Lenke 1型青少年特发性脊柱侧凸患者术后双肩失平衡的影像学评估

[目的]对行全椎弓根螺钉治疗的Lenke 1型青少年特发性脊柱侧凸患者术后双肩失平衡的影像学危险因素进行分析。[方法]选择长海医院行全椎弓根螺钉治疗的Lenke 1型青少年特发性脊柱侧凸患者80例,随访至少2年。测量T1倾斜(T1 tilt)、锁骨角(clavicle angle,CA)、影像学肩高(radiographic shoulder height,RSH)等影像学参数。根据RSH分级的绝对值术后是否大于术前,将其分为术后平衡组与失平衡组,并对两组患者的影像学参数进行对比分析。[结果]术后双肩失平衡的发生率为22.5%。双肩失平衡组正性T1倾斜、正性锁骨角的比例远高于平衡组(P<0.001)。术前双肩水平的患者术后更易出现双肩失平衡(25.8%vs 83.3%,P<0.001)。25.8%的双肩平衡患者上胸弯Cobb角≥30°,而双肩失平衡患者该比例高达55.6%(P=0.018);50.0%的双肩平衡患者主胸弯与上胸弯的Cobb角差值≥25°,而双肩失平衡患者该比例仅为22.2%(P=0.036)。平衡组30.6%患者随访时主胸弯与上胸弯矫正率的差值≥1.8,失平衡组中该比例达61.1%(P=0.019)。[结论]T1倾斜、锁骨角、术前双肩平衡状态、上胸弯Cobb角、主胸弯与上胸弯的Cobb角差值及主胸弯与上胸弯矫正率的比值是较好的预测Lenke 1型青少年特发性脊柱侧凸患者术后双肩失平衡的影像学参数。     

Lenke 1型青少年特发性脊柱侧凸病人矫形术后肩平衡的相关因素分析

目的 探讨术前右肩高Lenke 1型青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）病人术后的肩关节高度变化,并分析术后肩平衡的影响因素。方法 回顾性分析2015年1月至2017年12月于我院手术治疗的术前右肩高Lenke 1型AIS病人41例,根据术后肩部平衡状态分为双肩平衡组和双肩失衡组。分别测量两组病人术前、术后3个月及术后2年的影像学肩关节高度差（radiographic shoulder height,RSH）、上胸弯Cobb角、主胸弯Cobb角、锁骨角、胸廓锁骨角度差（clavicle chest cage angle difference,CCAD）和T₁倾斜角,并计算主胸弯矫正率、上胸弯矫正率、主胸弯柔韧度、上胸弯柔韧度等;分析双肩失衡组病人末次随访时RSH与术前影像学指标的相关性。结果 双肩失衡组术前的锁骨角和CCAD值均高于双肩平衡组,上胸弯柔韧度低于双肩平衡组（P＜0.05）。Pearson相关分析显示术前锁骨角、CCAD与术后RSH呈正相关（P＜0.05,r＞0）;上胸弯柔韧度与术后RSH呈负相关（P＜0.05,r＜0）;锁骨角变化、主胸弯及上胸弯矫正率、主胸弯角度变化与RSH变化呈正相关（P＜0.05,r＞0）。Logistic回归分析未见双肩失平衡的独立危险因素。结论 术前锁骨角、CCAD及上胸弯柔韧度是Lenke 1型AIS病人术后RSH的预测因素,应避免主胸弯过度矫正导致术后肩失衡的发生。     

