Application of posterior Moss-Miami transpedicular system for the treatment of adolescent idiopathic scoliosis

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.     

Posterior Selective Thoracic Fusion in Adolescent Idiopathic Scoliosis Patients： a Comparison of All Pedicle Screws versus Hybrid Instrumentation

Objective To analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion. Methods By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients who underwent selective thoracic fusion from February 2000 to January 2007 in our hospital, the patients were divided into 2 groups according to different instrumentation fashions： Group A was hook-screw-rod （hybrid） internal fixation type, Group B was screw-rod （all pedicle screws） internal fixation type, and the screws were used in every segment on the concave side of the thoracic curve. The parameters of the scoliosis were measured and the correction results were analyzed. Results Totally, 48 patients （7 males, 41 females） were included, with an average age of 14.4 years old and a mean follow-up time of 12.3 months. Thirty and 18 patients were assigned to group A and group B, respectively. The mean preoperative coronal Cobb angles of the thoracic curve were 48.8° and 47.4°, respectively. After surgery, they were corrected to 13.7° and 6.8°, respectively. At final follow-up, they were 17.0° and 9.5°, with an average correction rate of 64.6% and 79.0%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The mean preoperative coronal Cobb angles of the lumbar curve were 32.6° and 35.2°, respectively. After surgery, they were corrected to 8.6° and 8.3°, respectively. At final follow-up, they were 10.3° and 11.1°, with an average correction rate of 66.8% and 69.9%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The correction loss of the thoracic curve and lumbar curve in the 2 groups were 3.1° and 1.8°, 2.4° and 2.4°, respectively. No significant difference was noted （both P〉0.05）. The decompensation rate at final follow-up in these 2 groups were 4% （1/25） and 7.1% （1/14） respectively, with no significant difference （P〉0.05）.     

VIDEO-ASSISTED THORACOSCOPIC CORRECTION AND FUSION OF SCOLIOSIS

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.     

POSTERIOR SELECTIVE THORACIC FUSION IN ADOLESCENT IDIOPATHIC SCOLIOSIS

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.     

青少年特发性脊柱侧凸胸弯和胸腰弯/腰弯的结构性侧凸预测因素分析

Background:Recent studies have proven that the Lenke system is relatively efficient and consistent in classifying scoliosis curves. Basically speaking, the fusion should include the main curve and structural minor curve. Minor curve’s structural criteria were established to help guiding the surgeon in this decision-making process. To the best knowledge of the authors, there are no available studies showing the predictors of structural curves. Methods: Age, gender, cobb angle, perdriolle rotation, risser sign, number of vertebrae included in the curve, brace treatment and curve location were recorded from 145 idiopathic scoliosis patients from July 2001 to January 2007. All patients were divided into two groups: structural and non structural group. Demographics and baseline characteristics were compared between the two groups to do an initial screening. Logistic regression was used to analysis for factors affecting minor curves to be structural curves. Results: Structrual group had higher cobb angle(51.34±13.61° vs 34.20±7.21°,P=0.000),bending angle (33.94±9.92° vs. 8..46±5.56°, P=0.000) , curve rotation(23.25±12.86vs14.21±8.55, P=0.000),and lower flexibility(33.48±12.53vs75.50±15.52, P=0.000) than nonstructural curves. Other parameters didn’t show significant difference between the two groups. The results of the Logistic regression analysis show us that for adolescent idiopathic scoliosis, Cobb angle(OR 9.921,P=0.000) and curve location (OR 4.119,P=0.016) were significant predictors of structural curves. That is to say every ten-degree change of Cobb’s angle can increase the possibility of turning the minor curves into structural scoliosis by ten times. And thoracic curves showed, on the average, the possibility of becoming structural curves was about 4 times that of the thoracolumbar/lumbar curves. Conclusions: Curve severity and curve location affects minor curve’s structrual features in adolescent idiopathic scoliosis.     

Surgical Treatment of Scoliosis in Patients with Charcot-Marie-Tooth Disease

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.     

