青少年特发性脊柱侧凸患者体感诱发电位的特点及与Cobb角的关系

Objective To investigate the abnormality of somatosensory evoked potentials (SEPs) in adolescent idiopathic scoliosis (AIS) with different curve magnitudes, and to explore its effect on the etiopathogenesis of AIS. Methods Posterior tibial nerve SEPs were evaluated on 489 young operative treated AIS patients with a Cobb angle > 40°and 45 age-matched healthy control individuals. Absence of SEPs waveforms, prolongation of peek latency or asymmetrical peek latency were defined as pathological change. Base on the control reference, the incidence of pathological SEPs was determined in AIS group. The association of abnormal SEPs and curve severity for MS patients was also assessed. Results Peek latency corrected for body height was slightly longer in AIS patients than in controls, however, with no significant difference. Interside difference of latency was significantly larger in AIS patients. Abnormal SEPs were found in 166 of 489 AIS patients. Among these, 17 (10.2%) showed absent waveforms, 50 (30.1%) had unilateral latency prolongation, 38 (22.9%) had bilateral latency prolongation, and 120 (72.3%) showed significant interside difference. Statistical analysis failed to show a correlation between abnormal SEPs and the curve severity of spinal deformity. Conclusion Disorder of somatosensory pathways does exist in a subgroup of AIS patients, and it might be a primary factor other than secondary change, and could play an import role in the etiopathogenesis of AIS.     

雌激素β受体基因多态性与青少年特发性脊柱侧凸关系的研究

目的 比较分析青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者与对照组雌激素β受体(estrogen β receptor,ER β)基因型分布情况,探讨ER β基因多态性与AIS患者易感性、异常生长模式及低骨量之间的关系.方法 对2006年3月至2007年3月的288例(男17例,女271例)AIS患者进行人体形态学测量,记录其年龄、身高、体重、臂长、月经初潮情况、Cobb角、Risser征等指标,并收集其静脉血标本.经体检收集232名(男30名,女202名)健康青少年静脉血标本.应用聚合酶链反应-限制性片断长度多态性技术(PCR-RFLP)检测分析AIS组及正常青少年组ER β基因型,比较两组间及AIS组内各亚组ER β基因型分布情况.结果 AIS组与对照组ER β基因型分布差异无统计学意义(χ2=5.908,P＞0.05).AIS组内比较,初潮年龄≥12岁组Rr型频率高于初潮年龄＜12岁组(P＜0.05),而根据身高、体重指数(BMI)、臂长、Cobb角、Risser征等分组,基因型分布比较差异无统计学意义(P＞0.05).ER B基因两个多态性位点各基因型间所对应的骨密度比较差异无统计学意义(P＞0.05).结论 ER β基因多态性与AIS患者易感性无关联.Rr型患者存在初潮延迟现象,可能在AIS的进展中起一定作用.ER β基因多态性与骨量无相关,可能在AIS的低骨量中不起作用.     

严重脊柱侧弯患儿家长心理护理体会

严重脊柱侧弯是指脊柱在三维空间上发生的严重的结构和形态畸形,冠状面上cobb角＞90度,表现为头部偏离骨盆中心,双肩不等高,躯干倾斜或塌陷,胸廓畸形改变和肺功能损害.本院自2005年起开展分期手术,使用后路三维矫正技术治疗严重脊柱侧弯,对89例患者先行轮椅颅骨悬吊牵引,8～10周后再行手术治疗,重建躯体的平衡.     

脊柱手术后的慢性脊髓缺血性损伤

<正>病例资料患者女,13岁,骨软骨发育不良伴脊柱侧凸畸形,于2012年8月17日入院。全脊柱X线平片示脊柱三弯畸形,主弯Cobb角92°,胸弯Cobb角60°,腰弯Cobb角75°。全脊柱正位X线片示椎体高度降低,椎弓根间距自上至下保持不变;侧位X线片示胸椎后凸畸形,椎弓根变短。CT三维重建示椎体高度降低,椎体上下面毛糙不平。矢状面MRI示     

后路复位椎弓根长短节段固定治疗严重胸腰椎骨折的临床疗效比较

目的比较经后路复位椎弓根长、短节段固定治疗严重胸腰椎骨折的临床疗效。方法 68例严重胸腰椎骨折患者采用短节段固定42例,长节段固定26例。随访时摄X线正侧位片,测量伤椎前缘高度及脊柱后凸角度,并评估神经功能恢复情况、腰痛程度和腰椎活动度。结果临床疗效、伤椎前缘高度及脊柱后凸角度的恢复,两组无显著性差异,但合并椎体II度以上脱位者长节段固定较短节段固定椎体复位更好,后凸角度丢失也较少;短节段固定3例发生内固定失效。结论严重胸腰椎骨折选择后路短节段或长节段固定,都能达到较满意的伤椎复位、临床疗效和畸形矫正,合并严重脱位选用长节段固定,在伤椎复位、矫正后凸畸形、减少内固定失效更有优势。     