青少年特发性脊柱侧凸主胸弯融合后未融合上胸弯的变化及其与肩部平衡的关系

【摘要】 目的：探讨青少年特发性脊柱侧凸（AIS）患者主胸弯融合后未融合上胸弯的变化及其与肩部平衡的关系。方法：回顾性分析2008年1月~2010年12月在我院接受手术治疗的AIS患者,选取年龄10～18岁,Lenke分型为Lenke 1、2、3、4型,右胸弯且Cobb角＜80°,采用后路椎弓根螺钉系统固定矫形,固定融合上端椎在T4或T4以下,随访时间2年以上的患者,排除翻修手术和截骨手术患者。术前根据Lenke分型判断上胸弯是否为结构性,分成结构性上胸弯组和非结构性上胸弯组,统计比较两组术前、术后3个月和末次随访时外观肩部平衡以及影像学各项参数的变化。结果：共有62例患者纳入本研究,平均年龄14.4岁,随访时间24~62个月,平均36.4个月,其中结构性上胸弯组17例,非结构性上胸弯组45例。两组患者术后上胸弯均能自发性矫正,末次随访时,上胸弯Cobb角平均由27.9°减小至19.4°,T1倾斜角由-0.21°增加至4.7°,第一肋倾斜角（FRT）由0.4°增加至3.7°,锁骨角（CA）由-1.5°增加至0.8°,双肩高度差（CSH）由-13.0mm增加至5.2mm,改变均有统计学意义（P=0.000）。Pearson相关性分析显示,T1倾斜角的改变（术后T1倾斜角-术前T1倾斜角）与CSH变化（术后CSH-术前CSH）有较强相关性（r=0.624,P=0.000）,术后主胸弯的矫正率和FRT与CSH变化为中等程度相关（r=0.437,0.345,P=0.007,0.006）,术前主胸弯Cobb角与CSH变化为弱相关（r=0.262,P=0.040）。上胸弯Cobb角及柔韧性、主胸弯柔韧性、T1倾斜角等参数与CSH变化无统计学相关性。结论：AIS患者结构性与非结构性上胸弯在主胸弯矫正以后均有自发性矫正现象,但T1倾斜角、第一肋倾斜角和双肩高度差均会增加。右胸弯患者左肩被抬高的程度与T1倾斜角增加的程度、主胸弯的矫正率及术后第一肋倾斜角相关。     

Lenke 1型特发性脊柱侧凸患者术后顶椎区残留旋转的危险因素分析

[目的]探讨影响Lenke 1型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者术后顶椎区残留旋转的危险因素。[方法]选取2010年1月~2014年10月在本院行后路融合术的26例Lenke 1型AIS患者,其中男5例,女21例。按照术后顶椎区残留旋转的严重程度将AIS患者分为两组:A组(顶椎区椎体残留旋转比率70%)15例,B组(顶椎区椎体残留旋转比率70%)11例。分析两组患者的性别、年龄、Risser征、术前主胸弯Cobb角、主胸弯柔韧度、术前顶椎区椎体旋转角度、术前及术后的顶椎偏移距离和躯干偏移距离、胸椎矢状位Cobb角改善率、主胸弯矫正率以及顶椎区置钉密度。单因素分析对比两组患者在上述指标的差异性,并进行Logistic多因素回归分析。[结果]两组间患者的主胸弯柔韧度、术前顶椎偏移距离、主胸弯矫正率、顶椎区置钉密度差异具有统计学意义(P0.05);多因素回归分析显示导致术后顶椎区残留旋转的独立危险因素包括主胸弯矫正率、顶椎区置钉密度(P0.05)。[结论]Lenke 1型AIS患者主胸弯矫正率、顶椎区置钉密度是影响术后顶椎区残留旋转的危险因素。     

