Lenke Ⅰ型青少年特发性脊柱侧凸患者两侧肋骨长度的差异性研究

目的揭示青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者顶椎区两侧肋骨长度是否存在差异,并探讨其与AIS病因学的关系。方法研究对象为LenkeI型AIS患者62例,均为胸右主弯,年龄10～18岁(13.5±2.3岁),Cobb角25°～100°(43°±16°),顶椎位于T6～T10。根据Cobb角分为3组:A组,Cobb角<40°,28例;B组,40°≤Cobb角<60°,25例;C组,Cobb角≥60°,9例。采用CT三维重建的方法测量所有病例顶椎区包括顶椎及其上下各一椎体两侧肋骨的长度。结果A组中顶椎及其下一椎体凹侧肋骨显著长于凸侧(P<0.01),而其上一椎体两侧肋骨长度无显著性差异(P>0.05),B组及C组顶椎区凹侧肋骨均显著长于凸侧(P<0.01)。AIS患者顶椎区两侧肋骨长度的差值与Cobb角之间呈显著正相关(P<0.01)。结论LenkeI型AIS患者顶椎区两侧肋骨长度存在不对称,但此不对称是否为侧凸形成的一个原发致病因素有待进一步研究。     

使用EOS影像系统评价Lenke 5型青少年特发性脊柱侧凸的手术矫形效果

目的 使用EOS影像模拟三维重建方法评价后路悬臂梁联合直接椎体去旋转技术治疗Lenke 5型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)的畸形矫正效果.方法 采用回顾性研究方法,选取2018年3月至2019年2月在我院治疗的16例AIS Lenke 5型患者,其中男1例...     

后路矫正特发性脊柱侧凸相关问题的探讨

目的探讨后路矫正特发性脊柱侧凸的相关问题。方法回顾2001年1月～2006年10月42例特发性脊柱侧凸患者，冠状面Cobb角45°～145°，平均76．75°；矢状面Cobb角22°～105°，平均47．08°；Bending相主胸弯侧凸平均矫正率20．51％～39．19％。侧凸Cobb角80°～145°8例，采用一期后路松解，颅盆环牵引二期后路选择性节段椎弓根螺钉固定及胸廓成形术；侧凸Cobb角60°～79°16例，行同期后路松解选择性节段椎弓根螺钉固定术；侧凸Cobb角小于60。18例，勿需松解，即行选择性节段椎弓根螺钉固定。结果Cobb角80°～145。、60°～79。和小于60。的术后矫正Cobb角分别为10°～40°（34．50°）、6°～25°（18．66。）、4°～18°（10．11°）；术后侧凸平均矫正率分别达66．88％、73．31％和80．34％。术后后凸Cobb角平均矫正角度为29．50°、27．74°和22．65°，平均矫正率分别为57．35％、40．77％和10．30％。随访12～78个月（平均36个月），16例失访，随访26例中23例内固定无松脱断裂，畸形丢失率为1．53％～5．10％，平均3．01％。2例术后1年半复查发现断棒，再次矫形术。结论重度AIS应采用后路广泛松解，凹侧松解是关键。颅盆环牵引安全可靠。选择性节段椎弓根螺钉固定同样达到全节段椎弓根螺钉固定的矫形效果。融合范围应密切结合AIS的分型。胸廓成形术后早期对肺功能有影响，通过术后肺功能训练可恢复至术前水平。     