Computer-assisted minimally invasive spine surgery for resection of ossification of the ligamentum flavum in the thoracic spine

Background Ossification of the ligamentum flavum （OLF） has been widely recognized as one of the main causes of thoracic spinal canal stenosis and thoracic myelopathy.Decompression is the only effective strategy for treating thoracic myelopathy caused by OLF.The purpose of this study was to describe the clinical outcomes of computer-assisted minimally invasive spine surgery （CAMISS） for posterior decompression in patients with thoracic myelopathy caused by OLF.Methods In all cases,the surgical procedure was performed with the assistance of an intraoperative three-dimensional navigation system.Decompression of the spinal cord was performed with a high-speed drill; the supraspinal ligaments and spinous process were partially preserved.The outcomes were evaluated by a modified Japanese Orthopedic Association （JOA） scoring system and recovery rates.Results The mean duration of follow-up for the 14 cases was 3.9 years.All patients experienced neurological recovery,the mean JOA score improving from 6.1 points preoperatively to 8.6 points at final follow-up and the mean rate of recovery being 52.7% （excellent in two cases,good in eight,fair in three,and unchanged in one）.Conclusion CAMISS is a safe and effective procedure for resection of the OLF in the thoracic spine.     

Selective anterior thoracolumbar/lumbar fusion and instrumentation in adolescent idiopathic scoliosis patients

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.     

COA: Sagittal plane analysis of the spine and pelvis in adult idiopathic scoliosis

Background There has been an increasing recognition of the importance of sagittal spinopelvic alignment in patients with scoliosis as it relates to clinical outcomes. However, the changes seen in sagittal spinopelvic alignment in adult idiopathic scoliosis patients is poorly defined. This study was conducted to evaluate the sagittal alignment of pelvis and spine in adult idiopathic scoliosis patients.Methods The sagittal parameters of the spine and pelvis were analyzed in lateral standing radiographs of 124 patients （mean age 47.4 years） with adult idiopathic scoliosis, including thoracic kyphosis （TK）, thoracolumbar junction kyphosis （TLJ）, lumbar lordosis （LL）, pelvic incidence （PI）, sacrum slope （SS）, pelvic tilt （PT） and C7 plumb line （C7PL）. The patients were divided into three groups according to the age： 20-40 years, 41-64 years, and ≥65 years. The parameters were compared with those in normal adults and adolescent idiopathic scoliosis （AIS） patients. The relationship between all parameters as well as age and sagittal parameters were analyzed.Results The PI in patients with adult idiopathic scoliosis was 58.1°±13.0°, which was significantly higher than that in normal adults. The PT （19.9°±10.6°） was also higher than that in both normal adults and AIS patients, while the SS （38.1°±12.0°） was similar or smaller. As age increased, C7PL, PT and TJL increased while LL decreased. There was no relationship between age and both PI and TK. PT had the strongest statistical association with the C7PL.Conclusions PI is higher in adult idiopathic scoliosis than normal subjects. The PT is the most relevant pelvic parameter to the global sagittal alignment of the spine. Age significantly influences sagittal parameters of the spine and pelvis except the PI and TK.     

Postoperative Disc Wedging in Adolescent Idiopathic Thoracolumbar/Lumbar Scoliosis: a Comparison of Anterior and Posterior Approaches

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.     

青少年特发性脊柱侧凸术前柔韧性评价方法比较研究

目的 前瞻性比较术前悬吊牵引像（Tr）、仰卧位弯曲像（SB）和支点弯曲像在评价青少年特发性脊柱侧凸（AIS）柔韧性和预测手术矫形效果中的意义。方法根据入选／排除标准选择AIS68例,所有病例均为单弯（PUMC分型为Ia／Ib／Ic）,根据术前正位x像COBB角大小分4组：中度胸弯组（19例,40°〈COBB≤60°）、重度胸弯组（13例,COBB〉60°）、中度腰弯组（28例,35°〈COBB≤60°）和重度腰弯组（8例,COBB〉60°）。各组均按PUMC分型原则接受相同手术方法,均使用第3代节段性内固定系统。采用标准方法测量术前站立全脊柱正位像、Tr、SB和fulcrum以及术后正位像COBB角大小,计算出3种X线方法的侧凸柔韧性大小并与手术矫正率对比,所得结果进行统计学分析。结果中度胸弯组柔韧性为fulcrum（75％）〉SB（63％）〉Tr（50％）,手术矫正率为80％（与fulcrum柔韧性差异无统计学意义）。重度胸弯组柔韧性为fulcrum（39％）〉Tr（29．1％）〉SB（29．1％）,手术矫正率为57％。中度腰弯组柔韧性为SB（79％）〉fulcrum（76％）〉Tr（44％）,sB与fulcrum差异无统计学意义,手术矫正率为86％。重度腰弯组柔韧性为fulcrum（53％）〉SB（47％）〉Tr（38％）,fulcrum与SB差异无统计学意义,手术矫正率为67％。结论 Fulcrum可更好地评价AIS胸弯但只能预测中度胸弯的柔韧性和术后矫正率,fulcrum和SB评价腰弯柔韧性的价值无明显差异。     

