特发性胸椎侧凸前路矫形对胸主动脉偏移的影响及意义

目的 比较青少年特发性胸椎右侧凸患者前路开放小切口矫形手术和后路矫形手术对胸主动脉偏移的影响及其意义.方法 29例青少年特发性胸椎右侧凸患者分为两组.A组14例患者行开放小切口前路矫形术,男1例,女13例,平均14.3岁,胸弯Cobb角平均44.9°.B组15例患者行后路钉钩联合矫形术,男3例,女12例,平均14.2岁,胸弯Cobb角平均46.4°.两组患者手术前后均行胸椎T5～T12节段CT扫描,在每个节段测量右侧肋骨头至主动脉后壁的切线与双侧肋骨头连线的夹角(α)、椎管前缘中点与主动脉中心连线和双侧肋骨头连线的夹角(β)、椎体旋转(γ)、主动脉与椎体间距离(a)以及与左侧肋骨头前缘的垂直距离(b)并进行比较.将胸主动脉偏移与侧凸的三维矫形进行相关性分析明确胸主动脉偏移的原因.结果 A组患者手术后置钉安全角α、主动脉相对椎管前缘旋转角β较术前增大,在T8,T9差异有显著性(P＜0.05);椎体旋转γ角减小,在T8,T9差异有显著性(P＜0.05);主动脉与椎体间距离a减小,主动脉后壁与右侧肋骨头间距离b增大,两者和术前相比在T9有显著性差异(P＜0.05).B组手术前后椎体旋转及主动脉与相邻椎体的解剖关系无明显变化.A组α角、β角、b值增加量与γ角减小量呈明显相关性(P＜0.01);a值减少量与β角增加量具有良好相关性(P＜0.05);在顶椎区α角、β角、b值的增加量与顶椎偏移减少量、a值减少量与T5～T12后凸增加量明显相关(P＜0.01).结论 特发性胸椎右侧凸患者行小切口前路矫形术后胸主动脉相对椎体向前方偏移并靠近椎体.发生主动脉偏移的原因包括主动脉松解、椎体去旋转、冠状面和矢状面矫形.     

特发性胸椎右侧凸患者经胸前路手术时不缝合胸膜对主动脉偏移的影响

目的:探讨特发性胸椎右侧凸畸形患者行经胸前路手术时不缝合胸膜对主动脉偏移的影响.方法:20例青少年特发性胸椎右侧凸畸形行经胸前路手术的患者分为两组.A组13例,均为女性患者,平均14.0岁,胸弯Cobb角平均45.1°,术中均缝合胸膜.B组7例,均为女性,平均14.8岁,胸弯Cobb角平均64.6°,术中不缝合胸膜.统计两组患者术后胸腔引流量及胸腔引流管拔管时间.两组患者手术前后均行胸椎T5～T12节段CT扫描,在每个节段测量右侧肋骨头至主动脉后壁的切线与双侧肋骨头连线的夹角(α)、椎管前缘中点与主动脉中心连线和双侧肋骨头连线的夹角(β)、主动脉与椎体间距离(a)以及与左侧肋骨头前缘的垂直距离(b),并进行比较.结果:A组患者术后置钉安全角(α)、主动脉相对椎管前缘旋转角(β)较术前增大,在T8、T9差异有显著性(P<0.05);术后主动脉与椎体间距离(a)减小,主动脉后壁与右侧肋骨头间距离(b)增大,和术前相比在T9有显著性差异;术后平均胸腔引流量220ml,平均拔管时间6d.B组患者手术后α、β角减小,a值增大、b值减小,所有术后指标的改变在多数节段有显著性差异,术后平均胸腔引流量350ml,平均拔管时间8d.结论:特发性胸椎右侧凸患者经胸前路矫形术时缝合胸膜后主动脉相对椎体向前方偏移并靠近椎体,而不缝合胸膜者主动脉相对椎体向后方偏移并远离椎体,不缝合胸膜可给予前路或后路置钉更大的安全空间.     