成人特发性脊柱侧凸的后路截骨术

目的评价后路脊柱截骨术在治疗成人特发性脊柱侧凸的有效性和安全性。方法回顾性随访2000年1月至2004年12月间接受后路截骨矫形固定融合术并随访2年以上的53例成人特发性脊柱侧凸，男13例，女40例，平均年龄31．2岁（20～48岁）。按照弯曲部位分别为单胸弯23例，胸腰弯15例，双胸弯7例，胸腰双弯8例。术前平均胸椎Cobb角58．8°（44～93），腰椎49．5°（35°～79°），平均柔韧度胸椎28．2％，腰椎37．1％。躯干偏移平均38mm（3～79mm）。本组中37例术前合并腰背痛，5例合并椎管或神经根管狭窄所致的下肢症状。所有患者接受一期后路选择性经关节突椎板截骨矫正、经椎弓根固定融合术。通过病例查阅、X线片测量以及问卷随访，评价矫正情况和功能情况。结果所有患者均安全完成手术，无神经损伤等严重并发症发生。平均截骨节段3．1个（2～5个），平均手术时间3．5h（2．8～5．2h），平均出血量892ml（750～l520m1）。所有患者均获得2年以上随访（2～5年）。术后胸椎侧凸平均17．2°（19°～47°），最终随访时平均19．8°（11°～49°）。术后腰椎侧凸平均16．7°（7°～23°），最终随访时平均l8．9°（8°～26°）。术后躯干偏移平均为l1mm（0～2lmm），平均矫正71％。37例术前存在腰背痛者35例最终随访时腰背痛消失，5例术前存在下肢症状者术后完全消失。结论成人特发性脊柱侧凸行后路经关节突和椎板截骨可以获得满意矫正，疼痛症状缓解，是治疗成人特发性脊柱侧凸的安全有效的手术方法。     

特发性脊柱侧凸的生物力学研究进展

脊柱侧凸是复杂的脊柱三维畸形，主要表现为冠状面上脊柱的侧弯，合并横断面上椎体的旋转。脊柱侧凸是躯干的畸形，其特征是脊柱的侧向偏移和轴位旋转。在许多特发性脊柱侧凸病例中存在矢状面上胸椎生理后凸的减少以及肋骨的变形。少数特发性脊柱侧凸病例表现为主弯与次弯交界区的后凸畸形。     

合并无症状性Chiari—Ⅰ型畸形脊柱侧凸的手术治疗

目的探讨伴有无症状Chiari—Ⅰ型畸形的脊柱侧凸手术矫正的策略和方法。方法伴发脊柱侧凸的无自觉症状的Chiari—Ⅰ型畸形患者18例,男10例,女8例,平均年龄14．5岁。进行侧凸矫形,单纯后路矫形植骨融合固定10例,前路松解后路截骨固定矫形3例,前路松解固定和后路截骨固定3例,后路生长棒固定矫形2例。固定器械均采用中华长城内固定系列。其中17例患者行枕大孔扩大减压成形手术治疗后再行矫形手术。结果术前冠状面的Cobb角平均70．4°,术后Cobb角平均20．8°,术前矢状面后凸的平均46°,术后平均15．8°,术前平均身高148．9cm,术后平均身高154．8cm,平均增高5．9cm,平均随访24个月,侧凸和后凸矫正平均丢失分别为5％和4％,未发现假关节形成,17例对治疗结果表示满意。结论对于合并有Chiari—Ⅰ脊柱侧凸,针对不同年龄和侧凸弯曲和柔韧性,以及小脑扁桃体下移的程度,先行枕骨大孔扩大硬膜切开成形,再行侧凸矫形,可以取得安全满意的矫形效果。     

特发性脊柱侧凸患者髂骨松质骨中Ⅰ型胶原、骨钙素和骨保护素等mRNA的表达

目的探讨青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）女性患者骨组织中Ⅰ型胶原、骨钙素和骨保护素mRNA含量的变化与骨量减低之间的关系。方法43例AIS女性患者，年龄12～18岁。Cobb角范围40°～105°，平均50．3°±12．8°。将所有AIS患者分为两组：A组为骨量正常患者，B组为骨量减低患者。运用RT—PCR方法检测术中取髂骨松质骨块中Ⅰ型胶原、骨钙素和骨保护素mRNA的表达。结果本组病例中骨量正常者（A组）29例，而骨量减低者（B组）14例（32．6％）。两组患者的生长发育相关资料等无显著性差异。两组患者间骨钙素和骨保护素mRNA的相对含量无显著性差异，而A组患者Ⅰ型胶原mRNA的相对含量高于B组患者，但无统计学意义（F=1．761，P=0．196）。相关分析显示全部患者的Ⅰ型胶原相对含量与BMD值之间呈较弱的正相关性，骨钙素和骨保护素与BMD值无显著相关性。结论本组病例AIS女性患者的松质骨中Ⅰ型胶原、骨钙素和骨保护素等的mRNA表达量与骨量减低缺乏显著关联。不过，AIS女性患者的骨量减低与松质骨中Ⅰ型胶原含量之间的关系难以排除。     

