脊柱矫形后发生近端交界性后凸危险因素的荟萃分析

文题释义： 近端交界性后凸：是脊柱矫形术后出现的并发症之一,通常因手术近端内固定交界区的应力改变引起,是一种与脊柱融合相关的邻近节段疾病。 近端交界区后凸角：采用 Cobb 角测量法测量,它被定义为最上端固定椎体的下终板和上2个相邻椎体的上终板之间的后凸角,若该后凸角大于10°,且同术前相比增加10°以上,则认为发生了近端交界性后凸。 背景：对于实施脊柱畸形矫形的患者,近端交界性后凸是术后常见的并发症,可导致成年人和青少年脊柱畸形患者多种不良临床预后。因此,有必要对可能导致矫形术后患者发生近端交界性后凸的危险因素进行分析,以扩大对近端交界性后凸的认识并为预防其发生提供指导。 目的：通过荟萃分析评价影响脊柱畸形矫形术后发生近端交界性后凸畸形的危险因素。 方法：在PubMed、EMbase、Cochrane、中国知网和万方医学检索截止至2019年5月发表的公开文献,严格评价文献质量,根据纳入标准和排除标准选择文献,收集相关数据,使用RevMan 5.3软件统计分析相关数据,评估荟萃分析结果。 结果与结论：①共纳入26篇文献,总计4 498例患者,其中921例患者术后发生近端交界性后凸,经分析后显示脊柱矫形术后近端交界性后凸发生率为25%;②年龄,体质量指数,骨质疏松,手术椎体数量,最上端固定椎体至胸腰段(T₁₀-L₁),最下端固定椎体固定至骶骨/骨盆/髂骨,术后近端交界区后凸角、腰椎前凸角和矢状面垂直偏移,术前术后近端交界区后凸角变化、腰椎前凸角变化和矢状面垂直偏移变化,以上指标在近端交界性后凸患者和非近端交界性后凸患者之间差异有显著性意义(P < 0.05);③而性别、截骨、前后联合手术、术前近端交界区后凸角、术前腰椎前凸角在近端交界性后凸患者和非近端交界性后凸患者之间差异无显著性意义(P > 0.05);④该荟萃分析显示,非手术因素中高龄、体质量指数、骨质疏松;手术因素中固定节段> 5个椎体,最上端固定内固定至胸腰段,最下端固定至骶骨/骨盆/髂骨,术后近端交界区后凸角、腰椎前凸角、矢状面垂直偏移,术前术后近端交界区后凸角、腰椎前凸角、矢状面垂直偏移变化较大是近端交界性后凸发生的主要危险因素。可通过干预高危人群及手术方案的制定,降低近端交界性后凸的发生率。由于多种非手术因素和手术因素共同作用产生近端交界性后凸,仍需进行更严谨的流行病学研究为减少近端交界性后凸的发生提供可靠证据。 ORCID: 0000-0002-1890-0731(张健) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

一期后路VCR技术治疗活动期胸腰段脊柱结核伴严重后凸畸形

目的:评估一期后路全脊椎截骨(VCR)技术治疗活动期胸腰段脊柱结核伴严重后凸畸形的疗效.方法:自1998至2006年活动期胸腰椎结核伴严重僵硬角状后凸畸形患者36例,均应用VCR技术行一期后路全脊椎截骨矫形脊髓减压术,术后外支具制动3个月.所有病例随访至少2年,随访期间每6个月进行l临床评估和放射学检查.结果:无围手术期死亡发生,平均手术时间208(145～385)min,后凸Cobb角从术前平均57.2°(17°～86°)矫治到术后平均为8.9°(-6°～27°),C7-S1水平距离术前平均为13.6(8～19)mm,术后平均为3.6(-11～9)mm.术前有神经症状功能障碍者19例,术后神经功能改善率89.5%(17/19).围手术期并发症发生率为8.3%(3/36),包括肺炎和表层伤口感染,随访期并发症发生率为5.5%(2/36),表现为内固定植入物松动,25例(69.4%)获得良好的骨性融合.随访期间,25%(9/36)的患者对治疗结果非常满意,66.7%(24/36)的患者对治疗结果满意,2例一般,1例不满意.结论:一期后路VCR技术是一种治疗活动期胸腰段脊柱结核伴严重后凸畸形安全有效的外科手术方法,该手术技术要求高,外科医师必须熟练病理解剖并谨慎实施.     

