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1.
Objective To evaluate the different influences of anterior and posterior correction and fusion approaches upon disc wedging in adolescent idiopathic thoracolumbar/lumbar scoliosis. Methods The retrospective study was conducted with the medical records and radiographs of adolescent idiopathic thoracolumbar/lumbar scoliosis patients that underwent anterior (group A) or posterior (group B) correction and fusion surgery from December 1998 to May 2008. The correction of the main curve and changes of the disc wedging were analyzed. Results Fifty-three patients were included, 26 in group A and 27 in group B. The mean coronal Cobb angles of the main curve in group A and group B were significantly corrected after surgery (P〈0.05), with an average correction rate of 75.2% and 88.2%, respectively. Upon final follow-up, the coronal Cobb angles of the two groups were 18.9°± 11.1 ° and 7.7°±5.6°, respectively, with an average correction loss of 6.8°±6.5° and 2.7°±3.3°, respectively. The coronal Cobb angle after operation and at final follow-up, and the correction rate were significantly better in group B than those in group A (P〈0.05), while the coronal Cobb angle loss in group A was greater than that in group B (P〈0.05). The disc wedging before operation, after operation, and at final follow-up were 3.2°±3.0° 5.7°±3.0% and 8.6°±4.4° in group A, and 2.4°±3.2° , 3.3°± 3.4°, and 3.7°± 3.6° in group B, respectively. Postoperative disc wedging was significantly larger compared with preoperative measurements in group A (P〈0.05), but not in group B (P〉0.05). The difference between disc wedging at final follow-up and that after surgery was significant in group A (P〈0.05), but not in group B (P〉0.05). Between the two groups, group A had larger disc angles after operation and at final follow-up (P〈0.05), and a greater loss of disc angle (P〈0.05). Conclusion For adolescent idiopathic thoracolumbar/lumbar scoliosis, posterior approach using all pedicle screws might produce a better result in terms of disc wedging compared with anterior approach.  相似文献   

2.
Background Selective anterior thoracolumbar/lumbar (TL/L) fusion and instrumentation in adolescent idiopathic scoliosis (AIS) patients with a structural major TL/L curve and a nonstructural minor thoracic curve is rarely reported. We investigate the correction results of these patients.Methods By reviewing the medical records and roentgenograms of AIS patients undergone selective anterior TL/Lfusion and instrumentation, Cobb angle, correction rate of the major and minor curves, coronal balance, lowest instrumented vertebra (LIV) tilt, coronal disc angle immediately below the LIV (LIVDA) and radiographic shoulder height (RSH) were measured and analyzed.Results Forty patients were included. For the major TL/L curve, the mean coronal Cobb angle before and after operation were 43.9° and 8.7°, respectively, with an average correction rateof 80.2% (P=0.000). While for the minor thoracic curve, the mean coronal Cobb angle before and after operation were 27.2° and 14.3°, respectively, with an average spontaneous correction rate of 47.4% (P=0.000). At final follow-up, the coronal Cobb angles of the major and minor curves were 13.7° and 17.1°, respectively, with a mean correction loss of 5.0° and 2.9°, respectively. The coronal balance before and after operations was 13.2 mm and 11.5 mm, respectively. At the final follow-up, it turned to 5.6 mm,which was much better than that after operation (P=0.001). The mean LIV tilt was 23.5° before operation, and was significantly improved after operation (8.3°, P=0.000). At final follow-up, it was well maintained (10.6°). The LIVDA averaged 3.5° before operation, and aggravated to 5.5° after operation (P=0.100) and 7.4° at final follow-up (P=0.012),respectively. The RSH was 7.3 mm before operation, 5.6 mm after operation, and 2.2 mm at the final follow-up. The RSH at the final follow-up was significantly improved compared with that after operation (P=0.002).Conclusions Selective anterior TL/L fusion and instrumentation can get good correction results of both curves, with good results of the coronal balance and RSH in AlS patients, while a larger LIVDA.  相似文献   