青少年特发性脊柱侧凸胸椎形态学的MRI测量及临床意义

目的 通过磁共振成像(MRI)观察青少年特发性脊柱侧凸(AIS)和正常同年龄组青少年胸椎的形态学差异,探讨其临床意义.方法 胸椎轻度侧凸(MS)组患者10例(Cobb角15°～39°),胸椎中度侧凸(SS)组患者10例(Cobb角40°～75°).另选健康青少年10名作为对照(非侧凸组).所有研究对象均为女性,年龄13～14岁.用1.5 T磁共振扫描仪(Sonata,Siemens,Erlanger,德国)对所有研究对象进行全脊柱矢状面扫描,在图像工作站(Easy Vision,Philips Medical Systems,Best,荷兰)上重建脊柱矢状面图像,测量每个胸椎椎体前壁高度,后壁高度,棘突间高度,在横截面测量椎体横径长度,并进行对比分析.结果 椎体前后高度、宽度从T1到T12逐渐增加,并呈线性分布,脊柱侧凸组椎体高度普遍>正常同年龄非侧凸组患者.脊柱侧凸组患者椎体高度横径比值以及脊椎前后高度比值均>无侧凸组.胸椎侧凸顶椎区T6～T9椎体前方高度、椎体高度横径比值以及脊椎前后高度比值,脊柱侧凸组明显>非侧凸组,差异均有统计学意义(P<0.05).结论 AIS胸椎侧凸女性患者胸椎顶椎区存在显著的脊柱生长模式异常,与正常胸椎相比AIS的胸椎更高、并显得更为瘦长.     

正常人T4~T12肋骨头与相应椎体椎管解剖学及影像学研究

目的:观察正常人肋骨头和相应椎体及椎管的解剖学及影像学关系。方法:解剖测量组(A组),解剖10具正常成人尸体脊柱标本,测量各节段肋骨头对椎体遮挡率(即双侧肋骨头前缘连线到椎管前壁距离与椎体前缘到椎管前缘距离百分比),以及胸椎前路置钉时最大前方安全角度以及最大后方安全角度(最大前方安全角度即以肋骨头为参照物前路牢固置入螺钉时可向椎体前方形成的最大夹角;最大后方安全角度即以肋骨头为参照物置入螺钉时螺钉不进入椎管可向椎体后方形成的最大夹角);影像测量组(B组),测量30例健康成人胸椎CT平扫片,测量CT照片上各节段肋骨头对相应椎体遮挡率、胸椎前路置钉时最大前方安全角度以及最大后方安全角度。结果:两组肋骨头对相应椎体遮挡率自上而下逐渐减小(从T4约30%到T12约-0.4%),越往头侧肋骨头相对于椎体越靠前,越往下胸椎肋骨头定位相对靠后;前方最大安全角度渐增加(T4约27°到T12约38.3°,P<0.05),后方安全角度逐渐减小(T4约23°到T12约-9°,P<0.05),A、B组间比较统计学差异无显著性(P>0.05)。结论:术前CT片的测量肋骨头和相应椎体椎管的关系可指导胸腔镜辅助下胸椎前路手术置钉,在上段胸椎椎体前路置入螺钉时可考虑部分去除肋骨头,在下段胸椎前路置入螺钉时在肋骨头前缘可安全置入螺钉。     

