特发性脊柱侧凸共平面技术的初步临床应用及文献回顾

目的 探讨脊柱共平面技术（vertebral coplanar alignment,VCA）对特发性脊柱侧凸的应用效果。方法 回顾性分析在我院接受VCA技术矫形的5例特发性脊柱侧凸病人的临床资料。其中男1例,女4例,平均年龄为16.3岁（14~25岁）。收集术前、术后及最近一次随访时的站立位脊柱全长正侧位X线片及CT,测量主弯Cobb角、顶椎偏移、冠状面平衡、胸椎后凸角（TK）、矢状面平衡、顶椎椎体胸廓比值（apical vertebral body-rib ratio,AVB-R）、顶椎旁肋骨弥散间距（apical rib spread difference,ARSD）、剃刀背（rib hump,RH）及椎体旋转角（rotational angle to sacrum,RAsac）。结果 主弯Cobb角由术前的55.7°矫正至术后的14.7°,TK由术前的26.7°矫正至19.0°。术前Lenke矢状面形态为“+”的病人矫正至“N”,而术前Lenke矢状面形态为“N”的病人仍维持正常的TK。AVB-R、ARSD、RH及RAsac的矫正率分别为36.0%、60.1%、56.7%、54.9%。在24个月的随访期间,无明显矫形丢失,无冠状面、矢状面失代偿发生。结论 VCA技术应用于特发性脊柱侧凸的矫形可获得满意的椎体去旋转和矢状面重建效果。目前针对VCA技术的研究多为初步应用经验,其适应证的选择还需要在今后的临床应用中进一步总结。     

Clinical Application of the Roussouly Classification in the Sagittal Balance Reconstruction of 101 Adolescent Idiopathic Scoliosis Patients

PurposeAlthough Roussouly classification has been widely used in spinal surgery, it was mainly applied to degenerative scoliosis patients and correlational studies concerning adolescent idiopathic scoliosis (AIS) are still insufficient. This retrospective study explored the clinical application of Roussouly classification in surgeries and prognosis prediction for AIS.MethodsThis clinical research selected 101 AIS patients who received surgeries between August 2005 and November 2019. Whole spine standing radiographs were obtained for each patient preoperatively, postoperatively, and at the last follow‐up (>24 months). All patients were classified into “theoretical types” and “current types.” Patients were further divided into mismatch or match groups based on the consistency of their current type and theoretical type. The main parameters include: proximal junctional angle (PJA), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), fixed thoracic kyphosis (TK), global TK, fixed lumbar lordosis (LL), global LL, thoracic tilt, proximal thoracic alignment (PTA), lumbar tilt, spino‐sacral angle (SSA), and spinal tilt (ST).ResultsA total of 47.5% of AIS patients were subject to a preoperative mismatch of Roussouly classification. There was a significant difference in PI‐LL between the preoperative mismatch and match groups (p = 0.008). There was a significant difference in the rate of PI‐LL deformity between the match and mismatch groups with a preoperative mismatch (p = 0.037). A significant difference in thoracic tilt was observed between the postoperative mismatch and match groups (p = 0.019). The preoperative mismatch group has a higher risk of postoperative PI‐LL malformation than match group (OR = 2.303, 95% CI: 1.026, 5.165). When mismatch occurred postoperatively, there were significant differences between groups in the rate of pelvic deformity (p = 0.002) and PI‐LL deformity (p = 0.025) at the last follow‐up. Compared with the postoperative match group, mismatch group had an increased risk of pelvic deformity (OR = 5.029, 95% CI: 1.618, 15.629) and PJK deformity (OR = 3.017, 95% CI: 1.709, 11.375) at the last follow‐up. Short Form‐36 and Scoliosis Research Society 22 score of the match group was significantly higher than that of the mismatch group at the last follow‐up.ConclusionThe Roussouly classification mismatch before or after operation leads to increased risks of PI‐LL deformity and pelvis deformity postoperatively or at the follow‐up, which seriously worsens the clinical symptoms and prognosis of patients. Therefore, recovering to the theoretical type in Roussouly classification may effectively improve patients'' prognosis.     

Walking balance and compensatory gait mechanisms in surgically treated patients with adult spinal deformity

Background Context

Gait patterns and their relationship to demographic and radiographic data in patients with adult spinal deformity (ASD) have not been fully documented.