Lenke 1型青少年特发性脊柱侧凸患者不同上端融合椎对术后双肩平衡的影响

【摘要】 目的：探讨不同上端融合椎对术前双肩水平的Lenke 1型青少年特发性脊柱侧凸（adolescent idiopath?鄄ic scoliosis,AIS）患者术后双肩平衡的影响。方法：选取2006年6月~2009年6月在我院行后路主胸弯融合术并有2年以上完整影像学随访资料的32例Lenke 1型AIS患者。所有患者术前均表现为双肩水平,其中男6例,女26例,手术时年龄13~19岁,平均14.9岁,上胸弯Cobb角平均为23.7°±8.0°（10°~36°）,主胸弯Cobb角平均47.5°±6.9°（40°~62°）。按照上端融合椎不同将AIS患者分为两组：A组,上端融合椎为T3,19例;B组,上端融合椎为T4,13例。A组患者的手术时年龄、Risser征、上胸弯及主胸弯柔韧度与B组比较均无统计学差异（P>0.05）。采用方差分析比较两组患者术前、术后1年和末次随访时的上胸弯及主胸弯Cobb角、顶椎及躯干偏移距离、影像学肩关节高度差（radiographic shoulder height, RSH）、喙突高度差（CPH）和锁骨角（CA）。结果：A组随访时间2~4.5年,平均3.6±1.3年;B组随访时间2~4.8年,平均3.1±2.1年,两组比较无统计学差异（P>0.05）。术前、术后1年和末次随访时,A组患者的上胸弯Cobb角、主胸弯Cobb角、顶椎及躯干偏移距离、RSH、CPH及CA与B组比较均无统计学差异（P>0.05）。A、B两组患者术后1年和末次随访时的上胸弯Cobb角、主胸弯Cobb角、顶椎及躯干偏移距离、RSH、CPH、CA分别与术前比较均有显著性改善（P<0.05）;末次随访时,两组患者的上胸弯Cobb角及RSH、CPH、CA较术后1年均显著减小（P<0.05）,均获得较满意的双肩平衡。结论：对于术前双肩水平的Lenke 1型AIS患者,上端融合椎为T3或T4对重建术后双肩平衡的疗效无明显差别;对此类患者上端融合至T4即可获得良好的矫形效果和满意的双肩平衡。     

Lenke 5C型脊柱侧凸后路选择性矫形术下端融合椎影像学改变对冠状面平衡的影响

【摘要】 目的：探讨下端融合椎（lowest instrumented vertebra,LIV）相关影像学指标对Lenke 5C型特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）患者术后冠状面平衡的影响。方法：本研究包括30例行后路选择性融合的Lenke 5C型AIS患者,所有患者于术前、术后即刻及末次随访时拍摄站立前后位像及术前仰卧位拍摄左右Bending像。对术前、术后和末次随访时的冠状面平衡与LIV相关影像学指标（LIV偏移、LIV旋转、LIV倾斜度、LIV尾侧椎间盘开角）进行分析。结果：所有患者平均随访33个月（24~50个月）,其中LIV为L3者20例,L4者10例。30例Lenke 5C型AIS患者术前冠状面胸腰弯/腰弯Cobb角平均为49.8°±5.1°,术前冠状面胸弯Cobb角平均为25.6°±7.1°。相关性检验发现以下3个指标与术后即刻冠状面平衡（coronal trunk balance,CTB）有显著相关性：（1）术前CTB（r=0.69,r2=0.48,P<0.01）;（2）术前LIV倾斜度（r=0.63,r2=0.40,P<0.01）;（3）术后即刻LIV倾斜度（r=0.60,r2=0.36,P<0.01）。在末次随访时,不管是术前还是术后的LIV相关影像学指标均与末次随访时CTB无显著相关（P>0.05）。结论：对行后路选择性融合术的Lenke 5C型AIS患者而言,术前冠状面平衡与否及术前LIV倾斜度大小对预测术后即刻冠状面平衡有重要的作用。术前LIV倾斜大于25°的患者容易发生术后即刻冠状面失平衡。然而,LIV倾斜度对Lenke 5C型AIS患者术后冠状面平衡无显著影响。     