Chiari畸形患者脑脊液流体力学的磁共振研究进展

脑脊液存在于人的颅腔和椎管内。具有流动性。其流速较慢，流向和流速不恒定，湍流和涡流并存。对脑脊液流体力学研究，由于受到方法学上的限制，较血液流体力学研究困难。目前研究结果主要来源于动物实验和创伤性的检查。包括核素脑池造影、动态X线脑池脑室造影、颅内压监测等。远远不能满足科研和临床诊断治疗的需要。     

Jackson骶骨棒内固定技术与腰骶部常用内固定系统的生物力学比较性研究

目的：评估Jackson技术与几种腰骶部常用内固定系统的生物力学性能,为Jackson技术的临床应用提供生物力学依据。方法：15具小牛新鲜脊柱标本（L4到骶尾部全部脊椎）和5具人体新鲜脊柱标本（L3到骶尾部全部脊椎）分成骨密度相似的5组,分别用Dick,RF,Steffee,CD和Jackson等技术进行腰骶部固定,并测量它们的生物力学特征。结果：Jackson技术固定组比其它组更坚固和具有更好的稳定性,在前屈、后伸、侧弯及抗扭转时的载荷－应变／位移曲线上明显优于其它组（P＜0.01）。结论：Jackson技术是一种有效的腰骶部内固定技术。     

NF-1脊柱侧凸伴肋骨头脱位:行肋骨头切除术有必要吗?

正1型神经纤维瘤病(neurofibromatosis type 1,NF-1)脊柱侧凸伴肋骨头脱位是否需行肋骨头切除目前仍存在争议。既往文献认为,NF-1患者的神经功能状态、肋骨头侵占椎管的严重程度是决定治疗策略的关键因素~([1]);也有学者认为,对于无神经功能损害的患者,脱位肋骨头的切除是预防潜在神经功能损害的最重要手段~([2、3])。目前的共识是对于合并神经功能损害、相应的MRI检查明确证实脱位的肋骨头     

青少年特发性脊柱侧凸患者FBN3基因多态性研究

目的 探讨FBN3基因多态性与青少年特发性脊柱侧凸(AIS)发生发展以及AIS患者异常生长模式之间的关联性.方法 本研究包括273例AIS患者及287名正常青少年.采用PCR-RFLP的方法 对FBN3基因外显子区域的4个多态性位点进行基因分型.结果 rs35277492位点AIS患者组和对照组均只出现CC一种基因型.FBN3基因多态性位点rs35579498、rs12608849、rs7257948基因型及等位基因分布AIS组与正常对照组比较没有明显差异.在AIS组内,rs7257948位点校正身高≥160 cm2组AIS患者CC基因型要明显多于160 cm2组(P=0.01).rs35579498位点,月经初潮年龄≥12岁的AIS女性患者T等位基因型表现活跃(P=0.015),CT基因型明显高于初潮年龄<12岁患者(P=0.042).3个位点不同基因型所对应的最大Cobb角、臂长以及BMI差异均无统计学意义.结论 FBN3基因rs35277492、ra35579498、rs12608849、rs7257948位点多态性与AIS的发病及侧凸严重程度无明显相关性.FBN3 rs35579498位点在AIS组中T等位基因表达相对活跃(P=0.051),可能影响月经来潮,在一定程度上影响AIS的发病及侧凸的进展,而rs7257948位点可能影响AIS患者的身高.     

青少年特发性脊柱侧凸患者体感诱发电位的特点及与Cobb角的关系

Objective To investigate the abnormality of somatosensory evoked potentials (SEPs) in adolescent idiopathic scoliosis (AIS) with different curve magnitudes, and to explore its effect on the etiopathogenesis of AIS. Methods Posterior tibial nerve SEPs were evaluated on 489 young operative treated AIS patients with a Cobb angle > 40°and 45 age-matched healthy control individuals. Absence of SEPs waveforms, prolongation of peek latency or asymmetrical peek latency were defined as pathological change. Base on the control reference, the incidence of pathological SEPs was determined in AIS group. The association of abnormal SEPs and curve severity for MS patients was also assessed. Results Peek latency corrected for body height was slightly longer in AIS patients than in controls, however, with no significant difference. Interside difference of latency was significantly larger in AIS patients. Abnormal SEPs were found in 166 of 489 AIS patients. Among these, 17 (10.2%) showed absent waveforms, 50 (30.1%) had unilateral latency prolongation, 38 (22.9%) had bilateral latency prolongation, and 120 (72.3%) showed significant interside difference. Statistical analysis failed to show a correlation between abnormal SEPs and the curve severity of spinal deformity. Conclusion Disorder of somatosensory pathways does exist in a subgroup of AIS patients, and it might be a primary factor other than secondary change, and could play an import role in the etiopathogenesis of AIS.