凹侧撑开预矫形技术治疗重度僵硬性脊柱侧凸的早期研究

目的 研究凹侧撑开预矫形技术治疗重度僵硬性特发性脊柱侧凸的早期疗效和安全性。方法 回顾性分析2020年1月至2022年12月山西医科大学第二医院收治并进行手术治疗的重度僵硬性脊柱侧凸的8例病人的临床资料。手术均采用凹侧撑开预矫形后双侧依次上棒二次矫形的手术方法。分别测量术前、术后及末次随访时的影像学参数包括主弯Cobb角、次弯Cobb角、胸椎后凸角（TK）、腰椎前凸角（LL）、主弯顶椎偏距（AVT）、躯干偏移（TS）。结果 病人随访（9.0±6.3）个月（1~16个月）。术前主弯Cobb角：97.4°±10.0°,次弯Cobb角：55.6°±8.4°,TK：50.4°±20.3°,LL：62.7°±6.3°,AVT：（7.64±1.55） cm,TS：（2.00±1.93） cm;术后即刻主弯Cobb角：25.8°±8.1°,次弯Cobb角：21.0°±12.0°,TK：24.9°±9.6°,LL：31.6°±11.9°,AVT：（2.34±1.45） cm,TS：（1.26±0.63） cm;末次随访主弯Cobb角：21.2°±9.1°,次弯Cobb角：22.4°±16.1°,TK：32.8°±12.0°,LL：37.6°±14.0°,AVT：（2.41±0.81） cm,TS：（1.6±1.4） cm。除TS外,上述其他指标术后即刻、末次随访时的数值与术前比较,差异有统计学意义（P＜0.05）,但术后即刻与末次随访时的数值比较,差异无统计学意义（P＞0.05）。1例术后7个月出现迟发性感染,遂进行手术清创以及内固定取出术后再愈合。结论 采用凹侧撑开预矫形治疗重度脊柱侧凸能够获得满意的矫形效果,且出血少,术中及术后神经系统并发症发生率低,是一种安全有效且实用的治疗方法。     

The Standing and Sitting Spino‐Pelvic Sagittal Alignment in Patients with Instrumented Lumbar Fusion Might Correlate with Adjacent Segment Degeneration

ObjectivesSitting is a common weight‐bearing posture, like standing, but there still lacks enough understanding of sagittal alignment in sitting position for patients after lumbar fusion. This study aimed to investigate the accommodation of fixed spine from standing to sitting position and its influence on unfused segments.MethodsSixty‐two patients after lumbar fusion (test group) and 40 healthy volunteers (control group) were recruited in this research. All subjects underwent lateral radiographs of entire spine in the standing and sitting positions. The spinopelvic parameters including sagittal vertical axis (SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), thoracic kyphosis (TK), and pelvic tilt (PT) were measured. The changes in parameters of patients between two positions were compared with control group, and patients were divided in different groups based on fusion level and their parameters were compared.ResultsWhen changing from standing to sitting positions, a forward‐moving SVA and TPA were observed in both patients and control groups, accompanied by the decrease in LL, TK and increase in PT, but the changes of patients were smaller in TPA, LL, and TK (6.5° ± 7.2° vs 9.7° ± 6.0°, 7.7° ± 8.3° vs 13.6° ± 8.5°, 2.2° ± 6.5° vs 5.4° ± 5.1°, respectively, p < 0.05). Increase of PT in the lumbosacral fixation group was lower than that in the control group (4.4° ± 9.1° vs 8.3° ± 7.1°, p < 0.05). Patients who had adjacent segments degeneration (ASD) showed more kyphosis in unfused lumbar segments than the other patients (16.4° ± 10.7° vs −1.0° ± 4.8°, p < 0.05) from standing to sitting.ConclusionsThe spine straightens in lumbar and thoracic curve, combined with forward‐moving axis and pelvic retroversion when changing to the sitting position. However, these changes are relatively limited in patients after lumbar fusion, so the adjacent unfused lumbar segments compensate to stress during sitting and this may be related to ASD.     