退行性脊柱侧凸的最新研究进展

退行性脊柱侧凸（degenerativescoliosis）是一类成年人中出现的脊柱畸形,即在人体骨骼成熟以后,冠状面正直的脊柱出现侧方弯曲,Cobb’s角〉10°,但不包括由脊柱器质性病变如外伤、肿瘤等导致的脊柱侧凸。病变脊柱以腰段最为多见,少部分也可累及胸腰段,常伴随有腰椎前凸减少、椎体侧方滑移及椎管或神经根管狭窄等病变。与青年特发性脊柱侧凸不同,此病主要引起患者腰背部顽固性疼痛、跛行、神经根性症状等,严重影响患者的工作与生活。老年人为此病的高发人群,随着全球人口老龄化的进展,老年人群比例逐年升高,退行性脊柱侧凸的发病率也明显增加[2]。于是,对此类疾病的诊治手段及其疗效便成为临床医师与患者们共同关注的焦点。现就近年来对退行性脊柱侧凸相关的研究进行回顾、综述,以求能全面、详实地介绍此类疾患,探索更加科学、有效的治疗方法。     

不同分型系统对青少年特发性脊柱侧凸单胸弯融合和下端融合椎选择的影响

目的研究King分型系统和Lenke分型系统对青少年特发性脊柱侧凸（AIS）实际手术中融合弯和下端融合椎（LIV）选择策略的影响,探讨Lenke1型病例的融合原则。方法回顾分析我院2002～2007年收治的52例单胸弯AIS患者,其中男11例,女41例。胸弯Cobb角平均53°,腰弯Cobb角平均35°,所有患者颈7重力垂线均偏离骶骨中线。综合考虑腰弯角度的大小、腰弯的柔韧度、旋转中立椎、稳定椎以及患者的外观、平衡等因素,对所选病例分别用King分型理论和Lenke分型理论确定融合范围并选定下端融合椎,与实际手术中的融合范围进行对比分析。结果所有病例随访12～38个月,平均15个月,术后胸弯矫正至平均20°,矫正率为64％,最后随访Cobb角平均丢失2．7°;术后腰弯矫正至平均11°,矫正率为70％,最后随访Cobb角平均丢失2．4°。与实际LIV比较,相差3个或3个以上节段的病例,King分型系统有8例,Lenke分型系统有4例,Lenke分型系统的融合原则与实际手术更加相符,但主胸弯和腰弯的矫正率及角度丢失二者无明显差异;对于Lenke1A（KingⅢ、Ⅳ型）单胸弯患者,两种分型系统的原则无明显差异,实际手术中LIV的选择与Suk原则建议的LIV比较,相差均在1个节段以内;全椎弓根螺钉技术的主胸弯矫正率及最后随访时角度丢失优于CD技术。手术效果不满意2例,均为实际行选择性胸弯融合的病例,其中1例发生“曲轴现象”,胸弯角度丢失27°;1例发生腰弯失代偿,角度丢失15°。结论Lenke分型系统的融合原则与实际手术更相符,符合两种分型原则的病例的手术效果无明显差异;融合弯和下端融合椎的选择应充分考虑腰弯角度、腰弯柔韧度、旋转中立椎、稳定椎以及患者的外观、平衡等因素。     

特定运动疗法对青少年特发性脊柱侧凸矫正效果的Meta分析

目的 探讨特定运动疗法(physiotherapeutic scoliosis specific exercises,PSSE)对青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者的干预效果。方法 在知网、维普、万方、PubMed、Web of Science、Springerlink、IEEE数据库平台上检索关于PSSE干预AIS的随机对照研究。使用RevMan 5.4对PSSE改善AIS患者Cobb’s角、躯干旋转角(angle of trunk rotation,ATR)、胸椎后凸角(thoracic kyphosis,TK)和脊柱侧凸研究学会22 (Scoliosis Research Society-22,SRS-22)问卷评分开展Meta分析。结果 纳入9篇随机对照试验(randomized controlled trial,RCT)文献,AIS患者422例。Meta分析结果显示,PSSE改善AIS患者Cobb’s角(MD=3.29,95%CI:2.24～4.33,P <0.000 01),ATR (MD=1.65,95...     