支点弯曲柔韧性对成人特发性脊柱侧凸矫形效果的评估意义

目的 了解支点弯曲像柔韧性(FBF)与手术治疗成人特发性脊柱侧凸矫形率(CR)的关系,探讨支点弯曲柔韧性对成人脊柱侧凸矫形手术效果的评估能力.方法 对69例进行手术治疗的特发性成人脊柱侧凸患者拍摄术前站立位、支点弯曲位和术后站立位X线片,测量其胸段/胸腰段脊柱侧凸的Cobb角,计算支点弯曲柔韧性和矫形率,对二者进行统计学分析.结果 使用数据分析软件SPSS 10.0对FBF和CR率进行回归分析,得出:CR=0.213+0.768×FBF,即支点弯曲柔韧性每提高1个单位,矫形率提高0.768个单位(P<0.01).结论 支点弯曲矫形率和手术矫形率存在明显的线性关系,使用此方程,可对符合条件的多病例样本进行矫形率预测,能够客观评估新的矫形器械或矫形方法的矫形效果.     

The assessment of immediate post-operative scoliosis correction using pedicle screw system by utilising the fulcrum bending technique

Assessment of the curve flexibility is a crucial step in a surgeon's pre-operative planning for scoliosis surgery. Many techniques have been described. These include traction films, supine side bending films, push prone techniques, traction under general anaesthesia as well as fulcrum bending film. In this study, we studied the pre- and immediate post-operative radiographs of twenty eight adolescent idiopathic scoliosis (AIS) patients who were corrected using pedicle screw systems between January 2004 and August 2006. There were twenty two females and six male patients. The mean age of the patients were 17.5 years with a range of 12 to 38 years. Skeletal maturity of the patients was assessed by Risser's score. The majority was Risser 4 (15 cases, 53.6%). Based on King and Moe's classification, the most common curve was type 3 curve (15 cases, 53.6%). Among the twenty eight patients, twenty three patients underwent only posterior correction, while 5 patients underwent additional anterior release surgery. The mean pre-operative Cobb's angle for the posterior surgery group was 65.5 +/- 13.9 degrees and the mean post-operative Cobb's angle was 32.9 +/- 12.6 degrees. There was no difference between the mean correction estimated by fulcrum bending films (Fulcrum Flexibility) and the post- operative Correction Rate figures (44.2% vs. 49.9%). The mean Fulcrum Bending Correction Index (FBCI) in this group of patients is 112.8%. In the group of patients who underwent additional anterior release, their curves were noted to be larger and less flexible with the mean pre-operative Cobb's angle and Fulcrum Flexibility of 90.4 degrees +/- 9.3 degrees and 23.4% respectively. The Fulcrum Bending Correction Index (FBCI) for this group of patients was significantly higher than the posterior surgery group: i.e. 164.0% vs 112.8%. Thus, anterior release does help to improve the correction significantly. The fulcrum bending films give good pre-operative estimation of the amount of correction to be expected post-operatively. The fulcrum bending films can help to identify the curve types which might require anterior release in order to improve the scoliosis correction. Using the Fulcrum Bending Correction Index (FBCI) will also enable surgeons to quantify more accurately the amount of correction achieved by taking into account the inherent flexibility of the spine.     