The sagittal balance of the spine in children and adolescents with osteogenesis imperfecta

In severe forms of osteogenesis imperfecta, multiple compression fractures of the spine, as well as vertebral height shortening could be responsible for an increased thoracic kyphosis or a diminished lumbar lordosis. Theses progressive changes in sagittal shapes of the trunk could be responsible for a global sagittal trunk imbalance. We compare the parameters of sagittal spinopelvic balance in young patients with OI to those parameters in a control group of healthy volunteers. Eighteen patients with osteogenesis imperfecta were compared to a cohort of 300 healthy volunteers. A standing lateral radiograph of the spine was obtained in a standardized fashion. The sacral slope, pelvic tilt, pelvic incidence, lumbar lordosis, thoracic kyphosis, T1 and T9 sagittal offset were measured using a computer-assisted method. The variations and reciprocal correlations of all parameters in both groups according to each other were studied. Comparison of angular parameters between OI patients and control group showed an increased T1T12 kyphosis in OI patients. T1 and T9 sagittal offset was positive in OI patients and negative in control group. This statistically significant difference among sagittal offsets in both groups indicated that OI patients had a global sagittal balance of the trunk displaced anteriorly when compared to the normal population. Reciprocal correlations between angular parameters in OI patients showed a strong correlation between lumbar lordosis (L1L5 and L1S1) and sacral slope. The T9 sagittal offset was also strongly correlated with pelvic tilt. Pelvic incidence was correlated with L1S1 lordosis, T1 sagittal offset and pelvic tilt. In OI patients, the T1T12 thoracic kyphosis was statistically higher than in control group and was not correlated with other shape (LL) or pelvic (SS, PT or PI) parameters. Because isolated T1T12 kyphosis increase without T4T12 significant modification, we suggest that vertebral deformations worsen in OI patients at the upper part of thoracic spine. Further studies are needed to precise the exact location of most frequent vertebral deformities.     

胸腰椎骨折晚期后凸畸形的手术治疗

胸腰椎骨折晚期后凸畸形多由早期治疗失败引起，处理比较棘手。手术治疗有助于矫正畸形、重建脊柱矢状位平衡和促进神经功能恢复，手术入路以前、后路联合手术最为理想。     

Scheuermann’s disease: focus on weight and height role

The aim of this cross-sectional case-control study is the comparison of the weight and height between a group of children with Scheuermann’s disease (SD) and a comparable group of healthy ones and also the correlation of them with the degree and the morphology of the kyphotic curve. Following a school-screening program of 10,057 school students, aged between 11 and 17 years old, 175 adolescents with Scheuermann’s disease were diagnosed. The mean height and weight of 175 adolescents diagnosed to have SD compared with this of a group of normal children taken randomly from the group of 9,882 healthy children screened. The control group was comparable with the study group concerning age (p = 0.605) and sex. The weight, height and body mass index (BMI) were significantly lower in the healthy (control) group (p < 0.001). However, there was no correlation between weight (r = –0.019, p = 0.804), height (r = 0.053, p = 0.484) and BMI (r = –0.177, p = 0.019) with the magnitude of kyphotic curve. There was also no correlation between weight (r = –0.27, p = 0.722), height (r = –0.025, p = 0.744) and BMI (r = –0.038, p = 0.619) with Voutsinas index as well. Scheuermann’s disease is probably a multifactorial skeletal deformity. Weight and height do not seem to affect the magnitude and morphology of the main kyphotic curve in SD. It seems probably that this observation is not part of the pathogenetic mechanism of SD but a result of its cascade. The increased weight and height of these patients may be the secondary result of other disturbances (i.e. hormonal), which may play more crucial role in Scheuermann’s disease pathogenesis.     

SRS-Schwab Grade 4 osteotomy for congenital thoracolumbar kyphosis: a minimum of 2 years follow-up study

Background Context

Several osteotomy techniques including pedicle subtraction osteotomy and vertebral column resection have been employed in the correction of congenital kyphosis (CK) and satisfying outcomes have been demonstrated. However, the Scoliosis Research Society (SRS)-Schwab Grade 4 osteotomy, defined as resection of posterior elements, partial vertebral body, and superior adjacent disc, is rarely reported in the treatment of CK.

Autosomal recessive otofaciocervical syndrome type 2 with novel homozygous small insertion in PAX1 gene

Otofaciocervical syndrome (OTFCS) is described as a single gene disorder of both autosomal dominant and autosomal recessive inheritance. The major clinical features of OTFCS include ear malformations (external/middle/inner ear), facial dysmorphism, shoulder girdle abnormalities, vertebral anomalies, and mild intellectual disability. The autosomal recessive form of OTFCS syndrome (OTFCS2) has been recently reported to be caused due to homozygous mutations in PAX1 gene. Here we report a third family of OTFCS2 phenotype wherein whole exome sequencing identified a novel homozygous small insertion in PAX1 as the underlying genetic cause.     