Magnetic resonance evaluation of idiopathic scoliosis: A prospective study

The objective of the present study was to determine the incidence of unsuspected intraspinal pathology and to assess the value of atypical clinical features as predictors of these intraspinal pathologies, in patients with idiopathic scoliosis. Twenty-five consecutive patients (13 boys, 12 girls) with idiopathic scoliosis were prospectively evaluated with MRI. Magnetic resonance imaging detected intraspinal pathology in seven patients (28%), which included syringohydromyelia with Chiari I malformation (n = 5), and syringomyelia and dumb-bell neurofibromas in one patient each, respectively. Dural ectasia was also present in five patients. Atypical features, described in the literature as pointers to intraspinal pathologies such as the age < 11 years at presentation, presence of pain, hyperkyphosis, severe curves and the presence of the left thoracic or thoracolumbar curves, were seen to be equally distributed between the two groups (those with and without intraspinal pathologies), thus raising doubts about the importance of these features.     

Risk factors of rib metastases in nasopharyngeal carcinoma patients with rib 99mTc- MDP foci on whole-body bone scansCSCD

Objective To investigate the correlation of rib 99mTc-MDP foci on whole-body bone scan with clinical variables and rib metastases in nasopharyngeal carcinoma(NPC) patients, and to screen the risk factors of rib metastases. Methods We retrospectively reviewed 312 NPC patients with rib 99mTc-MDP foci on wholebody bone scan. Chi-square test and logistic regression were performed to evaluate the correlation between clinical variables and rib metastases. Results In all 312 NPC patients, rib metastases were associated with T stage, skull base bone invasion, other bone metastasis, number of rib foci, lateral localization on rib and foci type (P<0.01), and the risk factors of rib metastasis included skull base bone invasion, other bone metastases, lateral localization on rib and foci type (P<0.05). In 176 patients with pure rib foci, rib metastases were closely related to T stage, skull base bone invasion, other bone metastasis, number of rib foci and lateral localization on rib (P<0.05), while only lobar distribution (P=0.029) was the effective risk factor. In 198 patients with single rib focus, rib metastases were affected by skull base bone invasion and foci type (P<0.01), while only foci type (P=0.000) was the effective risk factor. In all 566 rib foci, uptake level and localization on rib were the effective risk factors of rib metastases(P<0.01). Conclusion In NPC patients with rib foci on whole body bone scan, the effective risk factors of rib metastases include skull base bone invasion, other bone metastases, lateral localization on rib, foci type, uptake level and anterior and posterior localization on rib. Follow up should be the main way for the pure rib foci on unilateral ribs. For multiples rib foci on bilateral ribs or single rib focus combined with other bones foci, additional image modalities should be required to exclude bone metastasis. © 2020, CHINA RESEARCH ON PREVENTION AND TREATMENT. All rights reserved.     

Clinical significance of pectoralis muscle strength in elderly patients with idiopathic pulmonary fibrosis

