Scolioses idiopathiques et congénitales

Résumé D'étiologie toujours inconnue, la scoliose idiopathique de l'adolescent ne peut être traitée efficacement que si le dépistage est très précoce, entre 8 et 10 ans. La preuve de l'évolutivité angulaire doit être faite avant d'entreprendre un traitement orthopédique, dont l'objectif sera de contrôler l'aggravation liée à la poussée de croissance pubertaire. De nouveaux protocoles à temps partiel sont actuellement à l'étude et s'adresseront à des courbures peu sévères et bien réductibles. Les indications opératoires sont posées en cas d'échec ou d'intolérance au traitement orthopédique. Les limites angulaires pour de telles interventions semblent diminuer progressivement, les techniques devenant plus fiables. On accorde par ailleurs de plus en plus d'importance au plan sagittal, compte tenu de la mauvaise tolérance à long terme des lordoses thoraciques. Malgré les progrès techniques, la réalisation d'une arthrodèse solide avec une greffe abondante reste le seul garant de la stabilité angulaire. L'évolution et l'histoire naturelle des courbures congénitales du rachis sont actuellement bien connues, ainsi que les malformations viscérales habituellement associées. La surveillance radiographique dès le plus jeune âge permet d'évaluer l'asymétrie de croissance vertébrale dans le plan frontal et sagittal. Ceci permet de proposer en cas d'évolutivité un traitement à visée étiologique précoce, sous forme d'une hémi arthrodèse et épiphysiodèse convexe, antérieure et postérieure pour freiner l'hypercroissance du côté de la malformation. Pour les formes dépistées plus tardivement, une greffe postérieure avec ou sans matériel est l'indication classique, en évitant absolument toute manoeuvre de distraction qui comporte un risque de complication neurologique, en particulier en cas de composante cyphotique associée.

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Idiopathic and congenital scoliosis

Summary The exact etiology of idiopathic scoliosis is still unknown and therefore the only way to improve the prognosis is to recommend an early screening program, between 8 and 10 years of age. Angular progression must be proven for every curve before any brace application. The goal of such a treatment is to control curve progression during the adolescent growth spur. Recent part-time bracing programs have been proposed for low angle and flexible curves. Surgery is indicated in case of failure or non compliance of the conservative treatment. Currently the angular limits for surgery seem to decrease, as a result of improved surgical techniques. Sagittal unbalance and loss of thoracic lordosis are of major importance for the treatment choice, since their poor outcome in the adult population. Despite technical improvements, the quality of a solid fusion is the most important factor for long lasting results. The natural history and evolution of congenital spine deformities have been precisely documented, as well as the frequently associated visceral problems. Repeated curve measurements in young children will evaluate the growth potential asymetry in the coronal and sagittal planes. In case of rapidly progressive curves, an early surgical treatment can be proposed, consisting in convex anterior and posterior hemiarthrodesis, producing an epiphysiodesis effect of the overgrowing convex side. For cases diagnosed in older ages, the classic indication is a posterior fusion, with or without instrumentation. It is important to avoid any excessive distraction, because of a high risk of neurological complications, especially in case of an associated kyphotic deformity.

Travail présenté aux Actualités. en Orthopédie Pédiatrique organisées par le Dr Cl. Karger, le 19 au 21 mars 1992 à Aubure     

骨髓腔静脉造影在特发性股骨头坏死诊断中的应用

本文介绍17例（34髋）特发性股骨头坏死、4例（4髋）正常人骨髓腔静脉造影所见。发现25髋有异常改变,并经病理证实。作者认为:①骨干返流;②2支或2支以上静脉不显影;③多条静脉明显变细;④干骺端瘀积是股骨头坏死的造影表现,前二者是可靠的诊断依据。造影结果提示髓腔静脉造影是一种安全而敏感的诊断技术。     

已酮可可碱对神经病理性疼痛大鼠的镇痛作用及机制

目的观察已酮可可碱（PTX）对神经病理性疼痛大鼠的镇痛作用及其机制。方法成年雄性SD大鼠96只随机分为假手术组、慢性坐骨神经结扎损伤（CCI）组和PTX组，CCI组和PTX组按Bennett法建立CCI模型．PTX组于术前1d开始至取材点每天腹腔注射PTX 100mg／kg．假手术组注射相同容积的生理盐水，CCI组造模后不做任何处理。于手术后1、3、7、11、14、21d用von-Frey filaments测定机械性痛觉过敏（MWT），按Hargreaves法测定热痛觉过敏（TWL）；并于1、7、14、21d时处死大鼠，取腰段脊髓用双抗体夹心ELISA法测定细胞因子含量。结果与假手术组相比，CCI模型大鼠机械痛阈于术后1d开始下降，7d最显著，热痛阈3d时下降最显著（P〈0．01）。PTX组痛阈在各时间点均较CCI组显著升高（P〈0．05）。CCI后1d即出现IL-6、TNFα、IL-1β蛋白含量升高，于术后7d达到高峰，14d时仍然较高（p〈0．05）。TNFα和IL-1β于术后21d明显下降至接近基础值，但IL-6表达一直持续至术后21d。PTX组脊髓细胞因子含量明显低于CCI组（P〈0．05）。结论PTX可显著抑制神经病理性疼痛，此作用与其抑制脊髓细胞因子表达有关。     