实时超声引导技术在脊髓性肌萎缩症合并严重脊柱侧凸病人腰椎穿刺中的应用

目的 探讨实时超声引导技术在脊髓性肌萎缩症（spinal muscular atrophy,SMA）合并严重脊柱侧凸病人腰椎穿刺中应用的临床疗效。方法 回顾性分析2022年1月至2023年8月经华中科技大学同济医学院附属同济医院收治的8例确诊为SMA合并严重脊柱侧凸病人的临床资料,男2例,女6例,SMA2型5例,SMA3型3例,年龄为20~51岁。病例均收治于我院神经内科,送至手术室由麻醉科医生采用实时超声引导技术进行腰椎穿刺和鞘内注射诺西那生钠治疗。记录穿刺成功率、穿刺节段、入路、操作时长、疼痛视觉模拟量表（VAS）评分、病人满意度评分、即时和随访不良反应发生情况。结果 8例病人共进行45次穿刺,成功率为100%。3例病人采用L_3/4节段右侧入路,5例病人选择L2/3节段左侧入路。4例病人选择经椎间孔入路,另4例病人选择经椎板入路。操作时长：（24.1±8.7） min,VAS评分：（2.2±0.7）分,病人满意度评分：（8.3±0.8）分。病人平均随访时间为6个月,未出现神经损伤、穿刺部位感染、血肿等严重不良反应。结论 对于SMA合并严重脊柱侧凸病人,采用实时超声引导腰椎穿刺技术成功率高,病人满意度高,且无严重不良反应,值得在临床中进一步推广和应用。     

不同弯型青少年特发性脊柱侧凸患者脊柱-骨盆矢状面参数研究

目的:探讨不同弯型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者脊柱-骨盆矢状面平衡情况。方法:回顾性分析2013年9月~2014年12月我科收治的161例AIS患者,其中男34例,女127例,年龄12~17岁(14.6±2.1岁)。在术前站立位全脊柱正侧位X线片上测量主弯Cobb角、颈椎角(cervical sagittal alignment,CSA)、胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacrum slope,SS)以及C7铅垂线与S1后上缘的水平距离(sagittal vertical axis,SVA)。根据不同弯型将AIS患者分为单胸弯组、双胸弯组和腰弯组,比较3组间脊柱-骨盆矢状位参数的差异,采用Pearson相关性分析对各参数间的相关性进行分析。结果:单胸弯组61例,其中男13例,女48例,主弯Cobb角为51.2°±8.7°;双胸弯组40例,其中男7例,女33例,主弯Cobb角为53.7°±5.2°;腰弯组60例,男14例,女46例,主弯Cobb角为48.9°±4.8°。3组患者年龄及性别分布均无统计学差异(P0.05)。3组间Cobb角大小的差异无统计学意义(P0.05)。单胸弯组的CSA、TK均显著小于双胸弯和腰弯组(P0.05),但后两组间的差异无统计学意义(P0.05),余各项矢状面参数3组间无统计学差异(P0.05)。在3组患者中,CSA与TK均呈显著性正相关(单胸弯组r=0.73,P0.05;双胸弯组r=0.29,P0.05;腰弯组r=0.60,P0.05),但与LL及骨盆参数(PI、SS、PT)无显著相关性(P0.05)。双胸弯组TK与LL呈正相关性(r=0.40,P0.05),而在另外两组则无相关性(P0.05)。结论 :单胸弯型AIS患者较双胸弯型和腰弯型患者具有更小的颈椎前凸,3种弯型AIS患者的颈椎前凸均与TK呈正相关。单胸弯型患者的TK较另外两种弯型患者更小。双胸弯型患者的TK与LL密切相关,而单胸弯型与腰弯型患者的TK与LL无关。     

