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This is a retrospective clinical, radiological and patient outcome assessment of 21 consecutive patients with King 1 idiopathic adolescent scoliosis treated by short anterior selective fusion of the major thoracolumbar/lumbar (TL/L) curve. Three-dimensional changes of both curves, changes in trunk balance and rib hump were evaluated. The minimal follow-up was 24 months (max. 83). The Cobb angle of the TL/L curve was 52 degrees (45-67 degrees) with a flexibility of 72% (40-100%). The average length of the main curve was 5 (3-8) segments. An average of 3 (2-4) segments was fused using rigid single rod implants with side-loading screws. The Cobb angle of the thoracic curve was 33 degrees (18-50 degrees) with a flexibility of 69% (29-100%). The thoracic curve in bending was less than 20 degrees in 17 patients, and 20-25 degrees in 4 patients. In the TL/L curve there was an improvement of the Cobb angle of 67%, of the apex vertebral rotation of 51% and of the apex vertebral translation of 74%. The Cobb angle of the thoracic curve improved 29% spontaneously. Shoulder balance improved significantly from an average preoperative imbalance of 14.5-3.1 mm at the last follow-up. Seventy-five percent of the patients with preoperative positive shoulder imbalance (higher on the side of the thoracic curve) had levelled shoulders at the last follow-up. C7 offset improved from a preoperative 19.8 (0-40) to 4.8 (0-18) mm at the last follow-up. There were no significant changes in rotation, translation of the thoracic curve and the clinical rib hump. There were no significant changes in thoracic kyphosis or lumbar lordosis. The average score of the SRS-24 questionnaire at the last follow-up was 91 points (max. 120). We conclude that short anterior selective fusion of the TL/L curve in King 1 scoliosis with a thoracic curve bending to 25 degrees or less (Type 5 according to Lenke classification) results in a satisfactory correction and a balanced spine. Short fusions leave enough mobile lumbar segments for the establishment of global spinal balance. A positive shoulder imbalance is not a contraindication for this procedure. Structural interbody grafts are not necessary to maintain lumbar lordosis.  相似文献
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Ming‐Hsiao Hu MD 《》2018,10(3):198-204

Objective

To identify factors that influence shoulder balance and to determine whether a model can be made to predict shoulder balance after corrective surgery.

Methods

This is a retrospective study in which we examined the records of with adolescent idiopathic scoliosis (AIS) patients who underwent single posterior spinal correction and fusion using all pedicle screws with derotation in our institution between January 2008 and June 2010. For the radiographic outcome measurement, we measured the preoperative lumbar curve, the main thoracic curve, and their difference (L_TH_D), and the degree of correction of the lumbar curve, the main thoracic curve, and their difference (c_L_TH_D) to evaluate their influence on postoperative shoulder balance. The preoperative flexibility of the proximal non‐fusion curve on the immediate postoperative tilt of the upper endplate of the uppermost vertebra of fusion segments (Up_FuS) was used to evaluate and predict the shoulder balance at follow‐up.

Results

For patients who had shoulder balance at follow‐up, the average balance time was 7.1 months, and in most of them, balance was detected within 12 months. The main thoracic curve has the greatest influence on preoperative shoulder tilt and correction of the main thoracic curve has the greatest influence on the postoperative alteration in shoulder balance. To evaluate the influence on the preoperative shoulder tilt, the lumbar curve must be larger than the main thoracic curve both pre operatively and postoperatively. If the preoperative flexibility of the proximal non‐fusion curve on the immediate postoperative Up_FuS includes the horizontal line (With Horizontal group), shoulder balance can be ensured. The postoperative Up_FuS can be evaluated based on the preoperative Up_FuS and the degree of correction of the lumbar and main thoracic curves.

