胸腔镜下前路松解结合后路矫形治疗Scheuermann病后凸畸形

目的探讨胸腔镜下前路松解结合后路矫形治疗Scheuermann病后凸畸形的效果。方法对16例Scheuermann病后凸畸形患者在胸腔镜下行前路松解、椎间盘摘除、植骨融合,结合后路矫形内固定。手术前后及随访期间测量后凸畸形Cobb角,了解后凸畸形矫正情况。评定术前及术后Oswestry功能障碍指数,了解背部疼痛缓解情况。结果16例后凸畸形患者均获得满意矫形,术前Cobb角平均788°(70°～92°),术后平均405°(36°～47°),最后一次随访平均417°(36°～50°)。患者背部疼痛症状明显改善,Oswestry功能障碍指数术前平均373(0～72),术后平均64(0～30)。结论胸腔镜下前路松解结合后路矫形是一种较好的治疗Scheuermann病后凸畸形的手术方法。     

Three-dimensional spinal curvature in idiopathic scoliosis

Scoliosis is usually considered as a deformity of the spine in the frontal plane, without reference to curvatures in other planes. In this study, the three-dimensional shape of the spine of 104 patients with untreated idiopathic scoliosis (5-55 degrees Cobb) was studied by means of stereo radiographs to determine relationships between curvature of the spine in the frontal plane view, in the lateral view, and in the intermediate views. There was a weak but statistically significant correlation (r = 0.2) relating greater scoliosis with lesser kyphosis or greater lordosis. In the thoracic region, the sagittal plane spinal curvature was less than that measured in a population without scoliosis (mean difference, 7.72 +/- 9.9 degrees). Seventy-four of 76 scolioses in the upper region of the spine with lateral curvature greater than 5 degrees Cobb were kyphotic. Sixty-four of 84 curves greater than 5 degrees Cobb in the lower region were lordotic. Measuring curvatures in the plane of symmetry of the rotated apical vertebra altered these ratios to 69 of 76 kyphotic in the upper region and 68 of 84 lordotic in the lower region. The plane of maximum curvature of sections of the spine with scoliosis was not related to the plane of symmetry of the rotated apical vertebra, for in kyphotic regions of the spine the rotations of these two planes were in opposite directions. In all cases, the magnitudes of the rotations were quite different, i.e., by a factor of -0.22 for curves in thoracic region and by a factor of 0.24 for curves in the lumbar region. This implies that mechanical measures to correct this spinal deformity or to prevent progression should apply different rotations to the apex from those applied to the curve as a whole and, in opposite senses, in curves in kyphotic regions. There was no evidence of an abnormality of sagittal curvature of a magnitude to implicate it in the etiology or in the treatment.     

Idiopathic scoliosis: characteristics and epidemiology

An epidemiological survey of idiopathic scoliosis derived by school screening in Greece has shown a three-fold rise in prevalence rate from 1% in 6-year-olds to more than 3% in 15-year-olds. Moderate curves (with a Cobb angle of 10 degrees to 19 degrees) are the most common curve magnitude encountered in both boys and girls. Typical curves (right thoracic, left lumbar, or right thoracic left lumbar double structural configurations) become relatively more prevalent with rising curve magnitude, while atypical curve patterns (left thoracic, right lumbar, or left thoracic right lumbar double structural configurations) reciprocally diminish. Growth is clearly an important environment in which curves progress and peak prevalence rates occur at the ages of 11 years and 13 years. Although it is not possible to prognosticate about the individual case, attention to these characteristics derived from epidemiological surveys is useful in assessing future curve behavior.     

