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.     

Relative anterior spinal overgrowth in adolescent idiopathic scoliosis—result of disproportionate endochondral-membranous bone growth?

There is no generally accepted scientific theory for the etiology of adolescent idiopathic scoliosis (AIS). As part of its mission to widen understanding of scoliosis etiology, the International Federated Body on Scoliosis Etiology (IBSE) introduced the electronic focus group (EFG) as a means of increasing debate on knowledge of important topics. This has been designated as an on-line Delphi discussion. The text for this EFG was written by Professor Jack Cheng and his colleagues who used whole spine magnetic resonance imaging (MRI) to re-investigate the relative anterior spinal overgrowth of progressive AIS in a cross-sectional study. The text is drawn from research carried out with his co-workers including measurement of the height of vertebral components anteriorly (vertebral body) and posteriorly (pedicles) in girls with AIS and in normal subjects. The findings confirm previous anatomical studies and support the consensus view that in patients with thoracic AIS there is relatively faster growth of anterior and slower growth of posterior elements of thoracic vertebrae. The disproportionate anteroposterior vertebral size is associated with severity of the scoliotic curves. In interpretating the findings they consider the Roth/Porter hypothesis of uncoupled neuro-osseous growth in the spine but point out that knowledge of normal vertebral growth supports the view that the scoliosis deformity in AIS is related to longitudinal vertebral body growth rather than growth of the canal. In the mechanical mechanism (pathomechanism) they implicitly adopt the concept of primary skeletal change as it affects the sagittal plane of the spine with anterior increments and posterior decrements of vertebral growth and, in the biological mechanism (pathogenesis) propose a novel histogenetic hypothesis of uncoupled endochondral-membranous bone formation. The latter is viewed as part of an intrinsic abnormality of skeletal growth in patients with AIS which may be genetic. The hypothesis that AIS girls have intrinsic anomalies (not abnormalities) of skeletal growth related to curve progression and involving genetic and/or environmental factors acting in early life is not original. While the findings of Professor Cheng and his colleagues have added MRI data to the field of relative anterior spinal overgrowth in AIS their interpretation engenders controversy. Three new hypotheses are proposed to interpret their findings: (1) hypoplasia of articular processes as a risk factor for AIS; (2) selection from the normal population to AIS involves anomalous vertebral morphology and soft tissue factors—this hypothesis may also apply to certain types of secondary scoliosis; and (3) a new method to predict the natural history of AIS curves by evaluating cerebro-spinal fluid (CSF) motion at the cranio–cervical junction. What is not controversial is the need for whole spine MRI research on subjects with non-idiopathic scoliosis.This paper provides an edited summary of the third electronic focus group (EFG) of the International Federated Body on Scoliosis Etiology (IBSE). It contains the research of Professor JCY Cheng MD and his colleagues on relative anterior spinal overgrowth in adolescent idiopathic scoliosis (AIS) that was debated by via e-mail by IBSE members in three rounds during November 2003–October 2004. The summary including Professor Chengs statement, comments, questions, answers, and responses 1–26 was circulated by e-mail to IBSE members on 19 October 2004 and no further comments were received. Ideas presented in this summary are personal opinions and are not necessarily shared by all those within IBSE. Some details about IBSE are contained in the edited summary of the first EFG of the IBSE [59].     

Analysis of vertebral morphology in idiopathic scoliosis with use of magnetic resonance imaging and multiplanar reconstruction