3.
Objective To evaluate the operative technique and preliminary results of video-assisted thoracoscopic anterior correction and fusion of scoliosis. Methods Eleven cases underwent thoracoscopic anterior correction and fusion of scoliosis from March 2003 to April 2005 in our hospital were reviewed. They were all females with an average age of 13.1 years old. Of which, 9 cases were idiopathic scoliosis, 1 case was congenital scoliosis, and 1 case was Marfan syndrome scoliosis. The coronal Cobb angle and apical vertebral translation before and after surgery as well as at final follow-up were measured. The operation time, blood loss during operation, and peri-operative complications were recorded. Results The mean operation time was 6.4 hours, mean instrumented vertebrae were 6.4 segments, and mean blood loss during operation was 364 mL. The coronal Cobb angles of the thoracic curve before and after surgery were 45.5° and 15.4° respectively, with an average correction rate of 65.4%. The lumbar curve was corrected from 28.4° to 11.8°, with an average simultaneous correction rate of 57.2%. All of the patients were followed up regularly with an average time of 21.4 months. At the final follow-up, the coronal Cobb angles of the thoracic and lumbar curves were 19.0° and 20.1°, with a 3.6° and 8.3° loss of correction, respectively. The apical vertebral translation was improved from 32.3 mm to 10.5 mm for the thoracic curve, and from 13.1 mm to 8.2 mm for the lumbar curve. There were 6 cases with peri-operative complications, including 1 case of thoracic effusion, 1 case of chylothorax, 1 case of locking plug loosing, 2 cases of aggravation of the unfused lumbar curve (1 case also with thoracolumbar kyphosis), and 1 case with a screw tip causing a contour deformity of the aorta. And 4 of them underwent revision surgery. Conclusions Video-assisted thoracoscopic anterior correction and fusion of scoliosis has good correction capability, less intraoperative bleeding, and favorable cosmetic effect for mild and moderate thoracic scoliosis, but with higher rates of correction loss of the lumbar curve and peri-operative complications. A surgeon should be cautious to perform this technique.  相似文献   

4.
Objective To define the criteria of posterior selective thoracic fusion in patients with adolescent idiopathic scoliosis.Methods By reviewing the medical records and roentgenograms of 17 patients with adolescent idiopathic scoliosis who underwent posterior selective thoracic fusion, the curve type, Cobb angle, apical vertebral rotation and translation, trunk shift, and thoracolumbar kyphosis were measured and analyzed.Results There were 17 King type Ⅱ patients (PUMC type: Ⅱb1 13, Ⅱc3 4). The coronal Cobb angle of thoracic curve before and after operation were 56.9°and 21.6° respectively, the mean correction rate was 60.1%. The coronal Cobb angle of lumbar curve before and after operation were 34.8° and 12.1° respectively, and the mean spontaneous correction rate was 64.8%.At final follow-up, the coronal Cobb angle of thoracic and lumbar curve were 23.5° and 15.2° respectively, there were no significant changes in the coronal Cobb angle, apical vertebral translation and rotation compared with that after operation.One patient had 12° of thoracolumbar kyphosis after operation, no progression was noted at final follow-up. There was no trunk decompensation or deterioration of the lumbar curve. In this group, 3.9 levels were saved compared with fusing both the thoracic and lumbar curves.Conclusion Posterior selective thoracic fusion can be safely and effectively performed in King type Ⅱ patients with a moderate and flexible lumbar curve, which can save more mobile segments and at the same time can maintain a good coronal and sagittal balance.  相似文献   

5.
Objective: To determine the effectiveness of posterior Moss-Miami transpedicular system for the treatment of adolescent idiopathic scoliosis in 24 patients with a 2-year minimum follow-up. Methods: 24 patients who underwent operations between September 2002 and November 2003 were evaluated for curve correction, spinal balance, and complications. Age at surgery averaged 13.8 years (range from 10 to 20). The spinal deformities were evaluated by Cobb method with anteroposterior and lateral bending radiographs. All patients were right thoracic curves. Posterior instrumentation (Moss-Miami transpedicular system) was used. The transpedicular screws were placed between T2 and L2. All the patients were assessed both clinically and radiographically. Follow-up averaged 2.8 years. Results: There was an average correction of 72% of the primary curve (pre-operation standing average 54 degrees (range from 40 to 67 degrees), post-operation average 15.2 degrees (range from 2 to 27 degrees), at last examination average 16.1 degrees (range from 2 to 30 degrees). Infection and neurological complications were not noted. No major complications were observed. Conclusions: Frontal and sagittal thoracic curve correction of thoracic scoliosis can be satisfactorily obtained using Moss Miami transpedicular instrumentation. It seems that control of the three columns of the spine by the transpedicular screws offers sufficient apical translation and coronal realignment.  相似文献   