Conclusion

Shoulder balance can be ensured in patients in the With Horizontal group after surgery. If the preoperative Up_FuS and the degree of correction of the main thoracic curve and the lumbar curve are considered in the preoperative plan, the desired postoperative Up_FuS can be achieved, ensuring shoulder balance at follow‐up.
  相似文献
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孙泽宇  李波  简月奎  罗旭 《骨科》2021,12(6):499-504
目的 探讨术前右肩高Lenke 1型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)病人术后的肩关节高度变化,并分析术后肩平衡的影响因素。方法 回顾性分析2015年1月至2017年12月于我院手术治疗的术前右肩高Lenke 1型AIS病人41例,根据术后肩部平衡状态分为双肩平衡组和双肩失衡组。分别测量两组病人术前、术后3个月及术后2年的影像学肩关节高度差(radiographic shoulder height,RSH)、上胸弯Cobb角、主胸弯Cobb角、锁骨角、胸廓锁骨角度差(clavicle chest cage angle difference,CCAD)和T1倾斜角,并计算主胸弯矫正率、上胸弯矫正率、主胸弯柔韧度、上胸弯柔韧度等;分析双肩失衡组病人末次随访时RSH与术前影像学指标的相关性。结果 双肩失衡组术前的锁骨角和CCAD值均高于双肩平衡组,上胸弯柔韧度低于双肩平衡组(P<0.05)。Pearson相关分析显示术前锁骨角、CCAD与术后RSH呈正相关(P<0.05,r>0);上胸弯柔韧度与术后RSH呈负相关(P<0.05,r<0);锁骨角变化、主胸弯及上胸弯矫正率、主胸弯角度变化与RSH变化呈正相关(P<0.05,r>0)。Logistic回归分析未见双肩失平衡的独立危险因素。结论 术前锁骨角、CCAD及上胸弯柔韧度是Lenke 1型AIS病人术后RSH的预测因素,应避免主胸弯过度矫正导致术后肩失衡的发生。  相似文献
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【摘要】 目的:评估纵向可撑开型人工钛肋技术(vertical expandable prosthetic titanium rib,VEPTR)治疗早发性脊柱侧凸(early onset scoliosis,EOS)合并肩部失衡的疗效。方法:回顾性分析在我院行VEPTR技术治疗的8例EOS合并肩部失衡的患者,其中男6例,女2例。初次手术年龄5.0±3.4岁(3~10岁),撑开间隔时间为6~12个月,随访3年以上。比较初次术前、初次术后以及末次随访时的侧凸Cobb角、顶椎偏移、喙突高度差(coracoid height difference,CHD)、锁骨角(clavicle angle,CA)、锁骨倾斜角差(clavicular tilt angle difference, CTAD)和躯干偏移距离(trunk shift,TS)。结果:VEPTR术后随访56±8个月(43~70个月)。全部患者共接受手术46次,平均5.8次/例;共进行撑开延长手术38次,平均4.8次/例(3~6次),平均10个月行撑开延长一次。初次术前、术后和末次随访时的主弯Cobb角分别为82°±19°、49°±19°和52°±18°,顶椎偏移分别为48±17mm、32±12mm和36±12mm,末次随访均较术前有明显改善(P<0.05)。胸椎高度由术前13.2±2.1cm增加到术后15.0±2.2cm,末次随访时增加至18.3±2.4cm;T1-S1高度由术前24.3±3.7cm增加到术后27.8±4.8cm,末次随访时增加至33.8±5.1cm。CHD初次术前为25±5mm,初次术后减至19±6mm(P=0.001),末次随访时为11±4mm(P<0.001)。CA、CTAD初次术前分别为9°±2°和13°±4°,初次术后分别降低为6°±4°和11°±4°(P<0.05),末次随访时则分别降低至5°±4°和9°±4°(P<0.05)。术前的CHD与TS进行相关性分析,结果显示二者存在显著性正相关(r=0.716,P<0.05)。TS初次术前为31±13mm,初次术后减至14±7mm(P=0.011),末次随访时为16±7mm(P=0.007)。结论:VEPTR技术作为一种非融合性矫形技术,依靠纵向撑开力可有效控制EOS患者主弯畸形的进展,维持脊柱的生长,还可促进肩部平衡的改善。  相似文献