Evidence of three-dimensional variability in scoliotic curves

In the current study, 98 patients with idiopathic scoliosis were selected for analysis. The object of this study was to determine whether three-dimensional variability exists within each class of the King classification, and to evaluate the currently used King classification in its ability to categorize different scolioses adequately. Anteroposterior and lateral radiographs were digitized, and three-dimensional models were reconstructed for each spine. Several parameters were recorded for each individual: age, gender, four Cobb angles, (1) anteroposterior, (2) lateral, (3) maximum (Cobb angle at the plane of maximum deformity), and (4) minimum (Cobb angle at the plane of minimum deformity), and the orientation of the planes of maximum and minimum deformity. Most of the curves were kyphotic, but a small percentage in each class were hypokyphotic or lordotic. This was not seen in the analysis in which the individual King classes were compared. It was seen, however, when the authors reanalyzed the data after having pooled the subjects and reclassified them according to presence or absence of kyphosis. The King classification was shown to be inadequate for describing spinal deformities in three dimensions, because different variants of sagittal spine configurations were seen which can look identical on the anteroposterior view. Therefore, the need for a new three-dimensional classification, which takes this variability into account, is established.     

Plantar weight-bearing pattern in idiopathic scoliosis

Eighty-four patients were objectively evaluated with a weight-bearing pattern analyzer to determine whether spine deformity has an effect on the amount of weight borne on the right versus left foot and on the fore versus the hind foot. Patients with idiopathic scoliosis treated with bracing and surgery and patients with Scheuermann's kyphosis treated with bracing were compared with control subjects. Patients with right thoracic and thoracolumbar curves did not bear more weight on the right foot, as was previously thought. Patients with relatively unaffected lumbar spines exhibited normal sagittal plane weight-bearing patterns, whereas patients with double major and lumbar curves did show abnormalities in the weight-bearing pattern. Bracing of curves less than 40 degrees did not alter the plantar weight-bearing pattern, but it did significantly alter the pattern in curves greater than 40 degrees. Surgically treated patients were found to have increased hindfoot weight-bearing irrespective of the curve type or surgery.     

The sagittal configuration and mobility of the spine in idiopathic scoliosis

The aim of this study is to see how the spinal sagittal configuration and mobility in 127 patients with idiopathic scoliosis are influenced by increasing scoliotic deformity and to determine when this deformity gets clinically significant compared to controls (n = 92). In patients with thoracic curves the degrees of thoracic kyphosis and lumbar lordosis were significantly less than those of the controls. Neither the kyphosis nor the lordosis were correlated to the Cobb angles. Even patients with small curves have straight spines in the sagittal plane; there is no tendency for the kyphosis and lordosis to decrease when the scoliotic deformity increases. This indicates that it is especially individuals with straight spines in the sagittal plane who are prone to develop scoliosis. It is also suggested that the limitation in spinal function for curves with Cobb angles below 50 degrees may be neglected.     

Sagittal profiles of the spine in scoliosis associated with an Arnold-Chiari malformation with or without syringomyelia

The sagittal spine of children with Arnold-Chiari I malformation with or without syringomyelia and associated scoliosis (ACS) has been poorly studied. A retrospective review of scoliosis secondary to ACS from three centers was undertaken. Sagittal and coronal plane variables were measured from standing radiographs. There were 30 ACS children (19 girls, 11 boys) with an average curve of 50 +/- 20 degrees and age of 11.2 +/- 3.2 years. Syringomyelia was present in 26 (87%). The scoliosis was thoracic in 25, thoracolumbar in 3 and lumbar in 2; 18 curves were right and 12 were left. A positive correlation was noted between cervical lordosis (CL) and thoracic kyphosis (TK). The 30 children with ACS scoliosis were compared with 26 children with adolescent idiopathic scoliosis (AID). The ACS group had more left curves (40% vs. 0%, P = 0.0002), more boys (37% vs. 8%, P = 0.01), and was younger (11.3 +/- 3.7 years vs. 14.2 +/- 1.8 years, P = 0.004). TK and CL were increased in ACS (TK: 40 +/- 13 degrees vs. 30 +/- 13 degrees, P = 0.005; CL: 16 +/- 21 degrees vs. -5 +/- 12 degrees, P < 0.0001). The ACS and AID groups were subdivided by CL >0 degrees and <0 degrees. In the ACS group, 19% (5 of 21) had CL <0 degrees, in the AID group 77% (20 of 26) had CL <0 degrees (P = 0.0001). When cervical lordosis is >0 degrees or thoracic kyphosis is >40 degrees (Cobb method), the clinician should strongly suspect the presence of an Arnold-Chiari I malformation with or without syringomyelia.     