Lenke 3型青少年特发性脊柱侧凸后路矫形术后身高增长的相关影响因素分析

目的:探讨Lenke 3型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患儿脊柱后路矫形术后身高增长(ΔSH)的相关影响因素。方法:选取2014年1月~2016年6月于我院行脊柱后路矫形手术的女性Lenke 3型AIS患儿90例,年龄15.0±2.6岁。于站立位全脊柱正侧位X线片上测量术前、术后的主弯侧凸Cobb角1(最大侧凸Cobb角)、侧凸Cobb角2(次之侧凸Cobb角)、脊柱高度(spinal height,SH)、胸椎后凸角(thoracic kyphosis,TK)及腰椎前凸角(lumbar lordosis,LL)。应用Pearson相关分析ΔSH与其他参数之间的相关性,应用线性回归探讨ΔSH的相关影响因素。结果:ΔSH为2.9±1.0cm。Pearson相关性分析示ΔSH与术前的侧凸Cobb角1(P=0.000)、侧凸Cobb角2(P=0.000)及TK(P=0.023)均呈显著相关性,与术后的侧凸Cobb角1(P=0.000)、侧凸Cobb角2(P=0.000)、LL(P=0.025)、侧凸Cobb角1变化(P=0.000)、侧凸Cobb角2变化(P=0.000)及TK变化(P=0.032)均呈显著相关性。线性回归分析示ΔSH与侧凸Cobb角1变化(P=0.017)、侧凸Cobb角2变化(P=0.001)均呈显著线性相关(R~2=0.333);另外,ΔSH与术前侧凸Cobb角1(P=0.006)、侧凸Cobb角2(P=0.007)、术前TK(P=0.038)亦呈显著线性相关(R~2=0.595)。结论:Lenke 3型AIS患儿脊柱后路矫形术后身高增长的相关影响因素包括术前、术后的主弯侧凸Cobb角、术前TK及其术后变化值。主弯Cobb角矫正是Lenke 3型AIS术后身高增加的最主要影响因素。Lenke 3型AIS患儿的术前侧凸Cobb角及术前TK可以较好地预测患儿术后身高恢复情况。     

青少年特发性脊柱侧凸术后肩部外观可塑性与融合策略

【摘要】 目的：本研究旨在探讨青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）术后肩部外观可塑性,分析基于该现象的胸弯融合上端椎选择策略。方法：对56例Lenke Ⅰ型AIS患者进行回顾性研究,术后随访2～5年。术前Cobb角主胸弯57.65°±12.28°、上胸弯20.34°±9.52°。根据术前肩部平衡、上胸弯柔韧度情况,主胸弯融合上端椎选择方案为：术前右肩抬高非僵硬性上胸弯（柔韧度＞30%）患者10例,选择端椎下位椎（端椎－1）;僵硬性上胸弯（柔韧度≤30%）患者7例,选择端椎。术前双肩平衡非僵硬性上胸弯患者,7例选择端椎上位椎（端椎＋1）,7例选择T3;僵硬性上胸弯患者,5例选择T4,6例选择T3。术前左肩抬高非僵硬性上胸弯患者4例,选择端椎上位椎（端椎＋1）;僵硬性上胸弯患者,1例选择T4,9例选择T3。配对t检验比较术后即刻、末次随访外观肩高（CSD）,评估术后肩部外观可塑性。并对术后肩部平衡进行主观评价,其中患者和家属一方或双方认为肩部外观未恢复平衡,为主观评价不满意。通过分析外观CSD变化,影像学冠状面平衡及T2～T5后凸角,患者及家属主观评价,总结基于肩部外观可塑性的上端椎选择策略。结果：末次随访Cobb角主胸弯19.16°±10.34°、上胸弯11.83°±8.65°,冠状面平衡0.67±0.56cm,T2～T5后凸角17.23°±7.28°。1例患者2年内随访主观评价左肩抬高,其余患者无并发症发生。术前、术后即刻、末次随访时,CSD值：1.04±0.24cm、0.92±0.22cm、0.63±0.16cm;CSD≥1cm患者例数：31例、23例、5例。术后即刻与末次随访CSD存在显著差异（t=7.98,P＜0.001）,最大肩部外观可塑值ΔCSD为1.69cm。随访中肩部恢复平衡的上端椎选择方案：术前右肩抬高非僵硬性上胸弯患者选择端椎－1,右肩抬高僵硬性上胸弯患者选择端椎,双肩平衡非僵硬性上胸弯患者选择端椎＋1或T3,双肩平衡僵硬性上胸弯患者选择T3后,患者末次随访CSD均＜1cm,主观评价满意;术前左肩抬高非僵硬性上胸弯患者选择端椎＋1后1例末次随访CSD为1.06cm,左肩抬高僵硬性上胸弯患者选择T3后1例末次随访CSD为1.02cm,主观评价满意。随访中肩部未恢复平衡的上端椎选择方案：术前双肩平衡僵硬性上胸弯患者选择T4后,2例CSD分别为1.45cm、1.54cm,其中1例随访2年内主观评价左肩抬高;术前左肩高僵硬性上胸弯患者选择T4,1例CSD较大为1.52cm。结论：AIS患者术后肩部外观存在可塑性,基于该特性Lenke Ⅰ型AIS患者胸弯融合上端椎策略为：术前右肩抬高非僵硬性上胸弯患者选择端椎－1,僵硬性上胸弯患者选择端椎;双肩平衡非僵硬性上胸弯患者选择端椎＋1,僵硬性上胸弯患者选择T3;左肩抬高非僵硬性上胸弯患者选择端椎＋1,僵硬性上胸弯患者选择T3。     