6.
Objective To retrospectively analyze the relationship between curve types and clinical results in surgical treatment of scoliosis in patients with neurofibromatosis type 1 (NF-1).Methods Forty-five patients with scoliosis resulting from NF-1 were treated surgically from 1984 to 2002. Mean age at operation was 14.2 years. There were 6 nondystrophic curves and 39 dystrophic curves depended on their radiographic features. According to their apical vertebrae location, the dystrophic curves were divided into three subgroups: thoracic curve (apical vertebra at T8 or above), thoracolumbar curve (apical vertebra below T8 and above L1), and lumber curve (apical vertebra at L1 and below). Posterior spine fusion, combined anterior and posterior spine fusion were administrated based on the type and location of the curves. Mean follow-up was 6.8 years. Clinical and radiological manifestations were investigated and results were assessed.Results Three patients with muscle weakness of low extremities recovered entirely. Two patients with dystrophic lumbar curve maintained their low back pain the same as preoperatively. The mean coronal and sagittal Cobb′s angle in nondystrophic curves was 80.3° and 61.7° before operation, 30.7° and 36.9° after operation, and 32.9° and 42.1° at follow-up,respectively. In dystrophic thoracic curves, preoperative Cobb's angle in coronal and sagittal plane was 96.5° and 79.8°,postoperative 49.3°and 41.7°, follow-up 54.1° and 45.3°, respectively. In thoracolumbar curves, preoperative Cobb's angle in coronal and sagittal plane was 75.0° and 47.5°, postoperative 31.2° and 22.8°, follow-up 37.5° and 27.8°, respectively. In lumbar curves preoperative Cobb's angle in coronal plane was 55.3°, postoperative 19.3°, and follow-up 32.1 °. Six patients with dystrophic curves had his or her curve deteriorated more than 10 degrees at follow-up. Three of them were in the thoracic subgroup and their kyphosis was larger than 95 degrees, and three in lumbar subgroup. Hardware failure occurred in 3cases. Six patients had 7 revision procedures totally.Conclusions Posterior spinal fusion is effective for most dystrophic thoracic curves in patients whose kyphosis is less than 95 degrees. Combined anterior and posterior spinal fusion is stronger recommended for patients whose kyphosis is larger than 95 degrees and those whose apical vertebra is located below T8. Patients should be informed that repeated spine fusion might be necessary even after combined anterior and posterior spine fusion.  相似文献   

7.
Objective :To introduce a key-vertebral-screws technique (KVST) in the surgical treatment of scoliosis extending to main thoracic levels, and to find the role of fulcrum bending in predicting the result of surgical treatment for scoliosis by this technique. Methods: Seventeen consecutive patients with scoliosis extending to main thoracic spine, who underwent pure posterior fusion without anterior or posterior release by KVST between January 2004 and July 2005 were evaluated for fulcrum bending flexibility, surgical correction rate, fulcrum bending correction index (FBCI) in main thoracic curves. Universal Spine System (USS) instrumentation was used in 15 cases, Monarch in another 2 cases. The severity of the curves was measured by Cobb's method using RadWork 6.0 software. Preoperative standing AP radiographs, preoperative fulcrum bending anterioposterior (AP) radiographs, postoperative standing AP radiographs, and most recent follow-up standing AP radiographs for spine were measured and recorded. All the data were analyzed with two-sample paired t-test by Origin 7.0 software. Results: Infection and neurological complications were not noted. No major complications were found. Just one case had some axial back pain, which got a full recovery from physiotherapy for 2 weeks. In the X-ray, there was an average correction of 71.5 % of the fused main thoracic curves, which had no significant lose of correction in final follow-up. For the whole fused main thoracic curves, the fulcrum bending flexibility were lower to operation correction rate (P=0. 013). The average FBCI was 123%. From the data, the more rigid curves (especially fulcrum bending flexibility 〈50%), the more correction rate operation could get, compared with fulcrum bending flexibility. Conclusion: (1) KVST is a good method in the surgical treatment of thoracic scoliosis, which can get satisfying result with lower medical cost. (2) Fulcrum bending flexibility is lower than operative correction rate by KVST in main  相似文献   

8.
Surgical treatment of degenerative scoliosis   总被引:1,自引:0,他引:1  
Objective To investigate the techniques of posterior lumbar interbody fusion and pedicle screws in the treatment of degenerative scoliosis and evaluate their clinical significance. Methods Twenty five patients with degenerative scoliosis were treated operatively during 1997 -2002. Among the 25 pateints,13 pateints were treated with Brantigan I/F carbon cages in 28 intervertebral spaces,7 patients were treated with Prospace cages in 15 spaces, 1 patient was treated with CONTACT cages in 2 spaces. The correcting effects, complications and follow-up results were analyzed retrospectively. Results The average correction rate of scoliosis was 59 % and the rate of pain relief was 88 %. There were a case of pseudoarthritis and a case of embolism. During follow-up, correction rate and height of dics spaces were not lost nor shift of interbody cages. Conclusion Posterior pedicle screws combined with interbody fusion is a safe and effective treatment for degenerative scoliosis. 5 refs, 2 figs.  相似文献   