Introduction:Investigations of muscle dysfunction in patients with idiopathic pulmonary fibrosis (IPF) are limited to peripheral muscles. However, decreased thoracic muscle mass is known and deterioration of chest wall muscle strength is not clear.Objective:The aims of the present study were to evaluate pectoralis muscle strength located on the chest wall and to investigate the relationship of spirometric measurements and respiratory muscle strength with pectoralis muscle strength.Methods:Elderly patient with IPF (mean disease duration 7.47±7.04 years) and the age-and sex-matched healthy volunteers were recruited in this cross-sectional study. The pulmonary function test was performed by a portable spirometer for spirometric variables and a gas analyzer for diffusing capacity for carbon monoxide (DL_CO). Maximal inspiratory (MIP) and expiratory pressure (MEP) were measured with mouth pressure device. Modified Medical Research Council Dyspnea Scale (MMRC) was used to determined dyspnea severity. The pectoralis muscle strength was assessed isometrically during shoulder joint horizontal adduction movement with a handheld dynamometer.Results:A total of 17 patients with IPF (9 males, mean age 69.06±3.94 years) and 19 healthy controls (10 males, mean age 70.95 ±4.99 years) were included. Patients with IPF had lower pectoralis muscle strength than healthy controls (p<0.001). Significant relationships were found between pectoralis muscle strength and MIP (r=0.79, p<0.001), MEP (r=0.81, p<0.001), FEV₁% (r=0.54, p=0.02), FVC% (r=0.68, p<0.003) and DL_CO (r=0.61, p=0.009). With multiple linear regression analysis, pectoralis muscle strength was the only independent predictor of FVC% (adjusted R²=0.37, p<0.05).Conclusion:In patients with IPF, pectoralis muscle strength decreases and is associated with pulmonary function. In particular pectoralis muscle strength is likely to have an important impact on FVC%. Therefore, we consider that this test should be included routinely in chest diseases and rehabilitation clinics. The trial was registered U.S. National Library of Medicine clinical trial registry (https://clinicaltrials.gov, Trial ID: {"type":"clinical-trial","attrs":{"text":"NCT04803617","term_id":"NCT04803617"}}NCT04803617)     

退变性腰椎侧凸两种手术方式的疗效观察

目的探讨退变性腰椎侧凸不同手术治疗方法的适应证选择,观察不同治疗方法的疗效。方法31例退变性腰椎侧凸患者,男8例,女23例。平均年龄55.3岁（51～76岁）,平均病程8．6年（4—17年）,腰椎侧弯Cobb’s角平均23．5°（15°-44°）。根据患者不同的临床表现,选择两种手术方法：A组（19例）以广泛腰痛症状为主诉,伴有失平衡状态,行椎弓根螺钉器械长节段固定矫形、椎管多节段开窗减压、横突间植骨融合;B组（12例）以下肢神经压迫症状为主诉,腰痛轻微,平衡良好。行短节段椎弓根螺钉固定（1．2个运动节段）、选择性椎管开窗减压、椎体间或横突间植骨融合。两组均术后1—2周佩带腰背支具活动,支具佩带3—6个月。结果术后平均随访24．7个月（16—67个月）,29例（93．5％）疼痛消失或仅感轻微疼痛,两组组内手术前、后VAS评分和Oswestry功能障碍指数（ODD评分有统计学差异。A、B两组组间比较,在手术时间和手术出血量上有统计学差异,而术后疼痛VAS评分和Oswestry功能障碍指数改善率均无统计学差异。结论退变性腰椎侧凸两种手术方式的疗效均满意。根据退变性腰椎侧凸不同的手术适应证,选择合适的手术方式是提高疗效的关键。     

Dynamics of fibrosis in chronic idiopathic (primary) myelofibrosis during therapy: a follow-up study on 309 patients

Controversial issues in chronic idiopathic myelofibrosis (IMF) are amongst others the evolution of the disease process and the influence of therapy on the dynamics of fibrosis. For this reason, a multicenter observational study was performed on 309 patients with IMF that had a long follow-up including 822 bone marrow biopsies at a median interval of 32 months. In addition to a control group (156 patients) with symptomatic treatment, monotherapy consisted of busulfan (30 patients), hydroxyurea (52 patients), interferon (26 patients) and various combinations (48 patients). Density and quality (reticulin/collagen) of fibers was determined by a semiquantitative scoring system. Independent of therapeutic regimens at the time of the last bone marrow biopsy 67% of the patients with grades 0-2 fibrosis revealed a progression, 42% stable state and 6% regression of myelofibrosis. Because of significant differences concerning frequencies of biopsies and endpoints of examinations, individual changes in the grades of fibrosis were evaluated with regard to treatment applied at standardized intervals of 20 months. According to this calculation no relevant differences in the dynamics of myelofibrosis (progression, stable state) was detectable in the control group compared to the other therapeutic modalities. The few patients with a regression of myelofibrosis usually presented with severe hypoplasia compatible with a myelo-ablative effect by aggressive chemotherapy. In conclusion, persuasive evidence has been produced that myelofibrosis in IMF is characterized by a stepwise progression and that this process is not significantly influenced by current treatment strategies.