Lenke 1、2型青少年特发性脊柱侧凸矫形术后内肩自发性平衡6个月观察

目的 观察Lenke 1、2型青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）病人行脊柱后路椎弓根钉矫形内固定植骨融合术后短期内肩自发性平衡的恢复情况。方法 回顾性分析2018年1月至2020年1月在本中心行后路椎弓根钉矫形内固定植骨融合术治疗AIS的21例病人手术前后的影像学资料，根据术前、术后即刻、术后6个月标准站立位脊柱全长X线片，测量主胸弯Cobb角、上胸弯Cobb角、腰弯角度、影像学肩高、锁骨角，并采用T₁倾斜角和颈椎轴线角评价内肩自发性平衡情况。结果 术后即刻和术后6个月的主胸弯Cobb角、上胸弯Cobb角、腰弯角度均较术前明显改善，差异有统计学意义（P＜0.05）。术前T₁平衡2例（9.52%，2/21），术后即刻6例（28.57%，6/21），术后6个月13例（61.90%，13/21），术后6个月时达到T₁平衡的比例较术前显著提高，差异有统计学意义（P＜0.05）；术前颈部平衡3例（14.29%，3/21），术后即刻13例（61.90%，13/21），术后6个月17例（80.95%，17/21），术后即刻、术后6个月时的颈部平衡比例均较术前显著升高，差异有统计学意义（P＜0.05）。结论 Lenke 1、2型AIS病人矫形术后内肩平衡（尤其是T₁平衡性）会有一定程度的自发性改善。     

Lenke 5、Lenke 6型青少年特发性脊柱侧凸后路矫形术后影像学与临床美学评估

【摘要】 目的：研究Lenke 5、Lenke 6型青少年特发性脊柱侧凸患者（adolescent idiopathic scoliosis,AIS）接受后路矫形术后临床美学的改善,探讨临床美学改善程度与影像学改善程度的相关性。方法：研究对象为28例以腰弯/胸腰弯为主弯的AIS患者,其中Lenke 5型患者12例,Lenke 6型患者16例。所有患者术前、术后均摄站立位全脊柱正侧位X线片,在X线片上测量主弯Cobb角及顶椎偏移（apical vertebral translation,AVT）,同时在照片     

The end of the crystalloid era?

The metabolic response to surgery causes sodium and water retention. It does not seem logical to pour crystalloid solutions into patients in the peri-operative period, particularly when these solutions can cause deterioration in lung function. Plasma volume must be maintained to prevent a decreased blood flow to vital organs such as the kidneys. Blood or colloid solutions, not crystalloid solutions, should be used for this purpose, since the latter are distributed throughout the whole extracellular space and are less effective in maintaining plasma volume. Water given as 5% dextrose should be given in minimal quantities to maintain intracellular hydration. Patients undergoing minor to moderate surgery when they are likely to be drinking within 24 hours do not usually require any intravenous infusion. Moreover, to administer intravenous fluids to these patients may cause harm. No fluid regimens should be inflexible and the patient's size, age and fluid losses should be taken into account.     