BACKGROUND: Several studies have provided data on the vertebral morphology of normal spines, but there is a paucity of data on the vertebral morphology in patients with idiopathic scoliosis. METHODS: The morphology of the pedicles and bodies of 307 vertebrae as well as the distance between the pedicles and the dural sac (the epidural space) in twenty-six patients with right-sided thoracic idiopathic scoliosis were analyzed with use of magnetic resonance imaging and multiplanar reconstruction. RESULTS: A distinct vertebral asymmetry was found at the apical region of the thoracic curves, with significantly thinner pedicles on the concave side than on the convex side (p < 0.05). The degree of intravertebral deformity diminished farther away from the apex, with vertebral symmetry restored at the neutral level. In the thoracic spine, the transverse endosteal width of the apical pedicles measured between 2.3 mm and 3.2 mm on the concave side and between 3.9 mm and 4.4 mm on the convex side (p < 0.05). In the lumbar spine, the pedicle width measured between 4.6 mm at the cephalad part of the curve and 7.9 mm at the caudad part of the curve. The chord length and the pedicle length gradually increased from 34 mm and 18 mm, respectively, at the fourth thoracic vertebra to 51 mm and 25 mm, respectively, at the third lumbar vertebra. The transverse pedicle angle measured 15 in the cephalad aspect of the thoracic spine, decreased to 7 at the twelfth thoracic vertebra, and increased again to 16 at the fourth lumbar vertebra. The width of the epidural space was <1 mm at the thoracic apical vertebral levels and averaged 1 mm at the lumbar apical vertebral levels on the concave side, whereas it was between 3 mm and 5 mm on the convex side (p < 0.05). CONCLUSION: Idiopathic scoliosis is associated with distinctive intravertebral deformity, with smaller pedicles on the concave side and a shift of the dural sac toward the concavity.     

Anterior lengthening in scoliosis occurs only in the disc and is similar in different types of scoliosis

BACKGROUND CONTEXTRelative anterior spinal overgrowth was proposed as a generalized growth disturbance and a potential initiator of adolescent idiopathic scoliosis (AIS). However, anterior lengthening has also been observed in neuromuscular (NM) scoliosis and was shown to be restricted to the apical areas and located in the intervertebral discs, not in the bone. This suggests that relative anterior spinal overgrowth does not rightfully describe anterior lengthening in scoliosis, as it seems not a generalized active growth phenomenon, nor specific to AIS.PURPOSETo determine if compensatory curves in congenital scoliosis exhibit a mechanism of anterior lengthening without changes in the vertebral body, similar to curves in AIS and NM scoliosis.STUDY DESIGN/SETTINGCross-sectional.PATIENT SAMPLECT-scans were included of patients in whom a short segment congenital malformation had led to a long thoracic compensatory curve without bony abnormality. Based on data of other scoliosis types, the calculated required sample size was n=12 to detect equivalence of vertebral bodies as compared with nonscoliotic controls. Out of 143 congenital scoliosis patients, 18 fit the criteria and compared with 30 nonscoliotic controls, 30 AIS and 30 NM scoliosis patients.OUTCOME MEASURESThe anterior-posterior length discrepancy (AP%) of the total curve and for vertebral bodies and intervertebral discs separately.METHODSOf each vertebral body and intervertebral disc in the compensatory curve, the anterior and posterior length was measured on CT-scans in the exact mid-sagittal plane, corrected for deformity in all three planes. The AP% was calculated for the total compensatory curve (Cobb-to-Cobb) and for the vertebral bodies and the intervertebral discs separately. Positive AP% indicated that the anterior side was longer than the posterior side.RESULTSThe total AP% of the compensatory curve in congenital scoliosis showed lordosis (+1.8%) that differed from the kyphosis in nonscoliotic controls (−3.0%; p<.001) and was comparable to the major curve in AIS (+1.2%) and NM scoliosis (+0.5%). This anterior lengthening was not located in the bone; the vertebral body AP% showed kyphosis (−3.2%), similar to nonscoliotic controls (−3.4%) as well as AIS (−2.5%) and NM scoliosis (−4.5%; p=1.000). However, the disc AP% showed lordosis (+24.3%), which sharply contrasts to the kyphotic discs of controls (−1.5%; p<.001), but was similar to AIS (+17.5%) and NM scoliosis (+20.5%).CONCLUSIONSThe current study on compensatory curves in congenital scoliosis confirms that anterior lengthening is part of the three-dimensional deformity in different types of scoliosis and is exclusively located in the intervertebral discs. The bony vertebral bodies maintain their kyphotic shape, which indicates that there is no active anterior bony overgrowth. Anterior lengthening appears to be a passive result of any scoliotic deformity, rather than being related to the specific cause of AIS.     

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.     

