凹侧撑开术或凸侧切除术治疗先天性颈胸段侧凸畸形的对比研究

目的:对比凹侧撑开与凸侧切除治疗先天性颈胸段侧凸畸形的技术差异,并评价其疗效。方法:收集2010年1月至2020年1月期间收治先天性颈胸段侧凸畸形8例患者的病历资料。男5例,女3例;手术时年龄为（12.5±4.5）岁（范围6~20岁）。C 7楔形椎1例,T 1半椎体及不对称蝶形4例,T ...     

后路半椎体切除节段固定矫正侧后凸畸形疗效初步观察

目的 :观察和评价由单个先天性半椎体引起的侧后凸畸形经一期后路半椎体切除及节段矫形内固定的初期手术效果。对象与方法 :对 10例由单个先天性半椎体引起的侧后凸畸形患者进行回顾性分析。年龄在 8～ 14岁之间 ,均经一期后路半椎体切除及节段性矫形内固定。随访 6个月～ 2年 (平均 1年 2个月 )。术前、术后及随访时摄站立位脊柱全长正侧位片进行观察。结果 :10例患者术前均有侧后凸畸形。术后侧凸角度由平均 69°改善至 2 8° (矫正率 60 %) ;后凸畸形由术前的平均 48°矫正至平均 19°。随访获初步或坚强融合 ,无神经系统损伤、感染及内固定失败等并发症发生。结论 :由先天性半椎体所引起的脊柱侧后凸畸形可经一期后路半椎体切除和节段矫形内固定而获得满意的矫形效果。手术适应证为由胸椎或胸腰段半椎体畸形所引起的青少年患者的结构性侧后凸畸形。     

青少年先天性半椎体脊柱侧凸畸形的手术治疗

[目的]探讨治疗青少年先天性半椎体脊柱侧凸畸形的手术方法及治疗效果。[方法]对18例青少午先天性半椎体脊柱侧凸患者,按照术式分为侧前路矫正、前后路联合矫正。首先通过胸腰段、腰段脊柱侧凸的半椎体、椎间盘切除,然后采用侧前路短节段椎体螺钉固定,旋转棒的三维旋转矫正脊柱的畸形7例;采用前后路联合入路,经后路行残余半椎体的关节突、椎板切除,凸侧加压、凹侧支撑固定11例。[结果]18例患者中侧凸平均矫正Cobb's角36.7°,矫正率77%,经18~28个月随访,达到满意的矫形效果,丢失率低,融合良好。[结论]小儿半椎体畸形应早期手术治疗。侧前路和前、后路联合半椎体切除临床效果满意,其中前路矫正手术用于胸腰椎、腰椎单一半椎体畸形。     

后路一期半椎体切除治疗脊柱上胸段侧后凸畸形

目的:观察后路一期半椎体切除、内固定植骨融合治疗上胸段侧后凸畸形的临床效果。方法 :2005年12月～2010年2月我院共收治半椎体所致脊柱上胸段侧后凸畸形患者8例,男4例,女4例;年龄11～15岁,平均13岁。3例患者合并神经系统症状。均行后路一期半椎体切除内固定植骨融合术,术前、术后和随访时拍摄站立位脊柱正侧位X线片,测量冠状面与矢状面局部后凸Cobb角;记录围手术期并发症;通过JOA评分评价术前、术后1周及末次随访时神经系统症状的改善情况。结果:全部病例随访6～50个月,平均22.8个月。手术时间150～420min,平均278min。术中出血量500～3500ml,平均1787ml。固定融合节段4～11节,平均8.5节。冠状面局部侧凸Cobb角由术前平均45.5°矫正至术后1周的14.4°;矢状面局部后凸Cobb角由术前平均47.9°矫正至术后1周的21.6°;3例合并神经系统损伤患者平均JOA评分由术前5分提高到末次随访时的8分。1例连接器固定患者术后10个月随访时发现细棒断裂,翻修后随访24个月效果良好。结论:对于先天性脊柱上胸段畸形,后路一期半椎体切除、内固定植骨融合术可取得良好的治疗效果。     