胸腔镜辅助小切口前路矫形置钉安全性的研究

目的评价特发性胸椎侧凸胸腔镜辅助小切口前路矫形椎体钉置入的安全性及其意义。方法特发性胸椎侧凸行胸腔镜辅助小切口前路CDH-TSRH矫形手术20例,女18例,男2例;年龄平均14.5岁。Lenke分型1A-6例、1AN5例、1BN6例、1CN3例(协和PUMC分型Ⅰa型12例、Ⅱb1型8例),术前胸弯冠状面Cobb角平均44.7°。利用PACS系统在固定节段椎体横断面CT片上测量右侧肋骨头与螺钉中心的距离a、椎管前壁与螺钉后缘距离b、降主动脉后壁与螺钉前缘距离c、螺钉突出对侧皮质的长度d、主动脉与椎体间的距离e、螺钉与双侧肋骨小头连线的角度α。将螺钉尖与主动脉的距离分为三级:距离>1mm为D级,≤1mm为A级,螺钉使主动脉发生变形为C级。在前后位X线片上测量螺钉与椎体中线的成角β。结果20例患者术后平均矫正率为77.7%。共使用椎体钉155枚,134枚(86.5%)获得双皮质固定,123枚(79.4%)螺钉尖距离主动脉>1mm。2枚螺钉进入椎管。置钉安全性在顶椎区和上下端椎区无差异,但与Cobb角相关。所有患者术中、术后及随访期间无血管、神经及内固定并发症。结论特发性胸椎侧凸胸腔镜辅助小切口前路矫形手术具有良好的矫形效果及较高的置钉安全性。术前CT检查可能有助于提高置钉安全性和避免可能发生的血管、神经并发症。     

退变性腰椎侧凸患者腹主动脉与腰椎椎体相对位置的影像学测量

目的:探讨退变性腰椎侧凸(degenerative lumbar scoliosis,DLS)患者腰椎左侧凸和右侧凸情况下,腹主动脉与腰椎椎体的解剖关系。方法:回顾性分析我院2015年1月～2018年6月142例DLS患者和132例无脊柱侧凸的正常人群(对照组),DLS患者包含80例左侧凸患者(左侧凸组)和62例右侧凸患者(右侧凸组),观察对象均处于矢状位平衡,两组在性别、年龄和体重指数(body mass index,BMI)上与对照组匹配。通过X线片测量DLS患者腰椎侧凸方向、Cobb角、顶椎位置及冠状位偏移距离;通过MRI T1加权像建立笛卡尔坐标系,测量主动脉-椎体角度(α)、旋转角度(γ)、主动脉-椎体距离(d)及主动脉后壁-椎体前缘间隙(Int)。α、γ、d和Int分别在左侧凸组与对照组、右侧凸组与对照组的组间对比采用独立样本t检验;Cobb角及冠状位偏移距离与α、γ、d和Int的相关性检验采用Pearson相关分析。结果:左侧凸组Cobb角为23.7°±12.7°(10.4°～42.5°),冠状位偏移距离为45.2±10.7mm(25.5～77.7mm);右侧凸组Cobb角为20.8°±10.4°(11.0°～48.4°),冠状位偏移距离为47.8±15.1mm(25.4～77.5mm),两侧凸组的顶椎分布(P=0.280)、Cobb角(P=0.311)和冠状位偏移距离(P=0.394)均无统计学差异。对照组α平均为-2.96°±6.40°,从T12～L4逐渐减小,而左侧凸组α(-2.57°±6.14°)无该规律,两组α比较无统计学差异(P=0.554);左侧凸组γ平均为5.57°±5.32°;左侧凸组d(4.62±0.57cm)自T12～L4逐渐增大,且与对照组(4.44±0.43cm)比较有统计学差异(P0.001);左侧凸组Int与对照组比较无统计学差异(P=0.832),即相对于正常人群,DLS左侧凸患者腹主动脉相对于椎体角度无改变,但距离稍远离左侧椎体。右侧凸组α(-3.41°±9.44°)自T12～L4逐渐减小,与对照组比较无统计学差异(P=0.762);γ为-9.02°±6.71°;d为4.54±1.84cm,与对照组比较无统计学差异(P=0.530);Int与对照组比较无统计学差异(P=0.807),即相对于对照组,DLS右侧凸患者腹主动脉与椎体的角度和距离无明显变化。Pearson相关分析显示,左侧凸组和右侧凸组Cobb角和冠状位偏倚距离与γ均存在相关性(均为P0.001),而与α、d和Int无明确相关性。结论:DLS右侧凸患者腹主动脉与椎体相对位置维持正常的解剖关系,左侧凸患者腹主动脉稍远离左侧椎弓根。DLS患者腹主动脉与腰椎相对解剖关系较正常人变化不大,但腰椎手术尤其是侧凸矫形过程中仍需要警惕腹主动脉损伤。     