9.
Objective: Apparently, scoliosis occurs in approximately one-third of patients with Charcot-Marie-Tooth disease. Little is known about the response of these curves to treatment. The purpose of this study was to evaluate the results of spinal surgery in these peculiar patients. Methods: We retrospectively evaluated the results of spinal surgery in eight patients who had scoliosis due to clinically and electrophysiologicaUy proven Charcot-Marie-Tooth disease. Radiographs were reviewed. The location and direction of the curve pattern, the age at the time of surgery, type of surgery, number of levels fused, instrumentations used, intra or postoperative complications, and results and need for reoperation were recorded. Results: Eight patients associated with Charcot-Marie-Tooth disease who underwent scoliotic surgery were identified. The average age and curve at the time of surgery were 21.1 years and 56.4° respectively. 62.5% of the curves had left thoracic component and more than one third was associated with thoracic hyperkyphosis. Long posterior spinal fusion was performed most often, with an average of 11.5 spinal segments fused. Instrumentation was used in all posterior fusions. At an average of 39 months (range, 24 to 72 months) postop- eratively, the fusion appeared to be solid in all patients. Conclusion: Scoliosis in patients with Chareot-Marie-Tooth disease differs from that in patients with idiopathic scoliosis in regarding to the etiology and the prevalence of thoracic hyperkyphosis, but the surgical management appears to be similar. Spondylodesis does not appear to be associated with a high rate of complications.  相似文献   

10.
Since February 1982, 23 patients with scoliosis were treated by releasing the soft tissues on the concave side and plaster spinal fusion jacket. Of these patients, 13 had congenital scoliosis and 10 idiopathic scoliosis. Follow-up for 1 to 8.5 years showed that the results of correction were satisfactory. The maximum degree of correction of the main curve in this series was from 74 degrees (Cobb method) before treatment to 3 degrees after treatment. The maximum rate of correction was 97.3%.
  相似文献   

11.
Mucosa-associated lymphoid tissue (MALT) is a term .that describes lymphoid tissue in various sites of the body, such as the gastrointestinal tract, thyroid, breast, lung, salivary glands, eye, and skin. MALT lymphoma of the lung is a subset of primary pulmonary lymphomas which originates from the MALT. Previously reported computed tomographic (CT) features of MALT lymphoma are the presence of consolidation or nodules in the lungs. To our knowledge, however, there have been rare reports of MALT lymphoma of the lung which are manifested on CT as multifocal cystic structures. The purpose of this report is to present a case of MALT lymphoma which, on high resolution CT (HRCT) scan, manifested as bilateral multifocal cystic structures, and to correlate these findings with the histological findings.  相似文献   

12.
长期住院卧床的老年病人随着年龄增长和内分泌的改变,容易造成骨钙流失,骨骼变得脆而易裂,又由于较少接受太阳照射、运动不足、营养不良等原因,导致骨质疏松而易发生自发性骨折n1。我院老年科于2011年2月收治1例长期卧床老年痴呆病人多处自发性骨折的患者,经分析老年人易发骨折的各种因素,对症处理,并且实施了前瞻性综合预防,取得了较好效果,现报告如下。  相似文献   

