青少年特发性脊柱侧凸影像学评估研究进展

青少年特发性脊柱侧凸(AIS)是一种复杂的脊柱三维畸形。影像学检查能测量AIS侧凸与旋转角度,预测病情进展,协助康复和手术治疗,包括X线平片、三维立体放射技术、计算机断层技术、磁共振成像技术和三维超声成像技术。本文综述其在AIS评估中的应用参数、信度与效度、优势与劣势。三维影像学成像评估技术将是今后的研究趋势。     

青少年特发性脊柱侧凸康复治疗现状与进展

正脊柱侧凸是一种三维的脊柱和躯干扭转异常,包括在冠状面上的侧方弯曲,水平面上椎体旋转和矢状面上脊柱正常生理曲度改变~[1]。青少年特发性脊柱侧凸(Adolescent Idiopathic Scoliosis,AIS)是脊柱侧凸中最常见的类型,发病率约为2%~3%~[1],最新调查显示其在我国的发病率为5.2%~[2]。目前AIS病因尚未明确,研究显示可能与遗传基因、不良姿势、某些激     

脊柱侧凸特定运动疗法研究进展

正脊柱侧凸是指脊柱在冠状面上向侧方弯曲,常伴有横断面上椎体旋转和矢状面上生理弧度改变,是一种三维畸形[1]。青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)是指一种发生于10岁以上至发育成熟前的青少年的病因不明的脊柱侧凸,发病率高。AIS是一种复杂的、多因素、     

超声成像在青少年特发性脊柱侧凸病变中的研究进展

近年来肌骨超声成像技术发展飞速, 应用日益广泛。伴随着医学影像融合、医工结合及人工智能等创新理念的渗透和推广, 人们逐渐开展了超声对脊柱侧凸病变的成像研究。青少年特发性脊柱侧凸(adolescent idiopathic scoliosis, AIS)作为一种复杂的脊柱三维畸形, 是最常见的脊柱侧凸治疗类型之一。AIS病因不明, 可对患者造成不同程度的身心损害。目前, X线是脊柱侧凸首选的影像学检查方法, 但其有辐射, 也不便于患者多次复查。超声作为一种无辐射、高分辨率、低成本且可便携的无创检查手段, 使其有可能用于脊柱侧凸的评估, 笔者就超声在AIS中的诊断进展进行综述。     

CT分析退行性腰椎侧凸伴椎体侧方滑脱的解剖学变化

背景:以前的研究主要集中于探讨椎体侧方滑脱与腰椎侧凸曲线变化及与疼痛之间的关系,很少有关于椎体侧方滑脱解剖学变化的详细报道.目的:观察退行性腰椎侧凸所致椎体侧方滑脱的解剖学改变.方法:选择烟台毓璜顶医院收治的退行性腰椎侧凸伴椎体侧方滑脱患者21例,男9例,女12例;年龄54～72岁,平均65岁;所有患者均行腰椎CT检查.通过腰椎冠状面重建CT图像测量椎体侧方滑脱距离,采用Aaro法在轴位CT图像上测量椎体旋转角度.结果与结论:椎体侧方滑脱在远端终椎非常多见,滑脱部位上端椎体向主弧曲线的凸面旋转,而下端椎体则向主弧曲线的凹面旋转.Cobb角平均值为25°,椎体侧方滑脱距离及旋转角度平均值分别为6.5 mm、6.7°,椎体侧方滑脱距离(X)与椎体旋转角度(Y)问有显著的相关性(r8=0.63;P＜0.01).     

无标记X射线片评价特发性脊柱侧凸不同大小Cobb角的一致性

背景:Cobb角测量是影响特发性脊柱侧凸King、Lenke和PUMC分型一致性的重要因素之一.文献报道冠状面Cobb角测量一致性较好.但是,纳入研究的Cobb角范围较大,无法对比研究,亦无曲度大小对Cobb角测量一致性影响的报道.目的:分析特发性脊柱侧凸曲度对Cobb角测量一致性的影响.方法:4名骨科医师独立测量53例特发性脊柱侧凸患者的94个冠状面曲度,包括53个胸弯和41个胸腰弯/腰弯,2周后打乱排序重新测量.应用组间相关系数判定可靠性和可重复性.结果与结论:94个侧凸角度测量误差平均7.3°(2°～27°),一致性极佳,可信度及可重复性分别为0.972(95%可信区间0.962～0.980)和0.961～0.977.＞45°～70°组41个侧凸,角度测量误差平均6.4°(2°～14°),一致性最佳,可信度0.960(95%可信区间0.935～0.977),可重复性0.914～0.930.20°～45°组31个侧凸,角度测量误差平均6.5.(2°～13°);＞70°组31个侧凸,角度测量误差平均10.1°(3°～27°).两组均取得了好到极佳的可信度[0.933和0.926,95%可信区间(0.884～0.965和0.865～0.965)]和可重复性(0.854～0.912和0.864～0.950).提示不同大小冠状面Cobb角的一致性结果相近,且角度越大,测量误差对一致性的影响越小.     