青少年特发性脊柱侧凸胸椎形态学MRI临床价值

[目的]观察青少年特发性脊柱侧凸胸椎形态学的MRI测量及其临床应用价值。[方法]研究对象为2018年1月～2018年12月期间本院接诊的胸椎侧凸患者共30例,根据Cobb角大小分别设为轻度组和中度组;另选取同期体检健康青少年15名设为正常组。为减少干扰因素。采用1.5T磁共振扫描仪扫描研究对象全脊柱矢状面,重建脊柱矢状面图像并测量各个胸椎前后壁与棘突间高度,于横截面对椎体横径长度进行测量,对比分析三组结果。[结果]轻度组和中度组患者椎体前后高度、宽度由T_(1～12)逐渐增加,呈线性分布,且两组椎体高度普遍大于正常组;轻度组和中度组患者椎体前后高度比值、高度横径比值均大于正常组。两组患者胸椎侧凸顶椎区T_(6～9)椎体前方高度、脊椎前后高度比值以及高度横径比值明显大于正常组,差异均存在统计学意义(P0.05)。[结论]青少年特发性脊柱侧凸女性患者胸椎形态学特点显著,与正常胸椎相比更加瘦长,胸椎顶椎区呈现出脊柱生长模式异常,MRI测量在临床诊断中具有重要价值。     

仰卧位和俯卧位测量青少年特发性脊柱侧凸患者胸主动脉与椎体毗邻关系的差异

目的　通过术前仰卧位MRI和术中俯卧位O形臂X线机获得青少年特发性脊柱侧凸(AIS)患者横断面影像学资料,探讨2种体位下主胸弯顶椎与胸主动脉的毗邻关系。方法回顾性分析2013年4月—2018年7月美国梅奥医学中心骨科采用后路手术治疗的18例AIS患者资料。患者术前均行仰卧位全脊柱MRI平扫和术中俯卧位脊柱O形臂X线机平扫,将影像资料上传至临床图像显示系统(Qreads 5.10)。选取主胸弯顶椎为测量平面,测量顶椎椎体旋转角度(AVR),主动脉到椎体距离(a线),主动脉到左侧椎弓根置钉点距离(b线),主动脉到椎管垂直距离(c线),主动脉到椎弓根置钉点连线的垂直距离(d线),主动脉椎体角(AVA),左侧椎弓根置钉点和主动脉内侧切线与椎体中轴线平行线间的夹角(∠α),左侧椎弓根置钉点和主动脉中心点连线与椎体中轴线平行线间的夹角(∠β)。采用配对样本t检验比较2种体位下各参数变化,采用Pearson相关分析对数据进行相关性分析。结果俯卧位AVR、c线均大于仰卧位,差异均有统计学意义(P 0.05),平均差值分别为2.71°、2.24 mm。俯卧位与仰卧位AVA平均差值为4.45°,差异有统计学意义(P 0.05);俯卧位AVR、a线、b线、c线、d线、AVA、∠α、∠β与仰卧位相应指标呈正相关;俯卧位∠β与主胸弯Cobb角呈正相关,与俯卧位及仰卧位AVR均呈负相关;俯卧位d线与主胸弯Cobb角呈负相关,与俯卧位及仰卧位AVR呈正相关。结论相较于仰卧位,脊柱侧凸患者俯卧位时顶椎旋转度增大,主动脉到椎管的垂直距离增大,主动脉向椎体右前方移动。     