Does the Use of Intraoperative Pressure Sensors for Knee Balancing in Total Knee Arthroplasty Improve Clinical Outcomes? A Comparative Study With a Minimum Two-Year Follow-Up

BackgroundIt is undetermined whether using sensors for knee balancing in total knee arthroplasty (TKA) improves patient outcomes. The purpose of this study was to compare clinical outcomes of sensor balance (SB) with manual balance (MB) TKA with a minimum two-year follow-up.MethodsA consecutive series of 207 MB TKAs was compared with 222 SB TKAs between April 2014 and April 2017. A single surgeon performed all surgeries, using the same prosthesis. The primary end point was the aggregated mean change in four subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS₄) between preoperative and two-year time points. Secondary outcomes included mean differences between groups in all five KOOS subscales, proportions of knee balancing procedures, and rates of reoperations including revisions and manipulations for stiffness.ResultsThe mean changes in the KOOS₄ aggregated means for MB TKA (42.4; standard deviation, 29.1) and SB TKA (41.5; standard deviation, 25.0) were not significantly different (mean difference, 0.9; 95% confidence interval: –2.6 to 4.4, P = .62). There were significantly more balancing procedures in the SB group (55.9% versus 16.9%; P < .01). There were no significant differences in the number of reoperations (1.4% SB versus 1.4% MB; P = .71) or manipulations for stiffness (3.7% SB versus 4.4% MB; P = .69).ConclusionThe use of sensors in TKA to achieve knee balance did not result in improved clinical outcomes, despite significantly increasing the number of surgical interventions required to achieve a balanced knee. Sensors did not alter the rates of revision surgery or requirements for manipulation. It remains to be determined whether precise soft-tissue balancing improves prosthetic survivorship and joint biomechanics.     

中国汉族正常成人心骶角的测定及意义

目的 :测量脊柱与内脏的测量参数心骶角在脊柱全长正侧位X线片上的数据,比较心骶角在不同性别和不同年龄组间差异,并探索其临床应用价值。方法:纳入正常成人108例,男53例,女55例,年龄18~60岁,按照性别和年龄(18~44为青年,45~60为中年)分成四组:第一组为青年男性组(21例);第二组为中年男性组(32例);第三组为青年女性组(26例);第四组为中年女性组(29例)。将脊柱全长正位X线片上S1上终板中点和心脏冠状位最外侧点连线与重垂线之间的夹角定义为冠状位心骶角;将脊柱全长侧位X线片上S1上终板中点和心脏矢状位最前点连线与重垂线之间的夹角定义为矢状位心骶角。采用单因素方差分析比较各组间角度差异。采用独立样本t检验比较男女性别间角度差异,采用组内相关系数评估观测者间信度、观测者内信度以及测量的可重复性。结果:冠状位心骶角测值:青年男性组19.6°±2.8°,中年男性组20.6°±3.5°,青年女性组19.5°±3.6°,中年女性组20.8°±2.3°。矢状位心骶角测值:青年男性组17.0°±4.4°,中年男性组16.7°±4.3°,青年女性组14.7°±3.5°,中年女性组16.3°±4.8°。冠状位和矢状位心骶角在各组间的差异无显著性(P0.05)。冠状位和矢状位心骶角在男女性别间无显著性差异(P0.05)。评估观测者间客观信度、观测者内精确信度和测量的可重复性的组内相关系数在0.89~0.98之间(P0.05)。结论:中国汉族正常成人心骶角是一个解剖常数,具有良好的信度和可重复性,可以作为脊柱-内脏指标参与评估脊柱在冠状位和矢状位的平衡。     

Urea and electrolyte measurement in pre-operative surgical patients

In a prospective study of 1062 patients who presented for routine and emergency surgical procedures, the frequency of urea and electrolyte measurement was determined. In addition, the incidence of abnormal urea and electrolyte measurements were recorded. It was found that these abnormal values were most frequent in the paediatric population (though they they had the fewest urea and electrolyte measurements performed) and in the over 60s. The American Society of Anesthesiologists' grade was found to be a useful predictor as to whether the urea and electrolyte measurement could be expected to be abnormal. It is suggested that American Society of Anesthesiologists' Grade I patients do not require routine urea and electrolyte measurements whilst those in grades 3, 4 and 5 and those on diuretics do.     