Idiopathic scoliosis: prognostic value of the profile

Summary A study was undertaken to establish the significance of the sagittal shape of the spine in 138 consecutively treated girls with early idiopathic thoracic scoliosis. All were treated in a Boston brace. Two groups were formed: group I consisted of 120 girls whose scoliosis remained stable in the brace, group II of 18 girls who required a spinal fusion for progressive curves despite the brace. For each spine, the orientation of each vertebra to the horizontal in the sagittal plane was measured on the earliest lateral radiogram, taken when the anterior curve still had a Cobb angle of less than 20°. A significant difference in spinal profile was found between the two groups. Progressive curves showed a more retroverted orientation of mid- and high thoracic vertebrae than stable curves.     

Trunk rotation in scoliosis the influence of curve type and direction in 150 children

We compared the angle of trunk rotation (ATR) from scoliometer readings with Cobb angle measurements of the lateral deviation of the spine in 150 children referred to hospital for evaluation of scoliosis. the mean Cobb angle in thoracic curves was 16 °, in thoracolumbar curves 17° and in lumbar curves 20°. in thoracic curves and in right convex curves no patient with a Cobb angle of 25° or more had an ATR below 9°. in thoracolumbar and lumbar and in left convex curves, 7° ATR was occasionally associated with scoliosis of 25° or more. the correlation coefficient between the ATR and Cobb angle in right convex curves was 0.65 compared to 0.57 in left convex curves. We conclude that a criterion of 7° ATR for thoracic or right convex curves and one of 6° ATR for thoracolumbar and lumbar or left convex curves seem adequate for identification of patients with Cobb angles of 25° or more, which reduces the need for spinal radiography and follow-up outside the school screening programs.     

Spinal deformities in tall girls

In a prospective study, 62 girls who consulted the paediatric department because of tall stature were examined for spinal deformities. Thirteen cases of scoliosis measuring 10 degrees or more were found. Eighteen girls had a thoracic kyphosis of more than 40 degrees and 11 had additional vertebral abnormalities indicating Scheuermann's disease. The incidence of scoliosis and Scheuermann's disease was much higher in our material than normal.     

Spinal deformities in tall girls

In a prospective study, 62 girls who consulted the paediatric department because of tall stature were examined for spinal deformities. Thirteen cases of scoliosis measuring 10 degrees or more were found. Eighteen girls had a thoracic kyphosis of more than 40 degrees and 11 had additional vertebral abnormalities indicating Scheuermann's disease. The incidence of scoliosis and Scheuermann's disease was much higher in our material than normal.     

Mechanisms of curve progression following sublaminar (Luque) spinal instrumentation.

Fifty-two patients with Luque instrumentation were reviewed for spinal deformities. Forty-two patients were reviewed during 1 year (longest 7.2 years) at follow-up. Two patients were included who lost correction within 1 year (both 8 months). Follow up averaged 2.9 years. Curve causes primarily were neuromuscular but included one was caused by idiopathic scoliosis, four by Scheuermann's disease, and 1 by post-laminectomy kyphosis. The Cobb angle progressed in 45% of patients postoperatively. Factors contributing to progression included progressive vertebral rotation or the crankshaft phenomenon (11), wire pull out (7), progressive pelvic obliquity (4), rod bending (3), pseudarthrosis (2), and rod migration (2). Factors correlating with progression were kyphosis, postoperative curve greater than 35 degrees, preoperative curve greater than 60 degrees, and not fusing to the pelvis in nonambulators. Crankshaft was common in patients Risser II or less but did not occur in more mature patients.     