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【摘要】 目的:探讨青少年特发性脊柱侧凸(AIS)患者主胸弯融合后未融合上胸弯的变化及其与肩部平衡的关系。方法:回顾性分析2008年1月~2010年12月在我院接受手术治疗的AIS患者,选取年龄10~18岁,Lenke分型为Lenke 1、2、3、4型,右胸弯且Cobb角<80°,采用后路椎弓根螺钉系统固定矫形,固定融合上端椎在T4或T4以下,随访时间2年以上的患者,排除翻修手术和截骨手术患者。术前根据Lenke分型判断上胸弯是否为结构性,分成结构性上胸弯组和非结构性上胸弯组,统计比较两组术前、术后3个月和末次随访时外观肩部平衡以及影像学各项参数的变化。结果:共有62例患者纳入本研究,平均年龄14.4岁,随访时间24~62个月,平均36.4个月,其中结构性上胸弯组17例,非结构性上胸弯组45例。两组患者术后上胸弯均能自发性矫正,末次随访时,上胸弯Cobb角平均由27.9°减小至19.4°,T1倾斜角由-0.21°增加至4.7°,第一肋倾斜角(FRT)由0.4°增加至3.7°,锁骨角(CA)由-1.5°增加至0.8°,双肩高度差(CSH)由-13.0mm增加至5.2mm,改变均有统计学意义(P=0.000)。Pearson相关性分析显示,T1倾斜角的改变(术后T1倾斜角-术前T1倾斜角)与CSH变化(术后CSH-术前CSH)有较强相关性(r=0.624,P=0.000),术后主胸弯的矫正率和FRT与CSH变化为中等程度相关(r=0.437,0.345,P=0.007,0.006),术前主胸弯Cobb角与CSH变化为弱相关(r=0.262,P=0.040)。上胸弯Cobb角及柔韧性、主胸弯柔韧性、T1倾斜角等参数与CSH变化无统计学相关性。结论:AIS患者结构性与非结构性上胸弯在主胸弯矫正以后均有自发性矫正现象,但T1倾斜角、第一肋倾斜角和双肩高度差均会增加。右胸弯患者左肩被抬高的程度与T1倾斜角增加的程度、主胸弯的矫正率及术后第一肋倾斜角相关。  相似文献
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【摘要】 目的:本研究旨在探讨青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)术后肩部外观可塑性,分析基于该现象的胸弯融合上端椎选择策略。方法:对56例Lenke Ⅰ型AIS患者进行回顾性研究,术后随访2~5年。术前Cobb角主胸弯57.65°±12.28°、上胸弯20.34°±9.52°。根据术前肩部平衡、上胸弯柔韧度情况,主胸弯融合上端椎选择方案为:术前右肩抬高非僵硬性上胸弯(柔韧度>30%)患者10例,选择端椎下位椎(端椎-1);僵硬性上胸弯(柔韧度≤30%)患者7例,选择端椎。术前双肩平衡非僵硬性上胸弯患者,7例选择端椎上位椎(端椎+1),7例选择T3;僵硬性上胸弯患者,5例选择T4,6例选择T3。术前左肩抬高非僵硬性上胸弯患者4例,选择端椎上位椎(端椎+1);僵硬性上胸弯患者,1例选择T4,9例选择T3。配对t检验比较术后即刻、末次随访外观肩高(CSD),评估术后肩部外观可塑性。并对术后肩部平衡进行主观评价,其中患者和家属一方或双方认为肩部外观未恢复平衡,为主观评价不满意。通过分析外观CSD变化,影像学冠状面平衡及T2~T5后凸角,患者及家属主观评价,总结基于肩部外观可塑性的上端椎选择策略。结果:末次随访Cobb角主胸弯19.16°±10.34°、上胸弯11.83°±8.65°,冠状面平衡0.67±0.56cm,T2~T5后凸角17.23°±7.28°。1例患者2年内随访主观评价左肩抬高,其余患者无并发症发生。术前、术后即刻、末次随访时,CSD值:1.04±0.24cm、0.92±0.22cm、0.63±0.16cm;CSD≥1cm患者例数:31例、23例、5例。术后即刻与末次随访CSD存在显著差异(t=7.98,P<0.001),最大肩部外观可塑值ΔCSD为1.69cm。