13.
BACKGROUND: Rheumatoid arthritis (RA), as a common systemic inflammatory autoimmune disease, affects approximately 1 in 100 individuals. Effective treatment for RA is not yet available because current research does not have a clear understanding of the etiology and pathogenesis of RA. Xinfeng Capsule, a patent Chinese herbal medicine, has been used in the treatment of RA in recent years. Despite its reported clinical efficacy, there are no large-sample, multicenter, randomized trials that support the use of Xinfeng Capsule for RA. Therefore, we designed a randomized, double-blind, multicenter, placebo-controlled trial to assess the efficacy and safety of Xinfeng Capsule in the treatment of RA. METHODS AND DESIGN: This is a 12-week, randomized, placebo-controlled, double-blind, multicenter trial on the treatment of RA. The participants will be randomly assigned to the experimental group and the control group at a ratio of 1:1. Participants in the experimental group will receive Xinfeng Capsule and a pharmaceutical placebo (imitation leflunomide). The control group will receive leflunomide and an herbal placebo (imitation Xinfeng Capsule). The American College of Rheumatology (ACR) Criteria for RA will be used to measure the efficacy of the Xinfeng Capsule. The primary outcome measure will be the percentage of study participants who achieve an ACR 20% response rate (ACR20), which will be measured every 4 weeks after randomization. Secondary outcomes will include the ACR50 and ACR70 responses, the side effects of the medications, the Disease Activity Score 28, RA biomarkers, quality of life, and X-rays of the hands and wrists. The first four of the secondary outcomes will be measured every 4 weeks and the others will be measured at baseline and after 12 weeks of treatment. DISCUSSION: The result of this trial will help to evaluate whether Xinfeng Capsule is effective and safe in the treatment of RA. TRIAL REGISTRATION: This trial has been registered in ClinicalTrials.gov. The identifier is N CT01774877.  相似文献   

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15.
Intraditional Chinese medicine (TCM),the so-called津液refers to all the fluid and liquid flowingand maintaining inside the human body.In Chineselanguage,津液is a phrase composed of twoChinese characters which describes two differentkinds of fluid or liquid in the human body .According to the theory of TCM,津refers to thepart of fluid that is thin in texture and flowss moothly inside the body while液refers to thepart of fluid that is thick in texture and mainlymaintains in the joints of the body to nourish andlubr...  相似文献   

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17.
Objective To observe the different impacts of electrolytic iron, FeSO4, and NaFeEDTA on body iron store of anemic school students. Methods Four hundreds anemic students at the age of 11-18 years were divided into four groups. Of which, three consumed different iron fortificants from wheat flour as food vehicle for six months and one consumed non-fortified flour (control). The fortification level of electrolytic iron, FeSO4, and NaFeEDTA was 60 mg Fe/kg, 30 mg Fe/kg, and 20 mg Fe/kg, respectively. Blood samples were collected at 0, 2, 4, and 6 months and hemoglobin (Hb), serum ferritin (SF), and transferrin receptor (TfR) were measured. Results The hemoglobin levels in three intervention groups increased, the increments of Hb in the NaFeEDTA group were significantly higher than that in the other groups. SF and TfR levels increased in the tested groups and body iron store in the NaFeEDTA group was higher than that in the other groups. These parameters did not show any significant changes in the control group. Conclusion NaFeEDTA and FeSO4 tortified wheat flour has positive impacts on iron status in anemic students and NaFeEDTA is more effective than FeSO4, while electrolytic iron is less effective in improving iron store in anemic students.  相似文献   

18.
Objective To examine the effects of chlorogenic acid (CGA) on lipid and glucose metabolism under a high dietary fat burden and to explore the possible role of peroxisome proliferator-activated receptor-α (PPAR-α) in these effects. Methods Twenty male golden hamsters were randomly divided into CGA treatment group (n=10, given peritoneal injection of CGA solution prepared with PBS, 80 mg CGA/kg body weight daily), and control group (n=10, given PBS i.p. at the average volume of the treatment group). Animals in both groups were given 15% high fat diet. Eight weeks after treatment with CGA, the level of biochemical parameters in fasting serum and tissues and the expression of hepatic mRNA and protein PPAR-α were determined. Results Eight weeks after treatment with CGA, the levels of fasting serum triglyceride (TG), free fatty acid (FFA), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), glucose (FSG), and insulin (FSI) were significantly lower in the GGA treatment group than in the control group. CGA also led to higher activity of hepatic lipase (HL) lower contents of TG and FFA in liver, and lower activity of lipoprotein lipase (LPL) in skeletal muscle. Furthermore, CGA significantly elevated significantly elevated the expression level of mRNA and protein expression in hepatic PPAR-α. Conclusion CGA can modify lipids and glucose metabolism, which may be attributed to PPAR-α facilitated lipid clearance in liver and improved insulin sensitivity.  相似文献   

19.
INTRODUCTION
A 56-year-old Chinese female patient with A (H1N1) influenza pneumonia accompanied by acute disseminated encephalomyelitis (ADEM) of the Central Nervous System (CNS) is described in this article. The patient had typical clinical manifestation, and the diagnosis was reached after MRI and other examinations. From this case, we can conclude that the virus of A (H1N1) influenza can infect CNS, and we should pay more attention to patients of A (H1N1) influenza pneumonia with neurological complications.  相似文献   

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