骨质疏松性椎体骨折患者胸腰椎椎体后壁形态学测量及临床意义

目的 :探讨骨质疏松性椎体骨折(osteoporotic vertebral fracture,OVF)患者胸椎、腰椎椎体后壁形态学差异及其临床意义。方法:选取我院2013年1月~2016年12月收治的临床资料完整的98例OVF患者,采用CT三维重建技术及多平面重建技术(multiplanar reconstruction,MPR)观察测量T6~L5椎体相关参数。测量椎体纳入标准:椎体无新鲜或陈旧性骨折、无感染征象、无肿瘤性骨质破坏、无半椎体及阻滞椎等先天畸形等;排除标准:已行经皮穿刺椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗的椎体。测量T6~L5椎体CT影像的如下参数:双侧椎体后缘线与椎弓根中轴层面的内侧骨皮质处的交点A、B的连线(AB),骨性椎管凸入椎体顶点O到线AB的距离(OC),椎体最前缘点P到AB的距离(PC),计算R=OC/PC(术中侧位像上骨性椎管凸入椎体深度与椎体中矢状径比值)。采用独立样本t检验比较T12与L1椎体OC值。结果:OC值自T6至T12在3.83±0.13mm到5.21±0.06mm之间,PC值自T6到L5在23.42±0.21mm到44.38±4.51mm之间,均呈逐渐增大趋势。OC值自T12至L5在5.21±0.06mm到0mm之间,呈逐渐减小趋势。R值在T6~T12均接近0.16(1/6),腰椎较胸椎明显减小,在L1~L3明显小于1/6,在L4、L5接近于0。T12与L1的OC值差异有统计学意义(P0.05)。结论 :中下胸椎椎体后壁形态与腰椎相比存在明显差异,OC的存在致中下胸椎椎体后壁在侧位像上的真实投影线位于椎体后1/6处。在中下胸椎行PKP时尽量避免骨水泥分布超过椎体后1/6从而减少骨水泥椎管内渗漏的发生。     

系列石膏与支具治疗对小儿先天性脊柱侧凸延迟手术的作用

目的 :观察支具治疗和系列石膏对小儿先天性脊柱侧凸的矫形效果,比较其在维持椎体生长以及延迟手术时间的作用。方法:收集2010年1月～2017年12月在我院行系列石膏或者支具治疗的先天性脊柱侧凸患者24例,男13例,女11例;首次治疗时年龄1.3～5.4岁(2.9±1.2岁)。其中12例采用系列石膏矫正,12例采用支具治疗。统计两组患者治疗前和末次随访时的侧凸Cobb角、胸椎后凸及腰椎前凸角、T1～T12椎体生长速度、延迟手术时间。结果:系列石膏组随访时间为16～56个月(29.2±14.3个月),佩戴石膏时间为13～23个月(18.5±3.7个月)。支具治疗组随访时间为15～46个月(26.7±12.5个月),佩戴支具时间为6～12个月(8.3±2.4个月)。系列石膏组侧凸Cobb角从术前30.1°～89.4°(56.2°±20.5°)降低至末次随访时的22.3°～78°(48.8°±18.0°)(P0.01),矫正率为13.2%,T1～T12胸椎生长速度为0.62～0.91cm/yr(0.78±0.16cm/yr),至末次随访时4例继续系列石膏矫正治疗,6例停止系列石膏矫正改为佩戴支具维持,2例行手术治疗,延迟手术16～56个月(28.8±14.3个月);支具组侧凸Cobb角术前为25.4°～62.6°(44.2°±16.4°)末次随访时为34.8°～68.8°(55.6°±16.7°),矫正率为-21.38%,T1～T12胸椎生长速度为0.45～0.71cm/yr(0.67±0.22cm/yr),至末次随访时2例继续支具治疗,10例进行手术治疗,延迟手术6～12个月(8.3±2.4个月)。支具治疗组的侧凸矫正率、T1～T12胸椎生长速度和延迟手术时间均低于系列石膏组(P0.01)。末次随访时两组胸椎前凸和腰椎后凸与治疗前比较均无显著性改变。结论:系列石膏和支具治疗均可延迟先天性脊柱侧凸患儿的首次手术时间,但系列石膏能更好地控制侧凸进展,更长时间延迟手术。     

The anatomical relationship between the aorta and the thoracic vertebral bodies and its importance in the placement of the screw in thoracoscopic correction of Scoliosis