随访中肩部恢复平衡的上端椎选择方案:术前右肩抬高非僵硬性上胸弯患者选择端椎-1,右肩抬高僵硬性上胸弯患者选择端椎,双肩平衡非僵硬性上胸弯患者选择端椎+1或T3,双肩平衡僵硬性上胸弯患者选择T3后,患者末次随访CSD均<1cm,主观评价满意;术前左肩抬高非僵硬性上胸弯患者选择端椎+1后1例末次随访CSD为1.06cm,左肩抬高僵硬性上胸弯患者选择T3后1例末次随访CSD为1.02cm,主观评价满意。随访中肩部未恢复平衡的上端椎选择方案:术前双肩平衡僵硬性上胸弯患者选择T4后,2例CSD分别为1.45cm、1.54cm,其中1例随访2年内主观评价左肩抬高;术前左肩高僵硬性上胸弯患者选择T4,1例CSD较大为1.52cm。结论:AIS患者术后肩部外观存在可塑性,基于该特性Lenke Ⅰ型AIS患者胸弯融合上端椎策略为:术前右肩抬高非僵硬性上胸弯患者选择端椎-1,僵硬性上胸弯患者选择端椎;双肩平衡非僵硬性上胸弯患者选择端椎+1,僵硬性上胸弯患者选择T3;左肩抬高非僵硬性上胸弯患者选择端椎+1,僵硬性上胸弯患者选择T3。  相似文献
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【摘要】 目的:观察以胸弯为主的青少年特发性脊柱侧凸(AIS)患者后路矫形术后肩部失平衡的发生情况,探讨其危险因素。方法:回顾性分析96例以胸弯为主的AIS患者的临床资料,Lenke分型为Lenke 1、2、3、4型,均为右胸弯且Cobb角<80°。男15例,女81例;年龄10~18岁,平均14.5岁。均采用后路椎弓根螺钉系统固定矫形,随访22~68个月,平均42.2个月。根据术后肩部平衡情况,将患者分为肩部平衡组和肩部失平衡组,分析比较两组患者的临床资料和影像学特点。结果:肩部失平衡患者17例,发生率为17.7%。单变量分析和Logistic回归分析的结果发现与术后肩部失平衡相关的3个独立因素为:术前锁骨角(OR=1.873,P=0.018)、术前主胸弯Cobb角(OR=2.222,P=0.028)和术后主胸弯Cobb角(OR=0.483,P=0.039)。其中锁骨角和术前主胸弯Cobb角为危险因素,术前锁骨角的正值越大,主胸弯角度越大,术后肩部失平衡的危险性越大;术后主胸弯Cobb角为保护因素,术后主胸弯残余角度较大时,能相对避免肩部失平衡的发生。结论:术前锁骨角为正性倾斜、主胸弯角度较大和术后主胸弯残余角度过小可能是AIS患者主胸弯矫正后肩部失平衡的独立危险因素。  相似文献
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【摘要】 目的:探讨不同上端融合椎对术前双肩水平的Lenke 1型青少年特发性脊柱侧凸(adolescent idiopath?鄄ic scoliosis,AIS)患者术后双肩平衡的影响。方法:选取2006年6月~2009年6月在我院行后路主胸弯融合术并有2年以上完整影像学随访资料的32例Lenke 1型AIS患者。所有患者术前均表现为双肩水平,其中男6例,女26例,手术时年龄13~19岁,平均14.9岁,上胸弯Cobb角平均为23.7°±8.0°(10°~36°),主胸弯Cobb角平均47.5°±6.9°(40°~62°)。按照上端融合椎不同将AIS患者分为两组:A组,上端融合椎为T3,19例;B组,上端融合椎为T4,13例。A组患者的手术时年龄、Risser征、上胸弯及主胸弯柔韧度与B组比较均无统计学差异(P>0.05)。采用方差分析比较两组患者术前、术后1年和末次随访时的上胸弯及主胸弯Cobb角、顶椎及躯干偏移距离、影像学肩关节高度差(radiographic shoulder height, RSH)、喙突高度差(CPH)和锁骨角(CA)。结果:A组随访时间2~4.5年,平均3.6±1.3年;B组随访时间2~4.8年,平均3.1±2.1年,两组比较无统计学差异(P>0.05)。术前、术后1年和末次随访时,A组患者的上胸弯Cobb角、主胸弯Cobb角、顶椎及躯干偏移距离、RSH、CPH及CA与B组比较均无统计学差异(P>0.05)。A、B两组患者术后1年和末次随访时的上胸弯Cobb角、主胸弯Cobb角、顶椎及躯干偏移距离、RSH、CPH、CA分别与术前比较均有显著性改善(P<0.05);末次随访时,两组患者的上胸弯Cobb角及RSH、CPH、CA较术后1年均显著减小(P<0.05),均获得较满意的双肩平衡。结论:对于术前双肩水平的Lenke 1型AIS患者,上端融合椎为T3或T4对重建术后双肩平衡的疗效无明显差别;对此类患者上端融合至T4即可获得良好的矫形效果和满意的双肩平衡。  相似文献
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