Intravenous fluids in minor surgery. Their effect on recovery from anaesthesia

The value of infusing a total of 2 litres of intravenous fluids intra- and postoperatively was assessed in 212 fasting patients undergoing minor surgery procedures. The treated patients (108) recovered from the effects of surgery and anaesthesia more quickly than patients without fluids (104). The results of improved quality of the postoperative recovery, a shorter hospital stay and earlier return to work, especially in those patients who had some difficulty in recovering from anaesthesia on previous occasions, encourages the more frequent use of intravenous fluids in minor surgery.     

Evaluation of current paediatric guidelines for fluid therapy using two different dextrose hydrating solutions

Simplified guidelines for intra-operative fluid therapy were evaluated in two groups of children (aged 3 months-10 years) undergoing minor non-haemorrhagic surgical procedures, randomly assigned to receive either 5% or 2.5% dextrose in 0.3% or 0.4% normal (N) saline. Blood samples were obtained at the time of induction and upon arrival in the recovery room. Fasting time was on average greater than 10 h and hypoglycaemia, defined as blood glucose less than 3.5 mmolċl⁻¹, was observed in 7.4% of the children at the time of induction. In both groups, blood glucose increased at the end of surgery, this increase being more significant in children receiving 5% dextrose than in those receiving 2.5% dextrose. In both groups, post-operative blood glucose values were higher in children of less than 4 years of age than in those aged 4 and over. Blood glucose changes were associated with a decrease in plasma sodium, this decrease being greater in children receiving 5% dextrose in 0.3 _N saline, especially in those less than 4 years of age. This study suggests that the use of a 5% dextrose hydrating solution in 0.3 _N saline is more likely to result in hyperglycaemia and hyponatraemia than a 2.5% dextrose in a 0.4 _N saline, particularly in children younger than 4 years of age.     

Short anterior correction of the thoracolumbar/lumbar curve in King 1 idiopathic scoliosis: the behaviour of the instrumented and non-instrumented curves and the trunk balance

This is a retrospective clinical, radiological and patient outcome assessment of 21 consecutive patients with King 1 idiopathic adolescent scoliosis treated by short anterior selective fusion of the major thoracolumbar/lumbar (TL/L) curve. Three-dimensional changes of both curves, changes in trunk balance and rib hump were evaluated. The minimal follow-up was 24 months (max. 83). The Cobb angle of the TL/L curve was 52 degrees (45-67 degrees) with a flexibility of 72% (40-100%). The average length of the main curve was 5 (3-8) segments. An average of 3 (2-4) segments was fused using rigid single rod implants with side-loading screws. The Cobb angle of the thoracic curve was 33 degrees (18-50 degrees) with a flexibility of 69% (29-100%). The thoracic curve in bending was less than 20 degrees in 17 patients, and 20-25 degrees in 4 patients. In the TL/L curve there was an improvement of the Cobb angle of 67%, of the apex vertebral rotation of 51% and of the apex vertebral translation of 74%. The Cobb angle of the thoracic curve improved 29% spontaneously. Shoulder balance improved significantly from an average preoperative imbalance of 14.5-3.1 mm at the last follow-up. Seventy-five percent of the patients with preoperative positive shoulder imbalance (higher on the side of the thoracic curve) had levelled shoulders at the last follow-up. C7 offset improved from a preoperative 19.8 (0-40) to 4.8 (0-18) mm at the last follow-up. There were no significant changes in rotation, translation of the thoracic curve and the clinical rib hump. There were no significant changes in thoracic kyphosis or lumbar lordosis. The average score of the SRS-24 questionnaire at the last follow-up was 91 points (max. 120). We conclude that short anterior selective fusion of the TL/L curve in King 1 scoliosis with a thoracic curve bending to 25 degrees or less (Type 5 according to Lenke classification) results in a satisfactory correction and a balanced spine. Short fusions leave enough mobile lumbar segments for the establishment of global spinal balance. A positive shoulder imbalance is not a contraindication for this procedure. Structural interbody grafts are not necessary to maintain lumbar lordosis.     