重度成人特发性脊柱侧凸脊柱-骨盆矢状面特点分析

【摘要】 目的：探讨重度成人特发性脊柱侧凸患者脊柱-骨盆矢状面平衡特点。方法：本研究纳入79名正常志愿者（正常组）、83例轻中度成人特发性脊柱侧凸患者（Cobb角<60°）以及69例重度成人特发性脊柱侧凸患者（Cobb角>80°）,再根据主弯部位分为胸弯组及胸腰弯/腰弯组,测量各组冠状面参数包括主弯Cobb角、冠状面偏移（CB）以及顶椎偏移（AVT）,矢状面参数包括矢状面偏移（SVA）、胸椎后凸角（TK）、胸腰后凸角（TLK）、腰椎前凸角（LL）、骨盆入射角（PI）、骨盆倾斜角（PT）和骶骨倾斜角（SS）、骨盆厚度（PTH）、骶骨股骨距离（SFD）、骶骨骨盆角（PRS1）、PI与LL差值（PI-LL）、PT与PI比值（PT/PI）以及C7铅垂线与骶骨中心距离（HA-C7PL）。比较各组间冠状面及矢状面参数的特点及各参数间的相关性。相关性分析使用Pearson相关分析。不同疾病组同一参数间的对比研究使用单因素方差分析及两两比较q检验。结果：与正常组相比,重度成人特发性脊柱侧凸患者的LL、TLK、TK及PRS1显著增大,PI、PT、PTH、SFD及PI-LL显著减小,重度胸腰弯/腰弯组的SVA显著增大而SS显著减小,但SVA在平衡范围内。正常组与轻中度胸弯组,冠状面及矢状面参数间无相关性。在轻中度胸腰弯/腰弯组、重度胸弯组及重度胸腰弯/腰弯组,Cobb角与TK、TLK具有相关性。在所有组中,LL与TK、LL与TLK、PI与PT及PI与SS均具有相关性。在正常组、重度胸弯组及重度胸腰弯/腰弯组中,TK与TLK具有相关性。轻中度胸腰弯/腰弯组CB与PT具有相关性;重度胸弯组中,CB与TLK、SS具有相关性;重度胸腰弯/腰弯组,冠状面Cobb角与LL及CB与PT、SS具有相关性。在重度胸腰弯/腰弯组中,LL与SVA具有相关性。在重度脊柱侧凸组中,TK与SVA具有相关性。结论：重度成人特发性脊柱侧凸矢状面排列具有自身特点,表现为TK、TLK、LL的显著增大与PI、PT的显著减小;冠状面参数中冠状面主弯Cobb角与TK、TLK及CB与SS均具有相关性,矢状面参数中TK、TLK与LL三者之间及TK与SVA之间均具有相关性;骨盆发生明显的形态学改变,表现为狭长水平的形态。     

Compensation Characteristics of Spinal Sagittal Malalignment According to Pelvic Incidence in Elderly Patients with Degenerative Lumbar Spinal Stenosis

Objective

Compensation characteristics of spinal sagittal malalignment according to pelvic incidence (PI) have yet to be elucidated. This study aimed to investigate the difference in compensatory segments according to PI in elderly patients with degenerative lumbar spinal stenosis (DLSS).

Methods

This retrospective study included 196 patients (143 females, 53 males) suffering from DLSS with an average age of 66.73 years in our department. Sagittal parameters were obtained on the whole spinal lateral radiograph, including T1-T12 slope (T1S-T12S), Cobb angle (CA) of the functional units of the thoracic spine, thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), PI, the ratio of PT to PI (PT/PI), PI minus LL mismatch (PI-LL), sagittal vertical axis (SVA). Patients were divided into the low and high PI groups according to the median value of PI. With reference to the value of SVA and PI-LL, each PI group was further grouped into the balance subgroup (SVA < 50 mm, PI-LL ≤10°), hidden imbalance subgroup (SVA < 50 mm, PI-LL > 10°), and imbalance subgroup (SVA ≥50 mm). Independent samples t-test/Mann–Whitney U test, one-way ANOVA/Kruskal-Wallis test, and Person correlation analysis were utilized for statistical test.

Results

The median value of PI was 47.65°. 96 and 100 patients were assigned to low and high PI groups, respectively. Correlation analysis indicated that the T8-T12 slope and T10-T12 slope were associated with PI-LL in the high and low PI groups, respectively (all, p < 0.01). For segmental lordosis, T8-9 to T11-12 CA and T10-11 to T11-12 CA were associated with PI-LL in the high and low PI groups, respectively (all, p < 0.01). In the high PI cohort, T8-12 CA and PT increased significantly from the balance to imbalance subgroups (both, p < 0.05). In the low PI cohort, T10-12 CA and PT first increased and then decreased from the balance to imbalance subgroups (both, p < 0.05).