Anterior-posterior length discrepancy of the spinal column in adolescent idiopathic scoliosis—a 3D CT study

Background Context

One of the characteristics of reported observations in adolescent idiopathic scoliosis (AIS) is that the thoracic spine is longer anteriorly than posteriorly, more pronounced around the apex than the transitional zones. This reversal of the normal kyphotic anatomy of the thoracic spine is related to questions of etiopathogenesis of AIS. The changes in the anatomy of the anterior column have been described rather in detail; however, the role of the posterior spinal column and the laminae has so far not been elucidated. If the posterior column exhibits a longitudinal growth disturbance, it could act as a tether, leading to a more or less normal anterior column with a deformed and shorter posterior aspect of the spine. So far, it has remained unclear whether this anterior-posterior length discrepancy is the result of relative anterior lengthening or relative posterior shortening, and which tissues (bone, disc, intervertebral soft tissue) are involved.

Observations on the growth of the adolescent spine

We have measured the increase in height and width of the vertebral bodies and expressed them as percentages of the total growth in children aged 10 to 17 years. The first group, 10 boys and 10 girls, each had a single thoracic adolescent idiopathic scoliosis while the second group, 10 girls, each had a single lumbar adolescent idiopathic scoliosis. No significant differences were found between the growth increments and spinal dimensions of the vertebral bodies involved in the scoliotic curve and those vertebrae outside the curve in the same patient. The vertebrae were more slender in girls than in boys.     

The association of disproportionate skeletal growth and abnormal radius dimension ratio with curve severity in adolescent idiopathic scoliosis

Abnormal anthropometric measurements during the peripubertal growth spurt have been documented in adolescent idiopathic scoliosis (AIS). Magnetic resonance (MR) imaging studies of the spine have suggested a disproportionate endochondral and membranous ossification in AIS. The present study aimed at investigating whether disproportional ossification and skeletal growth occurred in the peripheral bone of AIS patients using the radius as the target bone. Skeletally mature AIS girls with different severity (n = 290) and age-matched control healthy girls (n = 80) were recruited. The anthropometric parameters were recorded. The midshaft of non-dominant radius was scanned with peripheral quantitative computed tomography (pQCT) and the radius diameter was calculated from the cross-sectional area. Radius dimension ratio was derived from the ratio of radius diameter to radius length. The anthropometric parameters were compared between AIS and control with adjustment for age. The radius dimension ratio was further correlated with curve severity in AIS girls using Pearson’s correlation test. The analysis showed that the arm span and radius length were slightly longer in AIS girls. The BMI of AIS girls was significantly lower than the controls. The radius dimension ratio in severe AIS girls was significantly lower than the controls and the ratio of AIS girls correlated with the curve severity (r = −0.120; p = 0.039). The abnormal radius dimension ratio supported the presence of systemic growth abnormalities in AIS. Disproportional endochondral-membranous ossification could explain for the observation. The observation of the association of radius dimension ratio with curve severity provides an important potentially clinically measurable parameter for further longitudinal studies on the prognostication of curve progression in AIS.     

Strength reductions of thoracic vertebrae in the presence of transcortical osseous defects: effects of defect location,pedicle disruption,and defect size

Summary Transcortical osseous lesions were simulated in thoracic vertebrae to investigate the effects on vertebral strength of defect location, pedicle disruption, and defect size. Alternate vertebrae from 15 thoracic spines were assigned to five defect groups: anterior, posterior, lateral, one pedicle, or both pedicles. The remaining vertebrae served as controls. All vertebrae were tested to failure in combined axial — flexion loading. The intact failure load for each vertebra with a defect was estimated based on the actual failure loads of the control vertebrae from the same spine. The failure loads for vertebrae with transcortical defects (anterior, posterior, lateral) were significantly lower (P=0.0001) than estimated intact loads; this was not the case for vertebrae with single pedicle disruption (P=0.90). Relative strengths (defined as actual failure load divided by predicted intact failure load) for the anterior (mean=0.51), posterior (0.55) and lateral (0.58) defect groups were not significantly different from each other, but were different from the single pedicle defect group (1.09). Relative strength depended only weakly on defect size. Comparison of these results with those of a previous study of simulated defects in the vertebral centrum suggests that transcortical defects result in slightly greater reductions in vertebral strength than defects of comparable size involving only trabecular bone.     