儿童及青少年颈胸段/上胸段先天性脊柱侧后凸畸形手术治疗的疗效与并发症

目的:评估儿童及青少年颈胸段/上胸段先天性脊柱侧后凸畸形手术治疗的疗效和并发症。方法:回顾性研究2005年4月～2018年1月于我科接受手术治疗的颈胸段及上胸段先天性脊柱侧后凸畸形患者45例,男27例,女18例;年龄10.9±3.1岁(5～15)岁。术前所有患者均存在双肩不等高以及斜颈,2例患者存在脊髓受压及神经功能障碍(均为ASIA D级)。术前均行全脊柱CT平扫及三维重建,畸形顶点位于颈椎12例,位于胸椎33例;形成障碍型24例,分节障碍型5例,混合型16例;28例患者存在代偿性胸弯/胸腰弯;23例患者伴发其他部位的脊柱畸形。所有患者术前均行全脊柱MRI明确椎管内病变情况。对于计划进行颈胸段(C7/T1)截骨或颈椎固定的患者,行双侧椎动脉CT造影(CTA)检查。所有患者均行三柱截骨侧后凸矫形内固定植骨融合术,其中44例患者为单纯后路手术,1例接受C6-7半椎体切除患者行前后路联合手术。截骨水平位于颈椎12例,位于胸椎33例;半椎体切除术32例,全脊椎切除术10例,经椎弓根截骨术3例。6例患者代偿弯行手术治疗,其中4例接受后路融合术,2例接受双生长棒手术。于术后3个月、6个月及1年随访,此后每年进行随访。术前、术后及随访时均摄站立位全脊柱正侧位X线片,对原发侧凸、代偿侧凸及节段性后凸Cobb角与锁骨角、斜颈角度及矢状面平衡(sagittal vertical axis,SVA)进行测量。统计手术时间、术中出血量和手术并发症情况。结果:手术时间为269.1±65.3min(150～310min),术中出血量为987±157ml(500～2700ml)。45例患者均获1年以上随访,随访时间2.8±0.6(1～13)年。原发侧凸Cobb角术前为51.3°±13.9°,术后10.3°±6.4°,末次随访时12.4°±7.5°;代偿侧凸术前为32.1°±23.0°,术后11.1°±21.0°,末次随访时16.3°±23.1°;节段性后凸Cobb角术前为24.2°±15.2°,术后9.2°±8.7°,末次随访时10.4°±9.4°;斜颈术前为19.3°±5.0°,术后4.6°±3.0°,末次随访时5.7°±4.1°;锁骨角术前为7.5°±3.1°,术后2.7°±1.9°,末次随访时2.1°±1.2°;SVA术前为-9.1±16.1mm,术后-12.3±11.2mm,末次随访时-7.5±15.2mm。术后的原发侧凸Cobb角、代偿性侧凸Cobb角、斜颈角度、锁骨角及节段性后凸Cobb角与术前比较均有统计学差异(P0.05),末次随访时的原发侧凸、代偿性侧凸及节段性后凸Cobb角与术后比较有统计学差异(P0.05);SVA术前、术后及末次随访时均在正常范围内,无统计学差异(P0.05)。2例术前存在神经功能障碍者术后完全恢复正常。22例患者发生24例次并发症,其中一过性脊髓损伤伴C8神经根损伤1例,一过性神经根损伤14例,Horner综合征1例,内固定失败2例,血胸3例,切口延迟愈合1例,肺不张1例。结论:三柱截骨术治疗颈胸段及上胸段先天性脊柱侧后凸畸形矫形效果良好,但手术相关并发症风险较高,一过性神经根损伤较为常见,需引起外科医生充分的重视。     

一期后路半椎体切除治疗半椎体所致先天性脊柱畸形

目的探讨一期后路半椎体切除内固定治疗半椎体所致先天性脊柱畸形的可行性及疗效。方法自1998年10月～2003年6月,对11例半椎体所致的先天性脊柱畸形采用一期后路半椎体切除内固定矫形。男5例,女6例,年龄2.5～23岁,平均15.4岁。单个半椎体7例,多个半椎体2例,半椎体合并对侧骨桥或肋骨融合2例;病变位于胸段(T3、T4、T6、T9)4例、胸腰段(T11 1例、T12 1例、L1 2例)4例、腰段(L3 1例、L4 2例)3例。术前侧凸Cobb 角为44°～82°,平均60.5°;伴后凸畸形3例,Cobb角分别为13°(L4)、27°(L3)和48°(L1)。躯干偏移4~36.7mm,平均21.2mm。内固定使用CD2例,中华长城2例,SYNERGY1例,TSRH6例。结果手术时间平均为185min;术中出血平均850ml。长节段固定9例;短节段单侧固定1例,短节段双侧固定1例。术后平均随访1年10个月。固定融合节段为2~11个椎体,平均8.4个。侧凸Cobb角为0°～24°,平均18.7°,平均矫正率为69.1%;3例伴后凸畸形患者,后凸Cobb角分别为-11°、-8°和0°。术后躯干偏移0~16.3mm,平均为6.2mm,侧、后凸和躯干偏移无明显矫正丢失。术中并发症包括椎弓根或椎板骨折2例;1例术后出现切口渗液及脊柱轻度不稳定。结论应用一期后路半椎体切除、内固定治疗半椎体所致的先天性脊柱畸形效果满意,近期疗效可靠。     