Conclusion

T8-12 was the main compensatory segment of the thoracic spine in patients with high PI, while it was T10-12 in patients with low PI. In addition, the compensation potential of the lower thoracic spine and pelvis in patients with low PI was inferior to those with high PI.     

Prediction of Spirometric Values in Patients with Scoliosis

The prediction of normal spirometric values requires a measure of the non-deformed body height of scoliotic patients. The arm-span method has been used for estimating the non-deformed body height in spite of the fact that opinions about the normal relationships between body height and arm span differ. In order to minimize the error of estimation of non-deformed body height, the normal relationships between body height and arm span were determined for 91 males and for 118 females of ordinary body stature, varying age (5-78 years), and Swedish origin. The body-height/arm-span relationships were described by linear regression equations taking age into account. The results indicate significant sex and age differences in the arm-span/height ratio.

Multiple regression equations including arm span and age as regressors were used to calculate the non-deformed body height in scoliotic patients. The arm-span method was compared with the method using the degree of lateral curvature of the spine for calculation of non-deformed body height of scoliotic subjects. The arm-span method resulted in a correction of body height and predicted spirometric values that agreed closely with those obtained by the method using the degree of curvature of the spine. The two methods may be used alternatively. In accordance with earlier reports, the predicted spirometric values were underestimated when the measured body height was used.     

The characteristics of spinopelvic sagittal alignment in patients with lumbar disc degenerative diseases

Purpose

A comparative study of the spinopelvic sagittal alignment in patients with lumbar disc degeneration or herniation (LDD/LDH) in normal population was designed to analyse the role of sagittal anatomical parameter (pelvic incidence, PI) and positional parameters in the pathogenesis and development of the disease. Several comparative studies of these patients with asymptomatic controls have been done. However, in previous studies without lumbar MRI, a certain number of asymptomatic LDD patients should have been included in the control group and then impacted on the results.

Methods

Based on MRI findings, we divided 60 LDD or LDH patients and 110 asymptomatic volunteers into the normal group (NG) and the degeneration group (DG), which was further subdivided into the symptomatic (SDG) and asymptomatic (ADG) subgroups according to patients’ symptoms. Standing full spine radiographs were used to measure sagittal parameters, including PI, sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), sagittal vertical axis (SVA), and sacrum-bicoxofemoral distance (SFD).

Results

The PI, SS and LL in DG were significantly lower than NG, while the SVA and SFD were significantly greater (P < 0.05). PI correlated well with the SS and LL in all subjects. However, the trend lines of SS or LL over PI were downward in DG. PI was similar in SDG and ADG (P = 0.716) but SS and LL were significantly lower and SVA was significantly greater (P < 0.05).

Conclusions

PI may play a predisposing role in the pathogenesis of lumbar disc degenerative diseases. The secondary structural and compensatory factors would lead to a straighter spine after disc degenerative change.     

青少年特发性脊柱侧凸矫形术后多次口服与静脉应用氨甲环酸对于降低术后失血量及输血率的回顾性研究

目的 评估术后多次应用氨甲环酸能否有效降低青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）病人术后的失血量以及输血率,以及口服和静脉给药是否具有等效性。方法 回顾性分析2018年1月至2021年1月于我院行矫形手术的AIS病人的临床资料,筛选出术中采取同一给药方案给予氨甲环酸的病人：切皮前静脉滴注50 mg/kg氨甲环酸并以10 mg/kg/h持续滴注至手术结束。根据不同的术后给药方案将其分为口服组（于术后4、10、16 h口服1 g氨甲环酸）,静脉组（于术后6、12、18 h静滴0.5 g氨甲环酸）以及对照组（术后不给予氨甲环酸）。共有214例病人符合纳入标准。为提高组间可比性,本研究按口服组人数配平每组样本量,最终每组各纳入50例病人。记录并比较三组病人的术后失血量、输血率、引流量、凝血指标以及并发症等。结果 口服组、静脉组的术后失血量［（961.2±311.2） mL、（974.5±392.1） mL］和输血率（12%、14%）均显著低于对照组［（1 451.2±408.1） mL、36%］,差异有统计学意义（P＜0.05）。此外,口服组、静脉组的术后引流量、最大血红蛋白丢失值显著低于对照组,血红蛋白最低值显著高于对照组,差异有统计学意义（P＜0.05）,但口服组和静脉组间比较,差异无统计学意义（P＞0.05）。三组病人术前、术后第1~3天的凝血指标比较,差异均无统计学意义（P＞0.05）,且所有病人均未发生静脉血栓、肝肾功能异常等药物相关并发症。结论 术后多次给予氨甲环酸可以有效降低矫形术后失血量及输血率,口服给药与静脉给药具有等效性。     