Spine slenderness and wedging in adolescent idiopathic scoliosis and in asymptomatic population: an observational retrospective study

The origin of the deformity due to adolescent idiopathic scoliosis (AIS) is not known, but mechanical instability of the spine could be involved in its progression. Spine slenderness (the ratio of vertebral height to transversal size) could facilitate this instability, thus playing a role in scoliosis progression. The purpose of this work was to investigate slenderness and wedging of vertebrae and intervertebral discs in AIS patients, relative to their curve topology and to the morphology of control subjects. A total of 321 AIS patients (272 girls, 14 ± 2 years old, median Risser sign 3, Cobb angle 35° ± 18°) and 83 controls were retrospectively included (56 girls, median Risser 2, 14 ± 3 years). Standing biplanar radiography and 3D reconstruction of the spine were performed. Geometrical features were computed: spinal length, vertebral and disc sizes, slenderness ratio, frontal and sagittal wedging angles. Measurement reproducibility was evaluated. AIS girls before 11 years of age had slightly longer spines than controls (p = 0.04, Mann–Whitney test). AIS vertebrae were significantly more slender than controls at almost all levels, almost independently of topology. Frontal wedging of apical vertebrae was higher in AIS, as expected, but also lower junctional discs showed higher wedging than controls. AIS patients showed more slender spines than the asymptomatic population. Analysis of wedging suggests that lower junctional discs and apex vertebra could be locations of mechanical instability. Numerical simulation and longitudinal clinical follow-up of patients could clarify the impact of wedging, slenderness and growth on the biomechanics of scoliosis progression. These slides can be retrieved under Electronic Supplementary Material.     

Scoliosis and Growth: Patterns of Asymmetry in Normal Vertebral Growth

This study reviews published observations of asymmetrical appearance of primary ossification centres in human fetal vertebral arches. It reports studies of vertebral asymmetry in 39 vertebral columns of infants and children including asymmetry in pedicle length and vertebral arch height, asymmetry in neurocentral fusion, and vertebral body flattening on its left anterior aspect. It relates these patterns of asymmetry to the commonly observed left thoracic scoliosis of infancy and right thoracic scoliosis of adolescents and adults. It discusses the implications of these observed asymmetries of normal vertebral growth in the aetiology of scoliosis, and the possible influences of handedness and aortic pressure in the production of these vertebral asymmetries in adolescence.     

Scoliosis and Growth: Patterns of Asymmetry in Normal Vertebral Growth

This study reviews published observations of asymmetrical appearance of primary ossification centres in human fetal vertebral arches. It reports studies of vertebral asymmetry in 39 vertebral columns of infants and children including asymmetry in pedicle length and vertebral arch height, asymmetry in neurocentral fusion, and vertebral body flattening on its left anterior aspect. It relates these patterns of asymmetry to the commonly observed left thoracic scoliosis of infancy and right thoracic scoliosis of adolescents and adults. It discusses the implications of these observed asymmetries of normal vertebral growth in the aetiology of scoliosis, and the possible influences of handedness and aortic pressure in the production of these vertebral asymmetries in adolescence.     

Scoliosis and growth. Patterns of asymmetry in normal vertebral growth

This study reviews published observations of asymmetrical appearance of primary ossification centres in human fetal vertebral arches. It reports studies of vertebral asymmetry in 39 vertebral columns of infants and children including asymmetry in pedicle length and vertebral arch height, asymmetry in neurocentral fusion, and vertebral body flattening on its left anterior aspect. It relates these patterns of asymmetry to the commonly observed left thoracic scoliosis of infancy and right thoracic scoliosis of adolescents and adults. It discusses the implications of these observed asymmetries of normal vertebral growth in the aetiology of scoliosis, and the possible influences of handedness and aortic pressure in the production of these vertebral asymmetries in adolescence.     

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 effect of pedicle screw insertion through the neurocentral cartilage on the growth of immature canine vertebra