Thoracoscopically-assisted anterior spinal instrumentation is being used widely to treat adolescent idiopathic scoliosis (AIS). Recent studies have showed that screws placed thoracoscopically could counter the aorta or entrance into the spinal canal. There are a few studies defining the anatomic landmarks to identify the relationship between the aorta and the thoracic vertebral body using quantitative measurement for the sake of safe placement of thoracoscopic vertebral screw in anterior correction for AIS. The CT scanning from T4 to T12 in 64 control subjects and 30 AIS patients from mainland China were analyzed manually. Parameters to be measured included the angle for safety screw placement (α), the angle of the aorta relative to the vertebral body (β), the distance from the line between the left and the right rib heads to the anterior wall of the vertebral canal (a), the distance from the left rib head to posterior wall of the aorta (b), the vertebral body transverse diameter (c) and vertebral rotation (γ). No significant differences were found between the groups with respect to age or sex. Compared with the control group, α angle from T7 to T10, β angle from T5 to T10 and b value at T9, T10 were significantly lower in the scoliotic group. The a value was significantly lower in the scoliotic group. The c value showed no significant difference between the two groups. In conclusion, to place the thoracoscopic vertebral screw safely, at the cephalad thoracic spine (T4–T6), the maximum ventral excursion angle should decrease gradually from 20° to 5°, the entry-point of the screw should be close to the rib head. For apical vertebrae (T7–T9), the maximum ventral excursion angle increased gradually from 5° to 12°. At the caudal thoracic spine (T10–T12), the maximum ventral excursion angle increased, the entry-point should shift 3∼5 mm ventrally.     

The position of the aorta relative to the spine: a comparison of patients with and without idiopathic scoliosis

BACKGROUND: There is little information documenting the relationship of the aorta to the thoracic scoliotic spine. Recent studies have suggested that the ends of screws placed during an anterior spinal arthrodesis, and pedicle screws used for the treatment of right thoracic scoliosis, may be in proximity to the aorta. The purpose of this study was to analyze the anatomical relationship between the aorta and the spine in a comparison of patients with idiopathic right thoracic scoliosis and patients with a normal spine. METHODS: Thirty-six patients with adolescent idiopathic scoliosis with a right thoracic curve and forty-three with a normal straight spine were studied. Radiographs were analyzed to determine the Cobb angle, the apex of the curve, and the apical vertebral rotation for the patients with scoliosis. Axial magnetic resonance images from the fourth thoracic vertebra to the third lumbar vertebra at the midvertebral body level were used to measure the distance from the aorta to the closest point of the vertebral body cortex, the distance from the posterior edge of the aorta to the spinal canal, and the aorta-vertebral angle. RESULTS: No differences were found between the groups with respect to age or sex distribution. For the scoliosis and normal groups, boys had greater average vertebral body width and depth for all levels than did girls (p < 0.05). For the scoliosis group, the most common apical vertebra was the eighth thoracic vertebra, the average coronal curve measurement was 55.2 degrees, and the average apical rotation was 17.3 degrees. The average distance from the aortic wall to the vertebral body cortex at the apex of the curve was greater in the patients with scoliosis (4.0 mm) than at similar levels in the normal group (2.5 mm) (p < 0.05). The distance from the posterior aspect of the aorta to the anterior aspect of the spinal canal was less in the scoliosis group (11.1 mm) than in the normal group (19.2 mm) for the fifth to the twelfth thoracic level (p < 0.05). The aorta was positioned more laterally and posteriorly adjacent to the vertebral body at the fifth to the twelfth thoracic level in patients with scoliosis compared with that in normal patients as reflected in a smaller aorta-vertebral angle (p < 0.05). With an increasing coronal Cobb angle in the thoracic curve and apical vertebral rotation, the aorta was positioned more laterally and posteriorly (p < 0.05). CONCLUSION: In patients with right thoracic idiopathic scoliosis, the aorta is positioned more laterally and posteriorly relative to the vertebral body compared with that in patients without spinal deformity.     

