的PUMC分型与Lenke分型比King分型更全面,PUMC分型比King分型和Lenke分型更具手术指导意义。对不同部位的脊柱侧凸采用统一的凸侧Bending位X线片上Cobb角超过25°来定义结构性侧凸并不合适。     

Initial and treatment induced changes to muscle activation patterns in patients with adolescent idiopathic scoliosis compared to the frontal plane spinal configuration as measured with surface electromyography

Introduction Scoliosis affects 2-4% of the popula-tion in the U nited States[1]and unfortunately them ost com m on treatm ent prior to bracing and surgeryis no treatm ent at all. Scoliosis is a three dim en-sional deform ity of the spine which includes lateralbending,rotation and in m any instances flattening ofthe sagittal curves[2]. M echanical com pression anddistraction forces are known to m odulate growth invertebral growth plates,and they have been im plicat-ed in the progression of sco…     

Risk factor analysis of proximal junctional kyphosis after posterior fusion in patients with idiopathic scoliosis

Study design

A retrospective analysis of 150 adolescents who underwent spinal fusion for idiopathic scoliosis.

Objective

To analyse the incidence of the postoperative proximal junctional kyphosis after posterior fusion to the upper thoracic vertebra in adolescents with idiopathic scoliosis and to explore its risk factors.

Summary of background data

The reported incidence of the proximal junctional kyphosis after the posterior fusion in patients with idiopathic scoliosis varies depending on surgical methods and strategies adopted by the institution.

Methods

The changes in the Cobb angle of the proximal junctional kyphosis on the lateral spine X-ray were measured and the presence of PJK was recorded. The risk factors were screened using statistical analysis.

Results

PJK occurred in 35 out of 123 patients with an overall incidence of 28%. Among them, 28 patients (80%) experienced PJK within 1.5 years after surgery. The PJK-inducing factors included greater than 10° intraoperative decrease in thoracic kyphosis, thoracoplasty, the use of a pedicle screw at the top vertebra, autogenous bone graft and fusion to the lower lumbar vertebra (below L2).

Conclusions

There is a high incidence of postoperative proximal junctional kyphosis after posterior fusion to the upper thoracic vertebra within 1.5 years after surgery in adolescents with idiopathic scoliosis. In order to reduce its incidence, the risk factors for PJK should be carefully evaluated before surgery.