Objective: To explore the influence of pedicle screw insertion through the neurocentral cartilage (NCC) on the development of vertebrae and spinal canal in an animal experiment. Methods: Sixteen dogs were randomly assigned to three groups: in group 1, posterior muscles at the surgery site were dissected; in group 2, the pedicles were drilled through the NCC by screws; in group 3, screws were placed in the pedicles through the NCC. Vertebrae of T8, T10, T12, L2, L4 and L6 were studied with the average data of the adjacent two vertebrae serving as controls. Spiral computerized tomography (CT) was used to assess the morphologic parameters of studied vertebrae and their controls. Measurements were made by an independent radiologist on the first post‐operative day and 3 months after operation. Paired Student's t‐tests of studied vertebrae and their controls were performed to evaluate the effect of pedicle screw insertion. Results: In group 3, 3 months after operation the area, transverse diameter and anterior‐posterior diameter of the vertebral canal and length of pedicle of studied vertebrae were significantly smaller than those of control vertebrae (P < 0.05). There were no significant differences in morphologic parameters between the studied vertebrae and the control vertebrae in groups 1 and 2 (P > 0.05). Conclusion: (i) Pedicle screw placement has a significant impact on the growth of the canine vertebra canal, and may lead to iatrogenic spinal stenosis, but their placement has no significant effect on the vertebral bodies; and (ii) the NCC can repair itself automatically. Drilling pedicle bone through the NCC with a screw and then removing the screw has no obvious impact on the growth of vertebrae.     

Morphometry of the lumbar spine: anatomical perspectives related to transpedicular fixation

The pedicles of lumbar vertebrae were measured both directly and radiographically to determine the differences between the sexes and the accuracy of radiographic measurement. The lumbar pedicles of cadavera of forty-nine patients--twenty-four men and twenty-five women--who died between the ages of sixty and ninety-eight years were measured directly and on radiographs. The pedicles of lumbar vertebrae from fifty-one patients--twenty-three men and twenty-eight women--between the ages of twenty and fifty years who had low-back problems were measured on radiographs and computerized tomographic scans. Comparison revealed that the average transverse and sagittal diameters of the pedicles and the distance from the posterior aspect of the laminar cortex to the anterior aspect of the cortex of the vertebral body along the central axis of the pedicles were 5 to 20 per cent greater in men, but the transverse and sagittal angles of the pedicle did not differ significantly between the sexes. Measurements on radiographs and computerized tomographic scans of the transverse angles of the pedicles and of the distances from the posterior aspect of the laminar cortex to the anterior aspect of the cortex of the vertebral body from the second to the fifth lumbar vertebra were greater than direct measurements, even without magnification. Direct measurements of the diameters of the transverse and sagittal diameters of the pedicle of the fifth lumbar vertebra, however, were greater than the radiographic measurements.     

前路胸腔镜下青少年特发性胸椎侧凸矫形的初步临床结果

目的回顾胸腔镜下青少年特发性脊柱侧凸（adolecent idiopathic scoliosis,AIS）前路矫形的初步临床疗效。方法 2007年8月~2008年11月行胸腔镜下前路矫形患者8例,均为女性Lenkel A-型AIS患者,平均年龄为13.8岁。对手术前后及末次随访时的胸椎侧凸Cobb角、腰椎侧凸Cobb角、顶椎中点与C7中点垂线或骶骨平分线垂直距离（apical vertebral translation,AVT）、顶椎旋转角、胸椎后凸Cobb角及双肩高度差进行分析。结果所有患者术后随访3~12个月,胸椎侧凸Cobb角平均改善率为71%、矫形丢失率为6%;腰椎侧凸Cobb角平均改善率为60%、矫形丢失率为6%;AVT改善率为73%,丢失率为6%。所有患者顶椎旋转角度均无改善;胸椎后凸Cobb角无改变。双肩高度差除1例患者随访时丢失50%,其余改善率均为100%。结论柔韧度好的Lenkel A-型AIS行胸腔镜下前路矫形可获得良好的冠状面矫形,但矢状面矫形及椎体去旋转效果不佳,长期疗效有待继续观察。     