Is the Use of Spreaders an Accurate Method for Ligament Balancing?

BackgroundTo analyze 2 methods of manual spreader gap assessment accuracy, visual vs blinded, compared with a controlled tensioner in total knee arthroplasty.MethodsTwenty-two fresh frozen cadaver knees were used to perform total knee arthroplasty by 22 surgeons. Extension and flexion gaps were measured with empirical manual force application with spreaders in 2 different manners: (1) surgeons were blinded to gap geometry formation—blind method group (BM) and (2) surgeons viewed them—viewing method group (VM). A tensioner was used to measure the corresponding ligament tension applied during spreader measurements and to measure the extension and flexion gaps with standard force of 100 and 80 N (tensioner method [TM]) in each femorotibial compartment.ResultsAll measurements with spreaders (VM and BM) presented extension and flexion gaps oversized and asymmetric (P < .0001), when compared with the same gaps measured with the tensioner. Approximately 63% (P = <0.001) and 77.3% (P = .161) of the VM group and 68.2% (P = .018) and 77.3% (P = .161) of the BM group demonstrated asymmetry for extension and flexion gaps up to 3 mm to the TM. Gaps measured in the VM group presented results with slightly less oversizing and asymmetries than the measurements in the BM group compared with TM, although significantly different (P < .0001).ConclusionThe assessment of extension and flexion gaps with empirical manual applied force spreaders produced oversized and asymmetric gaps compared with the use of tensioner. No visual influence was observed during the spreader applied empirical manual force compared with the blinded assessment.     

The effect of single-level, total disc arthroplasty on sagittal balance parameters: a prospective study

A prospective radiographic study of the influence of total disc replacement on spinal sagittal balance. The goal of this study was to prospectively determine the effect of a single-level, total disc replacement on the sagittal balance of the spine, especially on sacral tilt (ST), pelvic tilt (PT), and lumbar lordosis. It has been shown that lumbar fusion may deleteriously alter the sagittal balance of the spine, including a decrease in the ST and lumbar lordosis. Clinically, postfusion pain has been shown to be significantly related to a decreased ST, increased PT, and decreased lumbar lordosis, independent of other factors such as pseudoarthrosis. To our knowledge, the influence of total disc replacement on spinal sagittal balance has not yet been reported in the literature. This is a prospective study of 35 patients who received a single level disc replacement using the Maverick Total Disc Arthroplasty system (Medtronic Sofamor Danek, Memphis, Tennessee) by a single surgeon at one institution from March 2002 to September 2003. The preoperative and postoperative radiographic evaluation included standing anteroposterior and lateral full spine films that included the femoral heads. The parameters studied were ST, PT, global and segmental lordosis, and global kyphosis. The average age of the 35 patients studied was 44.3 years (range 35–57). There were 18 females and 17 males. The disc arthroplasty was performed at the L4–L5 level in 19 patients and at the L5–S1 level in 16 patients. The average follow-up was 14 months (range 6–22 months). The preoperative values of global lordosis, ST, and PT were 51.5°, 37.8°, 16.9° and, at last follow-up, they were 51.4°, 37.4°, and 17.5°, respectively. These changes were not significantly different. When the groups were separated according to the level operated, there was still no statistical difference with regard to the overall lordosis, ST, PT or kyphosis from pre- to postoperative period or when the two groups were compared with each other. The level above the prosthesis has always significantly less lordosis. In the present study with use of a motion-preserving Maverick prosthesis, it appears that the patient is able to maintain the preoperative sagittal balance. The prosthesis has enough freedom of motion to allow the patient to maintain the natural sagittal and spinopelvic balance needed to prevent potential undue stress on the muscles and the sacroiliac joint. Although the number of patients is small, this is the first study to our knowledge that evaluates the sagittal balance after motion-preserving total disc arthroplasty.