The changes of relative position of the thoracic aorta after anterior or posterior instrumentation of type I Lenke curve in adolescent idiopathic thoracic scoliosis

The risk of impingement of the aorta associated with thoracic vertebral screw or pedicle screw instrumentation in the treatment of thoracic scoliosis has been an important concern. To understand this phenomenon more systematically, the relative position of the aorta with reference to the thoracic vertebrae in right thoracic adolescent idiopathic scoliosis (AIS) following anterior and posterior spinal instrumentation was analyzed in detail quantitatively; 34 patients underwent anterior (n = 14) or posterior (n = 20) spinal instrumentation were recruited in the present study. The relative position of the thoracic aorta, vertebral rotation, apical vertebral translation and thoracic kyphosis were measured from pre- and post-operative CT images from T5 to T12. The aorta was found to shift antero-medially in the anterior instrumentation group but not in the posterior spinal instrumentation group. It is likely that the disc removal, soft tissue release and spontaneous vertebral derotation of the scoliosis could account for the antero-medial shifting of the aorta. By the shifting, the space for contralateral screw penetration was reduced.     

Effect of Harrington instrumentation spondylodesis on scoliotic thoracic deformity. A retrospective 5-year analysis]

INTRODUCTION AND AIM OF THE STUDY: Harrington-Instrumentation (HI) was the golden standard of scoliosis surgery for more than two decades and is still frequently used. The effects of instrumentation on rib hump reduction in long term follow-up is not well documented. 104 patients with idiopathic thoracic scoliosis were studied with a minimum follow-up of five years (min. 5 y., max. 8 years). METHODS: The rib-cage deformity was determined as rib hump index (RHi) by measuring the rib hump to the depression. The long term effect of HI was investigated using full standing AP radiographs. Measuring cobb angle (CA), translation (TA) and rotation of apical vetebra (RA) were obtained for every patient preoperatively, postoperatively and at follow-up. Patient were analysed in 3 different groups. Single curve thoracic scoliosis (n = 54) (King III and IV), double curve thoracic/lumbar scoliosis (n = 35) (King I and II) and double curve thoracic scoliosis (n = 15) (King V). RESULTS: With an average preoperative measurement of 62.7 degrees and a postoperative measurement angle of 32.9 degrees the correction of CA achieved is 47.5% (23-73%). The mean thoracic translation improved by 50% (0-100%). Rotation of the scoliosis was not reduced significant. In follow up studies no loss of correction in frontal plane deformity was obtained. The mean RHi in all groups was seen to improve by 25-30% (min. 0%, max. 60%), depending on form of scoliosis. In group of patients King II/III scoliosis (n = 52) the mean RHi increased measurably to 11.5% (min. 0%, max. 50%) correction at long term follow up. In group of patients King I/II scoliosis average RHi was increased from 31% (5-100%) to 21% correction. The mean RHi correction in the group of patients King V scoliosis correction rate of 26% (0-50%) was unchanged at long term follow up. CONCLUSION: HI leads to a permanent and stable improvement of the frontal plane including apical vertebral translation. HI does not have derotational capabilities. The effect of the rib-cage deformity was less impressive with loss of correction at follow up.     

Structural vertebral changes in the horizontal plane in idiopathic scoliosis and the long-term corrective effect of spine instrumentation

Summary The rotation and structural changes of the apex vertebra in the horizontal plane as well as of the thoracic cage deformity were quantified by measurements on computed tomography (CT) scans from patients with right convex thoracic idiopathic scoliosis (IS). The CT scans were obtained from 12 patients with moderate scoliosis (mean Cobb angle 25.8°, r 13°–30°) and from 33 with severe scoliosis (mean Cobb angle 46.2°, r 35°–71°). In addition, CT scans of thoracic vertebrae from 15 patients without scoliosis were used as reference material. Ten of the scoliotic cases had had Cotrel-Dubousset instrumentation (CDI) and posterior fusion and had entered a longitudinal study on the effect of operative correction on the re-modelling of the apical vertebra. An increasingly asymmetrical vertebral body, transverse process angle, pedicle width and canal width were found in the groups with scoliosis as compared with the reference material. Vertebral rotation and rib hump index were significantly larger in patients with early and advanced scoliosis than in normal subjects. The modelling angle of the vertebral body, the transverse process angle index and the vertebral rotation in relation to the middle axis of the thoracic cage were significantly greater in patients with severe than with moderate scoliosis. The results of this longitudinal study suggest that the structural changes of the apical vertebra regress 2 years or more after CD instrumentation.     