青少年特发性脊柱侧凸患者脊柱柔韧性的影响因素

目的:探讨青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者脊柱柔韧性的可能影响因素.方法:选取2006年12月～2008年4月在我院脊柱外科手术治疗的204例AIS患者,男性36例,女性168例,平均年龄15.0岁;平均Cobb角50.1°;平均Risser征3.4度;主弯跨度平均6.8个椎体;主弯顶椎旋转度平均2.0度.摄站立位全脊柱正侧位及仰卧左右侧屈位X线片,计算主弯柔韧性.采用相关分析研究各临床指标与主弯柔韧性的相关性.结果:女性AIS患者的脊柱柔韧性明显高于男性(P<0.05);胸腰弯组和腰弯组AIS患者的脊柱柔韧性显著大于胸弯组(P<0.05),胸腰弯和腰弯组之间无显著性差异(P>0.05).女性AIS患者中的年龄及主弯Cobb角(站立位与侧屈位)均与脊柱柔韧性显著负相关(P<0.05),且胸弯女性AIS患者的月经初潮至手术时间及顶椎旋转度也与脊柱柔韧性显著负相关(P<0.05).男性胸弯AIS患者中侧屈位主弯Cobb角、胸腰弯/腰弯组中主弯Cobb角(站立位与侧屈位)均与脊柱柔韧性显著负相关(P<0.05).主弯跨度及Risser征与脊柱柔韧性均无明显相关性(P>0.05).结论:女性AIS患者脊住柔韧性受年龄、月经初潮至手术时间、主弯Cobb角(站立位与侧屈位)、弯型及顶椎旋转度等因素影响;男性AIS患者的脊柱侧凸柔韧性主要受主弯Cobb角及弯型影响.     

青少年特发性脊柱侧凸患者脊柱前后柱骨骺软骨的组织形态学对比研究

目的：探讨青少年特发性脊柱侧凸（adolescentid iopathic scoliosis，AIS）患者脊柱前后柱软骨组织学和软骨细胞的增殖与凋亡有无差异及其对脊柱侧凸发生、进展的影响。方法：26例11～16岁AIS患者随机分为2组．A组12例行前路松解术或前路矫形内固定术；B组14例行后路矫形内固定术。A组取胸弯上端椎、顶椎和下端椎椎体生长板，B组取下关节突软骨．进行组织学观察及免疫组织化学测定其软骨细胞的细胞增殖核抗原（proliferation cell nuclear antigen，PCNA）指数和聚腺苷二磷酸-核糖聚合酶（poly ADP-ribose polymerase，PARP）指数。采用组织学分级作为生长潜能的指标，PCNA指数和PARP指数分别代表细胞增殖指数和凋亡指数作为软骨内成骨活跃度的指标。结果：A组AIS患者前柱椎体生长板组织学分级、增殖-肥大层软骨细胞的增殖指数（PCNA）和凋亡指数（PARP）均明显高于B组AIS患者后柱下关节突软骨．且有统计学差异（P〈0．05）。结论：相同年龄段AIS患者脊柱前、后柱生长潜能和软骨内成骨活跃程度存在差异．可能导致前柱生长过快、后柱生长缓慢，从而可能对脊柱侧凸的发生和进展发挥重要作用。     

青少年特发性脊柱侧凸椎弓根螺钉的误置模式及危险因素

目的 评估青少年特发性脊柱侧凸(AIS)椎弓根螺钉不良置入的模式并分析其原因.方法 收集从2008年7月至9月行后路椎弓根螺钉固定的70例AIS患者的临床资料,其中男性12例,女性58例;年龄12～19岁,平均(14.5±2.7)岁;术前Cobb角40°～125°,平均62.0°±18.2°.术中根据解剖标志徒手置入椎弓根螺钉,所有患者术后均行CT检查.在PACS系统上通过PacsClient软件测量螺钉穿破椎弓根内、外壁以及椎体前缘的距离.定义穿破任一壁超过2 mm为不良置钉.不良置钉中穿破内壁超过4 mm或钉尖使主动脉变形定义为高危置钉.对数据进行统计学分析,探讨不良置钉的危险因素.结果 共置入椎弓根螺钉1030枚,胸椎773枚,腰椎257枚.不良置钉108枚(10.5%),其中穿破外壁35枚,穿破内壁56枚,穿破椎体前缘33枚(其中有16枚既穿破了椎体前缘又穿破了外壁).高危置钉16枚(1.6%).顶椎、顶椎近端第5节段和顶椎远端第4节段的不良置钉率高于其他节段,其中顶椎左侧和顶椎近端第5节段右侧不良置钉率均高于对侧.顶椎区高危置钉率最高,达4.8%.Cobb角>90°组不良置钉率高于Cobb角40°～90°组,椎体旋转Ⅲ～Ⅳ度组不良置钉率高于椎体旋转0～Ⅱ度组.结论 AIS不良置钉集中在顶椎、顶椎近端第5节段和顶椎远端第4节段3个区域,高危置钉多发生在顶椎区,危险因素包括Cobb角大小、旋转程度以及与顶椎的距离.