特发性脊柱侧凸Cobb’s角与顶椎多变量旋转畸形的相关性

背景：特发性脊柱侧凸是一种三维畸形，目前对其外观表现与畸变的内在规律所知甚少。目的：探讨特发性脊柱侧凸Cobb’s角与顶椎多变量旋转畸形之间的内在规律。设计：采用非随机对照的回顾性研究。地点和对象：研究地点为哈尔滨医科大学附属第二医院骨科，研究对象为特发性脊柱侧凸患者37例，男21例，女16例；年龄9～32岁。方法：行脊柱正位X线摄片测量侧凸的Cobb’s角及顶椎cT扫描测量顶椎的旋转角度(Aaro法)和双侧椎根轴心线与椎体轴心线夹角。主要观察指标：正位X线摄片Cobb’s角，CT片顶椎旋转角度及双侧椎弓根与椎体轴心角度。结果：在38&;#176;～124&;#176;内，侧凸Cobb’s角每增加1&;#176;，顶椎旋转增加0．39&;#176;。凸凹侧顶椎椎弓根轴心线与椎体轴心线夹角分别为(4．72&;#177;6．02)&;#176;，(14．22&;#177;6．52)&;#176;。结论：特发性脊柱侧凸Cobb’s角与顶椎旋转之间有明显的内在联系和线性关系，双侧顶椎椎弓根与椎体轴心角度有显著差异。     

存在腰弯的青少年特发性脊柱侧凸患者站立位及步行中骨盆冠状面倾斜程度分析

目的 评估存在腰弯的青少年特发性脊柱侧凸(adolescent idiopathic scoliosis, AIS)患者步态周期中骨盆冠状面倾斜程度。方法 回顾性纳入2020年9月—2023年2月北京协和医院康复医学科存在腰弯的AIS患者及同期微小弯患者(Cobb角<10°)。根据协和保守分型系统及全脊柱正位X线片,纳入存在腰弯的AIS患者。以双侧髂嵴作为骨盆冠状面的骨性标志点,测量患者站立位及步行周期中双侧髂嵴高度及其变化值,以评估存在腰弯的AIS患者骨盆冠状面倾斜程度。结果 共入选符合纳入与排除标准的存在腰弯的AIS患者209例、微小弯患者36例。存在腰弯的AIS患者组站立位髂嵴较高侧与脊柱凸侧之间关系“一致”(凸侧的髂嵴低于凹侧)的比例显著高于微小弯患者(58.9%比30.6%,P=0.002)。存在腰弯的AIS患者在整个步态周期中双侧髂嵴高度(支撑相最小值、支撑相最大值、摆动相最小值及摆动相最大值)变化值均具有统计学差异(P均<0.001),且凸侧的髂嵴高度变化值明显高于凹侧(P均<0.05),而微小弯患者在整个步态周期中双侧髂嵴高度变化值均无统计学差异(P均...     

实验性脊柱侧凸的病因学研究进展及相关建模方法

脊柱侧凸(scoliosis)是指脊柱的一个或数个节段在冠状面上偏离中线,并伴有水平面椎体旋转和矢状面上生理性前凸或后凸的减少或增加的一种复杂的三维平面的畸形。国际脊柱侧凸研究学会(scoliosis research society,SRS)将脊柱侧凸定义为：站立全脊柱正位 X 线平片的脊柱侧方弯曲,应用 Cobb 法测量如角度大于10°即可称之为脊柱侧凸。脊柱侧凸在儿童各种脊柱畸形中最为常见,其发病率达到0.5%~3%[1,2]。脊柱侧凸是疾病的一种表现,根据病因学特点,可将其分为以下几种类型：①特发性脊柱侧凸(idiopathic scoliosis,IS);②先天性脊柱侧凸(congenital scoliosis,CS);③神经肌肉型脊柱侧凸(neuromuscular scoliosis,NS)等。其中特发性脊柱侧凸是指原因不明的脊柱侧凸,最常见,约占总数的75%~80%。根据其发病的年龄不同,特发性脊柱侧凸又可分为：①婴儿型特发性脊柱侧凸(0~3岁);②少儿型特发性脊柱侧凸(4~10岁);③青少年型特发性脊柱侧凸(11~18岁)：占特发性脊柱侧凸的80%,国内外发病率为2%~4%,女性多见,男∶女的比例大约为1∶4[3];④成人型特发性脊柱侧凸(>18岁)[4]。     