Spinal mobility and posture and their correlations with growth velocity in structurally normal boys and girls aged 13 to 14

Spinal mobility and posture were measured and their correlations with growth velocity were calculated in 30 boys and 30 girls aged 13 to 14. The spinal measurements were carried out by noninvasive goniometric methods. In the thoracic spine kyphosis (P less than 0.01), forward flexion (P less than 0.01) and the sum of lateral flexions (P less than 0.05) were reduced in the girls compared with the boys. In the boys and girls alike, thoracic rotation to the left was smaller than to the right, but the difference was statistically significant (P less than 0.05) only for the girls. In the girls, thoracic forward flexion and rotation to the left had negative correlations (r = -0.38 and -0.39, P less than 0.05) with growth velocity. The hypothetical significance of the results for the explanation of the development of adolescent idiopathic scoliosis is discussed.     

End vertebra angle--a roentgenographic method to describe a scoliosis. A follow-up study of idiopathic scoliosis treated with the Boston brace

A new method of measuring the range of the lateral deviation of a scoliosis is introduced. Here the Cobb angle is divided into two separate parts, consisting of the angles between each end vertebra and the horizontal plane. This angle is called the end vertebra angle. One hundred and twenty-one patients with adolescent idiopathic scoliosis, treated with Boston braces, were measured according to this technique and these angles were compared with the Cobb angles. All patients had S-shaped, right convex thoracic and left convex lumbar scolioses. Three end vertebra angles were measured and called A, B, and C. The middle end vertebra angle (B) was responsible for the improvement of the scoliosis in the brace, measured according to Cobb, and also the remaining improvement 2 years after weaning from the brace. The proximal and distal end vertebra angles (A and C), however, were unchanged or had increased at the time of the follow-up study 2 years after weaning from the brace treatment when compared with the status before the treatment. This could not be observed by using the Cobb method only. If end vertebra angles A and B are not equal, the thoracic curve is asymmetric. This asymmetry can be of two types depending on which of the two end vertebra angles is the greater one. If A is greater than B, the result of brace treatment was more successful than that of the symmetric curves.(ABSTRACT TRUNCATED AT 250 WORDS)     

Height of girls with adolescent idiopathic scoliosis

In a Finnish population, the standing height of 1500 consecutive female patients aged 9-24 years (mean 13.9 years) with untreated idiopathic scoliosis of at least 10 degrees in their lateral curves was compared with the standing height of average girls. The mean magnitude of the major curves was 29.4 degrees (range 10 degrees-80 degrees), and that of the minor curves 20.3 degrees (range 0 degrees-66 degrees). A formula for the height loss caused by the lateral curves, and that caused by thoracic kyphosis, was derived. The corrected height of the girls with idiopathic scoliosis was highly significantly (P<0.001) greater than the height of average girls at the age of 11-15, and this high level of significance was present at the age of 11-13, even without correcting for the height loss caused by scoliosis. After maturation, the girls with idiopathic scoliosis were not significantly taller than average girls. On average, the magnitude of thoracic kyphosis did not affect the height of patients with scoliosis as compared with the height of normal girls of the same age.     

女性青少年特发性脊柱侧凸患者自我形象评估的相关影响因素分析

目的:探讨女性青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者自我形象评估的影响因素。方法:回顾性分析2010年9月～2011年3月在我院就诊的252例女性AIS患者,年龄12～18岁,平均14.5±1.8岁。均摄取患者站立位全脊柱正侧位X线片,并独立填写一份简体中文版SRS-22问卷。在站立位全脊柱正侧位X线片上测量Cobb角、顶椎旋转度、胸椎后凸角、腰椎前凸角、脊柱冠状面力线偏移及脊柱矢状面力线偏移等参数。采用相关分析研究各临床指标与自我形象评分的相关性。结果:患者平均Cobb角35.5°±12.8°;平均顶椎旋转度2.0°±0.7°;平均胸椎后凸角16.2°±9.0°;平均腰椎前凸角51.3°±9.8°;平均脊柱冠状面力线偏移1.2±0.7cm;平均脊柱矢状面力线偏移2.4±1.5cm;平均体重指数18.3±2.2;平均自我形象评分16.7±2.8分。胸弯和胸腰弯/腰弯的自我形象评分均与主弯Cobb角有相关性(r分别为-0.171,-0.225,P均<0.05);其中大角度胸弯组呈显著相关(r=-0.484,P=0.005)。而其他参数与患者自我形象评估均无明显相关性(P均>0.05)。结论:女性AIS患者的自我形象主要受主弯Cobb角的影响,其中大角度胸弯患者的自我形象受主弯Cobb角的影响最大。     