Prediction of Spirometric Values in Patients with Scoliosis

The prediction of normal spirometric values requires a measure of the non-deformed body height of scoliotic patients. The arm-span method has been used for estimating the non-deformed body height in spite of the fact that opinions about the normal relationships between body height and arm span differ. In order to minimize the error of estimation of non-deformed body height, the normal relationships between body height and arm span were determined for 91 males and for 118 females of ordinary body stature, varying age (5–78 years), and Swedish origin. The body-height/arm-span relationships were described by linear regression equations taking age into account. The results indicate significant sex and age differences in the arm-span/height ratio.

Multiple regression equations including arm span and age as regressors were used to calculate the non-deformed body height in scoliotic patients. The arm-span method was compared with the method using the degree of lateral curvature of the spine for calculation of non-deformed body height of scoliotic subjects. The arm-span method resulted in a correction of body height and predicted spirometric values that agreed closely with those obtained by the method using the degree of curvature of the spine. The two methods may be used alternatively. In accordance with earlier reports, the predicted spirometric values were underestimated when the measured body height was used.     

Sagittal spinal alignment in patients with lumbar disc herniation

A retrospective cross-sectional study was designed to evaluate total sagittal spinal alignment in patients with lumbar disc herniation (LDH) and healthy subjects. Abnormal sagittal spinal alignment could cause persistent low back pain in lumbar disease. Previous studies analyzed sciatic scoliotic list in patients with lumbar disc herniation; but there is little or no information on the relationship between sagittal alignment and subjective findings. The study subjects were 61 LDH patients and 60 age-matched healthy subjects. Preoperative and 6-month postoperatively lateral whole-spine standing radiographs were assessed for the distance between C7 plumb line and posterior superior corner on the top margin of S1 sagittal vertical axis (SVA), lumbar lordotic angle between the top margin of the first lumbar vertebra and first sacral vertebra (L1S1), pelvic tilting angle (PA), and pelvic morphologic angle (PRS1). Subjective symptoms were evaluated by the Japanese Orthopedic Association (JOA) score for lower back pain (nine points). The mean SVA value of the LDH group (32.7 ± 46.5 mm, ± SD) was significantly larger than that of the control (2.5 ± 17.1 mm), while L1S1 was smaller (36.7 ± 14.5°) and PA was larger (25.1 ± 9.0°) in LDH than control group (49.0 ± 10.0° and 18.2 ± 6.0°, respectively). At 6 months after surgery, the malalignment recovered to almost the same level as the control group. SVA correlated with the subjective symptoms measured by the JOA score. Sagittal spinal alignment in LDH exhibits more anterior translation of the C7 plumb line, less lumbar lordosis, and a more vertical sacrum. Measurements of these spinal parameters allowed assessment of the pathophysiology of LDH.     