退行性脊柱侧凸的研究进展

<正>退行性脊柱侧凸(Degenerative Scoliosis,DS)是指骨骼发育成熟之后的成人,主要由于椎间盘不对称性楔形变,相对应的小关节突关节退变及脊柱其他附件退行性变等原因,引起的脊柱失衡并侧凸。常伴有冠状位移位Cobb角>10°、旋转性半脱位和椎体矢状位滑脱即脊柱的三维旋转畸形。不仅影     

A Novel Method to Measure the Sagittal Curvature in Spinal Deformities: The Reliability and Feasibility of 3-D Ultrasound Imaging

The objective of this study was to test the reliability of sagittal spinal curvature measurements using 3-D ultrasound in patients with adolescent idiopathic scoliosis (AIS). Ultrasound spinous process angle (USSPA) and ultrasound laminae angle (USLA) were measured on sagittal ultrasound images, while the Cobb angle (XCA) was measured on sagittal X-ray images. Intra-class correlation coefficients (ICC) for the intra- and inter-observer variability, linear regression analysis and Bland-Altman method, including mean absolute difference (MAD), were investigated to evaluate the reliability and validity of the two ultrasound angles compared with XCA. Excellent measurement reliabilities were demonstrated for both ultrasound angles (ICC ≥ 0.91). Moderate to good and significant linear correlations and good agreement were demonstrated between the ultrasound methods and XCA (Thoracic [R² ≥ 0.574] / Lumbar [R² ≥ 0.635]). No significant differences were found for the MADs between both corrected ultrasound angles and XCA. Sagittal ultrasound angles were demonstrated to be reliable for assessing sagittal curvature using spinous processes and laminae and to have good and significant correlations with XCAs. Since it is non-ionizing and relatively low cost, this method opens the possibility of providing frequent curve monitoring and evaluation, and screening for AIS patients, particularly based on sagittal profiles.     

Investigation of the Phenomenon of Coronal–Sagittal Curvature Coupling on Curve Progression: An Exploratory Study using 3-D Ultrasound

A 3-D ultrasound system was determined to provide reliable and valid results for scoliosis assessment in the coronal and sagittal planes. The objective of this study was to investigate whether 3-D ultrasound can detect coronal–sagittal coupling and to study its potential effect on curve progression in patients with adolescence idiopathic scoliosis (AIS) as per the traditional Cobb angle classification. Radiographic and ultrasonic coronal and sagittal curvatures of 126 patients with AIS were evaluated. Thoracic kyphosis (TK) and lumbar lordosis (LL) with different coronal deformity were compared correspondingly based on either main thoracic or (thoraco)lumbar curve groups. The TK and LL of patients with single curves were also compared with study the curve effect on sagittal curvatures. A prospective cohort of 51 patients were followed for an average of 23 months for preliminary progression investigation. TKs in patients with larger main thoracic Cobb angles was significantly smaller than those with smaller main thoracic Cobb angles, judging by the results obtained from ultrasound and X-ray. The TKs of patients with only single right main thoracic curves were significantly smaller than those of patients with only single left (thoraco)lumbar curves. In addition, patients with progressive curves were observed to be relative hypokyphotic during early visits.     

Reliability and Accuracy of Tomographic 3-D Ultrasound for Grading Vessel Stenosis: A Phantom Study

The aim of this phantom study was to assess the accuracy of 3-D tomographic ultrasound (t3DUS) for grading stenosis, using the manufacturer's measurements as the gold standard. The percentage of maximum stenosis was obtained using 2-D ultrasound (2DUS) and t3DUS imaging techniques on a peripheral vascular phantom, including channels with 50%, 75% and 90% stenosis. The inter-observer reproducibility of t3DUS for grading stenosis was assessed using the intraclass correlation coefficient (ICC) and Bland–Altman plots. Mean and mean differences were used to evaluate the accuracy of 2DUS and t3DUS in measuring maximum stenosis in all channels. Inter-operator agreement was excellent, with an ICC value of 0.99 (95% confidence interval: 0.994–0.998, p < 0.001). Bias in measurements was –0.59 ± 2.01% (95% limits of agreement: 4.54, 3.36). The mean difference (MD) between maximum stenosis measurements and reference values for all channels was lower in t3DUS than in 2DUS (t3DUS MD: +1.01%, diameter reduction 2DUS MD: –6.10%; area reduction 2DUS MD: +8.20%). Tomographic 3DUS is a reproducible and accurate imaging method for grading stenosis. The current B-mode 2DUS stenosis grading criteria used in vascular assessment may be underestimating or overestimating the percentage stenosis. Further phantom and human studies investigating the reliability of t3DUS for grading stenosis and other metrics including plaque volume are required.     