长海支点侧屈位X线片在骨骼发育成熟的特发性脊柱侧弯柔韧性评估中的应用

目的 评价长海支点侧屈位X线片在骨骼发育成熟的特发性脊柱侧弯患者术前柔韧性评估中的作用和价值.方法 选取2013年6月至2015年2月19例骨骼发育成熟的特发性脊柱侧弯患者,女性15例,男4例;年龄20～30岁,平均(23.1±3.5)岁.采用第二军医大学长海医院自行研制的可升降可测重长海支点侧屈位装置对患者的25个胸椎及腰椎侧弯进行术前影像学柔韧性评估.评估内容包括术前站立前后位X线片、长海支点侧屈位X线片(基础支点侧屈位、最大支点侧屈位)、仰卧侧屈位X线片、传统支点侧屈位X线片以及术后1周站立前后位X线片.术前与术后参数间比较采用配对t检验,参数间的相关性采用Pearson相关性分析.结果 19例患者共包括25个结构性弯曲,其中17个主胸弯、8个胸腰/腰弯.仰卧侧屈位、传统支点侧屈位、长海基础支点侧屈位Cobb角与术后1周站立前后位Cobb角相比差异均有统计学意义(P均＜0.05);传统支点侧屈位、长海基础支点侧屈位Cobb角与长海最大支点侧屈位Cobb角相比差异均有统计学意义(P均＜0.05).主胸弯和胸腰/腰弯2种侧弯的评估结果与整体评估结果一致.整体数据的相关性分析提示长海基础支点侧屈位、长海最大支点侧屈位柔韧性指数与手术矫正率均呈正相关(r=0.84、0.87,P均＜0.01);长海最大支点侧屈位支点高度与支点上所测得的最大重量呈正相关(r=0.67,P=0.001),高度变化与支点重量变化也呈正相关(r=0.60,P=0.001).结论 与传统的支点侧屈位X线片及仰卧侧屈位X线片相比,长海支点侧屈位X线片可以更好地反映骨骼发育成熟的特发性脊柱侧弯患者的柔韧性,可用于辅助脊柱侧弯患者的术前柔韧性评估;长海支点侧屈位X线片的结果更接近椎弓根螺钉系统矫形的结果.     

应用多层螺旋CT曲面重建技术评价特发性脊柱侧凸柔韧度

目的 探讨应用多层螺旋CT曲面重建(CPR)技术评价特发性脊柱侧凸的冠状面和矢状面,提出特发性脊柱侧凸柔韧度评价的新方法,确立侧凸脊柱卧位的冠状面和矢状面特征.方法 45例10～18岁特发性脊柱侧凸青少年女孩进行了术前多层螺旋CT脊柱扫描.采用曲面重建技术分别对脊柱进行了冠状面和矢状面的重建,测量了主弯、代偿弯的Cobb角等各项数值,并与患者X线影像结果进行了比较分析.结果 侧凸曲面重建后,冠状面主弯曲面重建(CPR)图像的Cobb角较主弯X线站立位像Cobb角平均小10.17°,冠状面代偿弯CPR的Cobb角较代偿弯X线站立位像Cobb角平均小6.97°.对于侧凸冠状面柔韧度的评价,Fulcrum像方法提供了最大的术前矫正程度.对于主胸弯组和主腰/胸腰弯组的对比没有发现,10～14岁年龄组和15～18岁年龄组间仅术后Cobb角有差别.对于手术矫形率和柔韧度,主胸弯组和主腰/胸腰弯组Bending像两组的柔韧度有差异.不同年龄组比较发现手术矫形率、主弯柔韧度和代偿弯的柔韧度两组比较,10～14岁柔韧度较大.矢状面上,主胸弯组和主腰/胸腰弯组CPR胸后凸(T5～T12)角和CPR上胸弯(T1～T5)角两组之间比较,主胸弯的胸后凸角度较小.按年龄分组中,CPR胸后凸(T5～T12)Cobb角两组之间有差异,10～14岁组的胸后凸Cobb角度较小.相关分析示CPR主弯的柔韧度、Bending像的柔韧度和手术矫形率相关.结论 AIS主弯的卧位CPR柔韧度、Bending像柔韧度和侧凸的手术矫形率呈正相关.10～14岁AIS患者矢状面胸后凸较15～18岁患者减小,主胸弯AIS患者矢状面的胸后凸和上胸弯较主腰/胸腰弯AIS患者减小.脊柱侧凸CT下曲面重建对侧凸类型的诊断和侧凸三维的分析很有帮助,可以在1次扫描后获得对侧凸三维等多方面的评价.     