胸椎椎体侧后方滋养动脉孔对于螺钉内固定的定位意义

目的观察胸椎椎体侧后方滋养动脉孔的分布情况,并探讨其临床意义。方法取20例正常干燥成人胸椎骨标本（T5-T12节段）,观察胸椎椎体侧后方滋养动脉孔（以直径≥1．0mm为判定界限）的分布情况以及与上肋凹的相互关系,测量各节段椎体最大滋养动脉孔的直径（d）、最大滋养动脉孔至椎体上终板的距离（A）、最大滋养动脉孔至椎体后缘的距离（B）、双侧滋养动脉孔连线至椎管前壁的垂直距离（C）、双侧上肋凹前缘连线至椎管前壁的垂直距离（D）、滋养动脉孔平面椎体横径（a）和上肋凹前缘平面椎体横径（b）。结果从T5至T12椎体侧后方滋养动脉孔均位于椎体上肋凹的下方,且紧贴上肋凹的下缘,椎体侧后方滋养动脉孔各指标左右侧之间均无显著性差异,各椎体的侧后方滋养动脉孔d值和B值从T5至T12无明显变化趋势,而A值则逐渐增大,从T5至T10各节段同一椎体C值与D值有显著性差异。结论椎体侧后方滋养动脉孔位置固定,并且对椎体置钉的定位具有重要意义。     

Rib cage asymmetry in idiopathic scoliosis

Seventy-one patients attending a scoliosis clinic and 10 control subjects were studied by a stereoradiographic three-dimensional reconstruction of the spine and rib cage. The symmetry of each rib pair (at each anatomic level) was described by measurements of rib arc length, chord length, enclosed area, maximum curvature, and frontal and lateral angulations. Patients were divided into four groups: 19 with a single right thoracic curve, 15 with a single left lumbar or thoracolumbar curve, 22 with double curves, and 15 with a curve with less than 10 degrees Cobb angle. In the control group and the group with minimal scoliosis, there was no statistically significant rib asymmetry. Among the patients with scoliosis, 11 of 19 patients with right single thoracic curves had rib arc lengths greater on the right side at the curve apex, and nine of 15 patients with left lumbar scoliosis had longer ribs on the left side in the corresponding region of the thoracic spine. Eleven of 22 patients with double curves had symmetrical rib lengths (within +/- 3%), the other 11 had ribs longer on the left. These proportions should not have occurred by chance (p less than 0.001). The mean rib length difference in patients with single thoracic curves was 1.39% (right longer than left), in single lumbar curves it was 3.57% (left longer than right), and in double curves 3.18% (left longer than right). These differences between the groups of patients and control subjects were statistically significant (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

An analysis of the effect of the Zielke operation on the rib cage of S-shaped curves in idiopathic scoliosis

This report evaluates the rib cage in 16 patients with S-shaped idiopathic scoliosis having the Zielke operation and followed-up for an average period of 30 months. Methods used include Cobb angle and a segmental evaluation (T7-T12) of each of convex and concave rib-vertebra angles (RVAs), rib-vertebra angle differences (RVADs), vertebral rotation, tilt and displacement. Preoperatively, the apical convex ribs droop more than the concave ribs, but the most striking difference is an asymmetry of RVAs, with increasing droop of the concave RVAs from T7-T12. The effect of the Zielke operation (on the lower curve) is: (a) to correct the Cobb angle, vertebral tilt, and displacement of the upper (thoracic) curve; (b) to derotate the spine; (c) to elevate the mobile concave ribs; (d) to have little or no effect on the stiff apical convex ribs; and (e) to increase the droop of the mobile lower convex ribs. During follow-up, six of the upper (thoracic) curves progressed. The apical RVAD and apical convex RVA are not prognostic. The concave RVAs maintain their position while convex RVAs elevate relative to the concave ribs.