Stature and idiopathic scoliosis. A prospective study

A study of 130 scoliotic children with curves measuring 10 degrees or more has been performed in order to elucidate the importance of stature, growth and development. Girls with adolescent idiopathic curves measuring 15 degrees or more were taller than girls with smaller idiopathic curves and taller than those whose scoliosis was secondary to leg-length inequality (pelvic tilt scoliosis). No differences were observed as regards growth velocity or development. The increased standing height may be genetic but the uncoiling effect of the normal kyphosis to give a flat lateral profile is a more likely cause. The familial trend in idiopathic scoliosis may therefore be explained by the genetically determined shape of the spine in the median (sagittal) plane.     

Spinal deformity after combined thoracotomy and sternotomy for congenital heart disease

Patients with congenital heart disease are at an increased risk to develop scoliosis. The purpose of this study was to determine the incidence of spinal deformity in patients after thoracotomy and sternotomy for congenital heart disease. METHODS: Sixty-eight patients underwent thoracotomy followed by a sternotomy and met inclusion criteria. The medical records were reviewed to gather demographic data and medical and surgical history. Serial radiographs were reviewed. RESULTS: Scoliosis developed in 26% of the patients (10 boys, 8 girls). The mean Cobb angle was 40 degrees (range, 15-78 degrees). The mean age at diagnosis of scoliosis was 10.7 years (range, 2.9-17 years). The mean follow-up was 14.9 years (range, 5-20 years). Twelve percent (8 patients) required posterior spinal fusion. A kyphotic deformity developed in 21% (14 patients). In patients with scoliosis, the mean kyphosis was 38 degrees (range, 2-88 degrees). Patients with a cyanotic cardiac condition had a 4-fold incidence of scoliosis. There was no correlation between the development of scoliosis or kyphosis and the age at time of procedures, number of surgeries, sex, heart size, or side of the aortic arch. CONCLUSIONS: The risk of developing scoliosis in children with congenital heart disease is more than 10 times that of idiopathic scoliosis. Spinal deformities, including scoliosis and/or hyperkyphosis, were found in 38% of the patients. Curves develop at a younger age, which increases the risk of progression. The sagittal alignment in scoliosis patients tends toward hyperkyphosis. The thoracic spine receives a "double hit" when both procedures are combined.     

Spinal mobility and posture in 8- to 16-year-old children.

Spinal mobility and posture were measured in 294 8-16-year-old boys and girls, divided into five age groups. The upper thoracic sagittal alignment was more vertical among girls, but the postural curves showed no significant age-related differences for either sex. Among both boys and girls thoracic extension, lateral flexion, and rotation decreased significantly between the ages of 12 and 13, but with the exception of extension they returned to the previous level by age 16. Girls were significantly different from boys at 13 years of age. In the thoracic spine, girls had less kyphosis, and were stiffer in forward and lateral flexion, with more rotation to the right than to the left. In the lumbar spine, lateral flexion increased after the age of 10 in both sexes. Between the ages of 8 and 14 lumbar lateral flexion was significantly greater among girls than among boys, whereas extension and rotation was greater only at the ages of 8 and 10 years. With increasing age, a shift from left to right dominance in lumbar lateral flexion was found in girls only.