浸润式超声与接触式超声测量头静脉内径的可重复性研究

目的 评价浸润式、接触式超声在测量头静脉内径中的可重复性.方法 由2名从事超声诊断工作10年以上的医师,对重庆医科大学附属大学城医院收治的38例预行桡动脉-头静脉内瘘成形术前的患者,在左前臂同一位置处、不同时间点,分别使用浸润式、接触式超声2种方法进行头静脉内径测量.使用组内相关系数(interclass correl...     

特发性脊柱侧弯患者躯干倾斜角与脊柱Cobb角、冠状面平衡的相关性研究

目的:研究单胸腰弯特发性脊柱侧弯患者的躯干倾斜角与脊柱Cobb角、冠状面平衡的相关性,为明确脊柱形变与躯干外观畸形的关系提供理论基础.方法:在前期的脊柱侧弯筛查中,选取符合要求的患者40例,其中男性5例,女性35例.使用Scoliometer测量患者的躯干倾斜角(ATI);选取患者近一个月的脊柱全长X光片,测量Cobb...     

Reliability of 3-D ultrasound measurements of cervical lymph node volume

This study was undertaken to evaluate the reliability of three-dimensional (3-D) ultrasound in measuring cervical lymph node volume. Ultrasound examination of the neck was performed on 15 healthy subjects (eight men and seven women). For each subject, the volume of cervical lymph nodes was measured twice with 3-D ultrasound by two operators, to evaluate the reproducibility of measurements (interoperator variability). 3-D ultrasound measurements of cervical node volume were performed with and without using SonoCT and XRES imaging. Each 3-D data set was reviewed and remeasured by the operators to evaluate the repeatability of measurements (intra-operator variability). Results showed that the reproducibility and repeatability of 3-D ultrasound volumetric measurements of cervical nodes was improved when SonoCT and XRES imaging were used. There was a high repeatability of 3-D ultrasound measurements of cervical node volume (> 90%). A high reproducibility of measurements was found in the posterior triangle nodes (90.3% - 90.9%). When SonoCT and XRES imaging were used with the scanning, there was a high reproducibility for parotid node measurements (87.4%) and a satisfactory level of reproducibility for submental (61.8%), submandibular (69.3%) and upper cervical node (79%) measurements. 3-D ultrasound is a useful and reliable method in measuring cervical lymph node volume. However, further studies to improve the reproducibility of 3-D ultrasound measurements of submental, submandibular and upper cervical node volume are suggested.     

比较超声和MRI评估正常胎儿胸廓发育

目的 比较超声和MRI评估正常胎儿胸廓发育的可重复性和一致性。方法 选取30胎正常胎儿,分别以超声和MRI测量胎儿胸廓横径、前后径、面积、胸围、胸廓体积和肺体积,采用组内相关系数（ICC）及Bland-Altman图分析同一医师及不同医师间测量结果的可重复性和一致性,以Pearson相关分析观察超声测量胎儿肺体积、胸廓体积与MRI测量值的相关性。结果 同一医师及不同医师以超声测量胎儿胸廓二维指标的可重复性和一致性均高于MRI,而以MRI测量胎儿胸廓体积和肺体积的可重复性和一致性均高于超声;同一医师以超声测量胎儿胸廓横径的可重复性最高[ICC=0.996 4,95%CI（0.992 5,0.998 3）],且一致性最高[界限宽度－0.004 7±0.057 3,95%CI（－0.026 1,0.016 7）]。超声与MRI测量胎儿肺体积和胸廓体积高度相关（r=0.915、0.957,P均<0.001）。结论 超声和MR均可评估正常胎儿胸廓发育,胎儿胸廓发育的二维指标测量超声优于MRI;三维指标测量MRI优于超声,但两者相关性高。     

A Novel Technique for the Semi-Automated Measurement of Embryo Volume: An Intraobserver Reliability Study