俯卧位脊柱全长加压CT检查在骨质疏松性脊柱骨折伴后凸畸形治疗中的作用

目的 :探讨俯卧位脊柱全长加压CT检查在骨质疏松性脊柱骨折伴后凸畸形治疗中的意义。方法 :回顾性分析我院2016年4月~2017年4月收治的18例骨质疏松性脊柱骨折伴后凸畸形患者临床资料,其中男1例,女17例,年龄63.5±7.5岁(47~75岁)。患者术前均行俯卧位脊柱全长加压CT检查,术前、术后2周及末次随访时行站立位位脊柱全长X线片检查。影像学测量局部后凸Cobb角(local kyphosis Cobb angle,LKCA)、胸椎后凸角(thoracic kyphosis,TK)和腰椎前凸角(lumbar lordosis,LL)。计算"后凸柔韧度"(站立位LKCA-俯卧位LKCA)/站立位LKCA×100%,根据其指导手术方案。分别比较术前俯卧位加压脊柱全长CT和术前、术后2周及末次随访时站立位脊柱全长X线片测得的LKCA、TK和LL。结果:术前站立侧位X线片所测得的LKCA、TK和LL分别是52.46°±15.63°、36.13°±9.55°和33.31°±10.33°,术前俯卧位脊柱全长加压CT定位像测得的LKCA、TK和LL分别是36.94°±15.69°、28.09°±7.62°和26.99°±6.75°,差异有统计学意义(P0.05)。后凸柔韧度(31.6±9.89)%(16.4%~60.6%)。术后2周LKCA和TK、LL分别为18.30°±3.57°、18.23°±6.75°和26.99°±6.75°,同末次随访LKCA、TK和LL分别是20.86°±5.34°、17.92°±6.31°和18.54°±4.77°相比,无统计学差异(P0.05)。术后2周、末次随访时、术前站立位脊柱全长X线片的LKCA、TK、LL同术前俯卧位脊柱全长CT相比有统计学差异(P0.05)。结论 :俯卧位加压脊柱全长CT定位像作为一种全新的新型影像学技术,对骨质疏松性脊柱骨折伴后凸畸形的临床影像学的准确评估和手术方案的制定具有十分重要的指导意义。     

经皮椎体后凸成形术治疗骨质疏松性胸腰椎压缩性骨折的临床观察

目的探讨经皮椎体后凸成形术治疗骨质疏松性胸腰椎压缩性骨折的疗效。方法我院采用经皮椎体后凸成形术治疗骨质疏松性胸腰椎压缩性骨折69例。结果术后随访不同时间其VAS评分较术前明显改善。术后疗效评价:治愈18例,显效30例,有效19例,无效2例。结论采用采用经皮椎体后凸成形术治疗骨质疏松性胸腰椎压缩性骨折的临床疗效确切,值得临床推广应用。     

Assessment of lumbosacral kyphosis in spondylolisthesis: a computer-assisted reliability study of six measurement techniques

Although recognized as an important aspect in the management of spondylolisthesis, there is no consensus on the most reliable and optimal measure of lumbosacral kyphosis (LSK). Using a custom computer software, four raters evaluated 60 standing lateral radiographs of the lumbosacral spine during two sessions at a 1-week interval. The sample size consisted of 20 normal, 20 low and 20 high grade spondylolisthetic subjects. Six parameters were included for analysis: Boxall’s slip angle, Dubousset’s lumbosacral angle (LSA), the Spinal Deformity Study Group’s (SDSG) LSA, dysplastic SDSG LSA, sagittal rotation (SR), kyphotic Cobb angle (k-Cobb). Intra- and inter-rater reliability for all parameters was assessed using intra-class correlation coefficients (ICC). Correlations between parameters and slip percentage were evaluated with Pearson coefficients. The intra-rater ICC’s for all the parameters ranged between 0.81 and 0.97 and the inter-rater ICC’s were between 0.74 and 0.98. All parameters except sagittal rotation showed a medium to large correlation with slip percentage. Dubousset’s LSA and the k-Cobb showed the largest correlations (r = −0.78 and r = −0.50, respectively). SR was associated with the weakest correlation (r = −0.10). All other parameters had medium correlations with percent slip (r = 0.31–0.43). All measurement techniques provided excellent inter- and intra-rater reliability. Dubousset’s LSA showed the strongest correlation with slip grade. This parameter can be used in the clinical setting with PACS software capabilities to assess LSK. A computer-assisted technique is recommended in order to increase the reliability of the measurement of LSK in spondylolisthesis.