退行性腰椎滑脱症的矢状面形态分型及其临床意义

目的:基于矢状面形态特点对退行性腰椎滑脱症(degenerative spondylolisthesis,DS)进行分型,评价其在腰椎侧前方入路手术治疗DS中的指导价值。方法:回顾性分析2015年1月～2016年12月我院收治的37例L4 DS患者的临床资料,其中男15例,女22例;年龄50～67岁(58.5±9.5岁)。由3名观察者分别根据DS患者术前L4/5节段矢状面形态分为3型:(1)开口型,腰椎滑脱角(slip angle,SA)5。;(2)平行型,0°≤SA≤5°;(3)闭口型,SA0°。所有患者均采用侧前方腰椎椎间融合术(anterolateral lumbar interbody fusion,ALLIF)治疗,术中参照患者矢状位形态分型调整手术体位摆放、cage置入位置和固定等。测量术前及术后腰椎前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)和脊柱矢状面平衡(sagittal vertical axis,SVA);评估术前及术后末次随访时的腰痛和下肢痛疼痛视觉模拟评分(visual analogue scale,VAS)、腰椎Oswestry功能障碍指数(Oswestry disability index,ODI)和健康调查简表(the MOS item short from health survey,SF-36)评分。对3名观察者的分型结果进行Kappa—致性检验,并对各组患者临床资料进行统计学分析。结果:3名观察者之间分型的一致性Kappa值为0.826～0.894,观察者自身的一致性Kappa值为0.875～0.916,均高度一致。37例DS患者中开口型12例(A组),平行型17例(B组),闭口型8例(C组),术前各组间LL、PT、SS具有统计学差异(P0.05),C组LL、SS显著性低于其余两组(_P0.05;),各组间PI、SVA无统计学差异(P0.05);术后A、B组脊柱-骨盆矢状面参数均较术前无显著性变化(P0.05),而C组PT较术前显著性降低,SS、LL显著性增加(P0.05)。术前C组患者腰痛VAS显著大于其余两组(P0.05),术后各组腰痛、腿痛VAS,ODI及SF-36评分均较术前显著性改善(P0.05),其中C组腰痛VAS、0-DI和SF-36心理健康评分改善幅度均大于其余两组(P0.05)。结论:基于DS矢状面形态特点分型简单、方便且可信度高,根据DS不同分型制定相应的ALLIF治疗策略可以获得满意的临床疗效。     

先天性脊柱侧凸合并脊髓纵裂的手术治疗

目的 :探 讨先 天 性脊 柱侧 凸 合并 脊髓 纵 裂患 者的 矫 形手 术治 疗 方法 及效 果 。方 法:回顾 性 分析 31 例 先天性 脊柱 侧 凸合 并脊 髓 纵裂 患者 的 临床 资料 、手术 方 法 及 治疗 结 果 。 结果 :31 例 患 者中 合 并 骨 性纵 裂 4 例 ,纤维性 纵裂 23 , 例 混合 性 纵裂 例 纵 裂涉 及 胸段 4 , 10 ,例 腰段 例 胸 段 及腰 段 6 , 14 , 例 颈 段到 腰 段 例 1 。 矫形 手术方 法 包 括 前路 矫 形 内 固定 2 例 ,后 路 矫 形 内固 定 14 例 ,前 路 松 解 联合 二 期 后 路矫 形 内 固 定 10 例 ,一 期 前 后路半 椎体 切 除联 合后 路 矫形 内固 定 例 仅 例 患者 在 后路 矫形 手 术时 先行 切 除了 骨嵴 ,纤 维 性纵 裂均 未 予处 5 。 1理。 手术 前 、后 脊柱 侧 凸主 弯冠 状 面 Cobb 角、 顶椎 偏 距、 顶 椎 旋 转度 、 躯 干 偏移 平 均 分 别为65.4° 35.1° 和 ;51.2m m 和32.2m m ;1.3° 1.2°13.5m m 和 ; 和 8.9m m ,主弯冠 状 面矫 形率 平 均为 49.1%。术 后均 无 神经 功能 缺 陷发生或 神经 功 能缺 陷加 重 。结论 :根 据 合并 脊髓 纵 裂的 类型 、患 者的 神 经功 能状 态 选择 相应 的 治疗 方法 ,先 天 性脊柱侧 凸可 以 获得     

Postural Control in Scoliosis: A Statokinesimetric Study in Patients with Scoliosis due to Neuromuscular Disorders and in Patients with Idiopathic Scoliosis

Statokinesimetric characteristics were analysed in patients with scoliosis which had developed in the course of degenerative neuromuscular disorders and in patients with adolescent idiopathic scoliosis. Patients with Duchenne and limb-girdle muscular dystrophy and spinal muscular atrophy showed markedly decreased oscillations of the body's centre of gravity, in addition to a forward shift of its mean position. Thus the postural equilibrium in neuromuscular patients with scoliosis is even more efficiently controlled than normal. On the other hand, patients with idiopathic scoliosis did not show any significant changes as compared with normal subjects. The present study therefore does not support the suggestion that the pathogenesis of scoliosis, at least in neuromuscular patients, is triggered by an impairment of descending postural control.