微血管减压术治疗三叉神经痛的预后影响因素研究

目的　探讨影响微血管减压术治疗三叉神经痛手术疗效的因素。方法　分析 6 2例经微血管减压术治疗的三叉神经痛患者的临床特征、术中所见和术后疗效。血管对神经根的压迫程度分为单纯接触、接触和移位、单纯粘连、粘连和移位、萎缩五种。手术疗效包括术后疼痛立即缓解、延迟缓解、明显减轻和无效。结果　 6 2例患者起病时均表现为典型三叉神经痛 ,但在术前 17例已经转变为不典型。术中发现压迫血管与三叉神经根之间单纯接触 14例、接触和移位 7例、单纯粘连 15例、粘连和移位 18例、萎缩 8例。术后平均随访 14个月 ,疼痛在术后立即缓解 32例 (5 1 6 % ) ,延迟缓解 17例 (2 7 4 % ) ,明显减轻 11例 (17 7% ) ,无效 2例。结论　病程短、症状典型、以动脉压迫为主且能够充分减压的患者 ,术后多能获得好的疗效。相反 ,以静脉压迫为主 ,病程长及症状不典型的患者 ,术后疗效多不理想     

特发性脊柱侧凸PUMC分型的可重复性及可信度研究

目的:探讨特发性脊柱侧凸PUMC(协和)分型系统的一致性,并对影响分型一致性的因素进行分析.方法:随机选取南京鼓楼医院2004年～2006年治疗的80例特发性脊柱侧凸患者,其中男性15例,女性65例,平均年龄14.6岁(10～18岁),均有完整的术前站立位正侧位X线片及仰卧位左右Bending片共四张.由4名脊柱外科专科医生分别根据PUMC(协和)分型标准进行分型,2周后此4位医生分别对这些患者的X线片再次进行分型,收集分型结果分别作可信度和可重复性分析,计算Kappa值检验一致性并对影响分型一致性的因素进行统计分析,结果:80例患者均可用PUMC分型,分型可信度平均Kappa值为0.801,可重复性Kappa值为0.878.PUMC分型不一致中包括上胸弯的界定18次;胸弯明显时,代偿性与结构性腰弯的界定15次;腰弯明显时,代偿性与结构性胸弯的界定18次;单弯顶点的判断20次;测量角度的差异18次.结论:PUMC(协和)分型学习曲线相对较短,易于掌握且具有良好的可信度和可重复性.     

Uveal effusion syndrome complicated by anterior ischemic optic neuropathy

We report on a case of idiopathic uveal effusion syndrome complicated by AION. To our knowledge such an association hasn't been previously described. We suggest that scleral thickening caused obstruction of vortex veins followed by uveal effusion and compression of posterior ciliary arteries within their intrascleral tract, leading to AION. Nevertheless it can't be excluded that AION was the result of mechanical compression on ciliary vessels of optic disc by choroidal detachment.     

耳后小切口入路手术治疗三叉神经痛1100例临床分析

本文报告自１９８４年１月至１９９３年４月，对诊断为原发性三叉神经痛久治不愈者１１００例，采用局麻、耳后小切口入路行桥小脑角探查术。据术中发现不同病因采用神经血管减压术、肿瘤切除术等治疗。本组死亡２例，近期总有效率为９９．５％。对本病的治疗方法、术式的选择、并发症和副反应的防治等问题，进行了讨论。     

Allodynia in rats infected with varicella zoster virus—a small animal model for post-herpetic neuralgia

The most common complication of herpes zoster is post-herpetic neuralgia (PHN), which has been defined as severe pain occurring 1 month after rash onset or persisting for greater than 3 months. PHN is classed as a neuropathic pain that is associated with mechanical allodynia where normally innocuous tactile stimuli are perceived as painful. The development of therapies to treat PHN has been hampered by the lack of animal models, which mimic the clinical situation. We have previously reported that varicella zoster virus (VZV) infection in the rat results in mechanical allodynia and thermal hyperalgesia. Here, we report that following VZV infection of the left footpad rats develop a chronic mechanical allodynia, which is present for longer than 60 days post-infection and which resolves by 100 days PI. The model is robust and reproducible with animals consistently developing allodynia by 3 days PI and continuing to present with symptoms for at least 30 days. The reproducible nature of the induction and course of the allodynia allows the use of this model to determine the effect of various compounds on, and to investigate the pathogenic mechanisms underlying the development of VZV-induced allodynia. Comparative studies using HSV-1 show that the induction of the chronic allodynia is VZV-specific and is not a result is of virus replication-induced tissue damage or accompanying inflammation.Therefore, we propose that the rat VZV infection model could prove useful in studying the mechanisms underlying post-herpetic neuralgia.     

Pathological forms of brain electrical activity and localization of its sources in patients with trigeminal neuralgia

No significant differences from the typical electroencephalogram were observed in patients with trigeminal neuropathy. In patients with typical trigeminal neuralgia, the electroencephalogram variations were detected both in the changes of dominant activity and in the appearance of individual pathological phenomena. The three-dimensional localization of pathological activity generators points to the involvement of the median nonspecific brainstem structures into pathological process evoked by trigeminal neuralgia. Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 124, No. 9, pp. 275–279, September, 1997