The aim was to assess intraobserver reliability of a new semi-automated technique of embryo volumetry. Power calculations suggested 46 subjects with viable, singleton pregnancies were required for reliability analysis. Crown rump length (CRL) of each embryo was analyzed using 2-D and a 3-D dataset acquired using transvaginal ultrasound. Virtual organ computer-aided analysis (VOCAL) was used to calculate volume of gestation sac (GSV) and yolk sac (YSV) and SonoAVC (sonography-based automated volume count) was used to quantify fluid volume (FV). Embryo volume was calculated by subtracting FV and YSV from GSV. Each dataset was measured twice. Reliability was assessed using Bland-Altman plots and intraclass correlation coefficients (ICCs). Fifty-two datasets were analyzed. Median embryo volume was 1.8cm³ (0.1 to 8.1 cm³); median gestational age 7 + 4 weeks; median CRL 13 mm (2 to 29 mm). Mean difference of embryo volume measurements was 0.1cm³ (limits of agreement [LOA] –0.3 to 0.4 cm³); multiples of mean (MoM) 0.38; mean difference of CRL measurements 0.3 mm (LOA –1.4 to 2.0 mm), MoM = 0.26. ICC for embryo volume was 0.999 (95%CI 0.998 to 0.999), confirming excellent intraobserver agreement. ICC for CRL was 0.996 (95%CI 0.991 to 0.998). Regression analysis showed good correlation between embryo volume and CRL (R² = 0.60). The new semi-automated 3-D technique provides reliable measures of embryo volume. Further work is required to assess the validity of this technique. (E-mail: shyamaly@doctors.org.uk)     

Quantitative Ultrasound for Predicting Curve Progression in Adolescent Idiopathic Scoliosis: A Prospective Cohort Study of 294 Cases Followed-Up Beyond Skeletal Maturity

Adolescent idiopathic scoliosis (AIS) is prevalent among adolescents and can carry significant morbidities. We evaluated the use of quantitative ultrasound (QUS) for predicting curve progression in patients with AIS. We recruited 294 girls with AIS at a mean age of 13.4 years, and they were prospectively followed beyond skeletal maturity for curve progression. We recorded 3 calcaneal QUS measurements at baseline, namely broadband ultrasound attenuation (BUA), velocity of sound (VOS), and stiffness index (SI). Logistic regression analysis indicated that SI, age, menarchal status, and Cobb angle were significant prognostic factors to be included in the final prediction model. The adjusted odds ratio of curve progression for Z-score of SI≦0 was 2.00 (95% CI: 1.08–3.71). The area under the ROC curve was 0.831 (95% CI: 0.785–0.877). The results of this study indicate that SI was an independent and significant prognostic factor for AIS and could be considered in addition to other prognostic factors when estimating the risk for curve progression and planning treatment for patients with AIS.     

Inter-Rater,Intra-Rater,and Inter-Machine Reliability of Quantitative Ultrasound Measurements of the Patellar Tendon

The use of ultrasound (US) to perform quantitative measurements of musculoskeletal tissues requires accurate and reliable measurements between investigators and ultrasound machines. The objective of this study was to evaluate inter-rater and intra-rater reliability of patellar tendon measurements between providers with different levels of US experience and inter-machine reliability of US machines. Sixteen subjects without a history of knee pain were evaluated with US examinations of the patellar tendon. Each tendon was scanned independently by two investigators using two different ultrasound machines. Tendon length and cross-sectional area (CSA) were obtained, and examiners were blinded to each other's results. Tendon length was measured using a validated system involving surface markers and calipers, and CSA was measured using each machine's measuring software. Intra-class correlation coefficients (ICCs) were used to determine reliability of measurements between observers, where ICC > 0.75 was considered good and ICC > 0.9 was considered excellent. Inter-rater reliability between sonographers was excellent and revealed an ICC of 0.90 to 0.92 for patellar tendon CSA and an ICC of 0.96 for tendon length. ICC for intra-rater reliability of tendon CSA was also generally excellent, with ICC between 0.87 and 0.96. Inter-machine reliability was excellent, with ICC of 0.91–0.98 for tendon CSA and 0.96–0.98 for tendon length. Bland–Altman plots were constructed to measure validity and demonstrated a mean difference between sonographers of 0.03 mm² for CSA measurements and 0.2 mm for tendon length. Using well-defined scanning protocols, a novice and an experienced musculoskeletal sonographer attained high levels of inter-rater agreement, with similarly excellent results for intra-rater and inter-machine reliability. To our knowledge, this study is the first to report inter-machine reliability in the setting of quantitative musculoskeletal ultrasound.