脊柱侧凸畸形支点侧屈位数字X线摄片对矫正预测评估的价值

目的:通过青少年特发性脊柱侧凸的4种术前数字X线摄影,分析适宜的摄影体位及影像,评估临床脊柱矫形的预测矫正数据。方法:对42例特发性脊柱侧凸患者的53个结构性弯曲行术前脊柱站立正位、仰卧牵引正位、仰卧侧屈正位及支点侧屈正位数字X线摄影,比较摄影特点计算校正率,并与术后站立位影像对比。测量所有Cobb角并进行统计学评价。结果:术前胸弯组和腰弯组中,仰卧牵引正位平均Cobb角分别为(43±2)°和(38±2)°,支点侧屈正位平均Cobb角分别为(35±1)°和(19±1)°,术后的Cobb角分别为(32±1)°和(18±1)°;仰卧侧屈正位平均Cobb角分别为(41±2)°和(33±2)°,支点侧屈正位Cobb角分别为(29±1)°和(12±1)°,术后Cobb角分别为(27±1)°和(12±1)°。术前及术后Cobb角之间比较:支点侧屈正位无显著性差异,而仰卧牵引正位和仰卧侧屈正位有显著性差异,(P<0.05)。支点侧屈正位校正度与校正率均大于仰卧牵引正位及仰卧侧屈正位。结论:站立正位和支点侧屈正位可保持同一状态下重复性的摄影姿势,能主动配合且易标准化。支点侧屈正位能真实反映侧凸的僵硬程度及柔韧度,较准确地预测脊柱侧凸矫形的校正度。     

脊柱侧凸旋转与手术矫正率的相关性

目的探讨脊柱侧凸旋转与手术矫正率的关系。方法2005年1月~2006年12月,44例青少年特发性脊柱侧凸患者接受手术矫正治疗。术前均行全脊柱磁共振成像(MRI)检查,测量以顶椎为中心9个椎体上下终板层旋转角度,计算椎体和椎间盘机械旋转,以获得脊柱的旋转顺应性;拍摄凸侧Bending位及手术前后胸腰椎正侧位X线片,测量凸侧Bending相Cobb角及手术前后正侧位Cobb角,比较手术前后测量指标差异,计算侧凸柔韧性及矫正率。对侧凸旋转顺应性和柔韧性与手术矫正率进行相关性分析。结果手术前后冠状位和矢状位Cobb角比较均有显著差异(P<0.05)。相关性分析显示,侧凸柔韧性与冠状位Cobb角呈负相关(r=-0.574,P=0.013),而与手术矫正率相关性差;旋转顺应性与冠状位Cobb角无显著相关性,与手术矫正率之间则呈显著正相关(r=0.887,P=0.000)。结论特发性脊柱侧凸患者的侧凸旋转顺应性与后路椎弓根螺钉去旋转矫形的手术矫正率高度相关,术前测量并计算旋转顺应性对于该类手术效果的预计具有重要的意义。     

CORRECTIVE SURGERY OF CONGENITAL SCOLIOSIS WITH TYPE II SPLIT SPINAL CORD MALFORMATION

CONGENITALspinaldeformitiesareusuallyduetovertebraldevelopmentaldisordersduringthefirst8weeksofgestation,1thisperiodalsoin volvesclosureoftheneuraltube,thuspatientswithcon genitalspinaldeformitiesmayalsohaveneuraltubedeform itiesamongstwhichsplitspinalcor…     

ANTERIOR SPINAL FUSION WITH TSRH INSTRUMENTATION FOR SCOLIOSIS

Objective. To introduce a new spinal internal fixation system, Texas Scottish Rite Hospital (TSRH), and to investigate its early clinical outcomes.Methods. The preliminary clinical outcomes of 15 patients with thoracolumbar or lumbar scoliosis treated by anterior spinal fusion with TSRH instrumentation were studied retrospectively. Fourteen patients were diagnosed as idiopathic scoliosis and 1 as neuromuscular scoliosis.Results. Preoperatively, the Cobb's angle on the coronal plane was 55. 8° (range 35° - 78°), and 14° postoperatively, with an average correction of 74. 8 %. The average unfused thoracical curve was 35. 9 ° preoperatively (range 26° - 51°) and 21. 8° (10°-42° ) postoperatively, with 40% correction. The sagittal curve of lumbar was kept physiologically, preoperative 27. 9° and postoperative 25. 7° respectively. The trunk shift was 13.4 mm (5 - 28mm) preoperatively and 3. 5 mm (0-7 mm) postoperatively. The averaged apic vertebra derivation was 47. 8 mm (21 - 69 mm) before operat