一期后路经椎弓根半椎体切除节段固定治疗先天性胸腰椎侧后凸畸形

目的评价一期后路经椎弓根半椎体切除节段固定术治疗完全分节的胸腰椎半椎体畸形所致的先天性脊柱侧后凸畸形的疗效。方法采用一期后路经椎弓根半椎体切除内固定矫形术治疗了12例完全分节的胸腰椎半椎体畸形所致的脊柱侧后凸畸形。其中男8例，女4例，年龄为7～17岁，平均11．3岁。观察并测量术前术后及随访时站立位脊柱X线片冠状面和矢状面Cobb角、侧凸的顶椎偏移。结果随访10～34个月，平均16个月。术后冠状面平均矫正64．1％，随访中无明显丢失。后凸由术前平均32。矫正至平均19°，随访中无明显丢失，顶椎偏移由术前平均4．5cm矫正至平均1．2cm。无脊髓损伤及切口感染等并发症。结论一期后路经椎弓根半椎体切除内固定矫形术是治疗完全分节的胸腰椎半椎体畸形所致的脊柱侧后凸畸形的有效方法。     

胸椎楔形截骨术矫正胸段侧凸畸形

目的　探讨胸椎体楔形截骨在顶椎位于胸段脊柱侧凸矫形中的应用价值。方法　采用后路凸侧椎体楔形截骨、凹侧软组织松解、椎弓根系统内固定治疗胸段脊柱侧凸 2 3例 ,其中特发性脊柱侧凸畸形 2 0例 ,侧方半椎体畸形3例。共行截骨 2 9个椎体 ,T10 以上椎体截骨 14个 ,最高为T5椎体 ,T10 以下椎体截骨 15个。所有病例皆采用椎体冠状面楔形截骨。结果　术后随访平均 19.2个月 (4个月～ 36个月 )。术前Cobb角为 6 5°～ 110° ,平均为 74 .4°。术后测量的Cobb角为 10°～ 35° ,平均矫正率为 76 .5 % ;术后平均身高增长 4 .5cm。手术中失血为 80 0～ 82 0 0ml,平均170 0ml。术后皆无神经系统及其他方面的并发症。结论　单一后路椎体楔形截骨可有效矫正胸段脊柱侧凸     

后路半椎体切除矫形治疗儿童先天性胸腰段脊柱后凸畸形

[摘要]目的：探讨后路截骨矫形治疗儿童不完全分节半椎体畸形所致先天性脊柱后凸畸形的临床效果。方法：回顾性分析我院2006年11月～2010年11月期间收治的14例先天性半椎体脊柱后凸畸形的患儿,其中男6例,女8例;年龄5．6～13岁,平均10-3岁。     

后路半椎体切除短节段融合固定术治疗儿童腰骶段半椎体畸形及近端代偿侧凸自发矫正的影响因素

目的:评价后路半椎体切除、短节段融合固定术治疗儿童先天性腰骶部半椎体畸形的效果,探讨术后近端代偿侧凸(PCC)自发矫正的影响因素.方法:回顾性分析2012年1月～2018年12月我院诊治的25例腰骶部半椎体患儿的临床资料,其中男14例,女11例,年龄3.3～13.0岁(6.74±2.81岁),L4～S1半椎体10例,L...     

Rib-vertebral angle asymmetry in idiopathic, neuromuscular and experimentally induced scoliosis

The concave and convex rib-vertebral angle (RVA) at levels T2–T12 was measured on AP radiographs of 19 patients with right convex idiopathic thoracic scoliosis and 10 patients with major thoracic right convex neuromuscular scoliosis. The difference between the angles on the concave and the convex sides, the RVAD, was calculated. The RVAs were also measured on radiographs from three animal groups in which spinal curves had been induced experimentally in a variety of ways. Group 1 comprised 16 rabbits that had been subjected to selective electrostimulation of the latissimus dorsi, the erector spinae and the intercostal muscles. Group 2 comprised four dead rabbits whose spines had been subjected to manual bending. Group 3 comprised eight rabbits that had undergone mechanical elongation of one rib. In both the idiopathic and the neuromuscular group, the convex RVA was smaller than the concave RVA between levels T2 and T8, with a maximal difference between T4 to T5. From T9 to T12 the concave RVA was smaller than the convex. The RVA in relation to the scoliotic segment, i.e. the apex level of the curve and the two neighbouring vertebrae above and below this level, showed similar results. With increasing Cobb angle the RVADs increased linearly with the greatest difference at the second vertebra above the apex. In the three experimental groups the pattern of the RVADs between T6 to T12 was basically similar to the findings of the clinical study. From the results of these clinical and experimental studies, it is concluded that the typical pattern of the RVAs on the concave and convex sides seems to be independent of the underlying cause of the spinal curvature. It is likely that the RVADs result from a passive mechanical adaptation of the ribs to the lateral curvature of the spine.     

顶椎切除术治疗僵硬型脊椎侧凸

采用顶推切除术作为僵硬型脊柱侧凸矫形手术的一个组成部分，治疗僵硬型脊柱侧凸２３例。其中先天性侧凸１１例，术前平均侧弯角度为９１．３°，术后为４６．０°，平均矫正率为４９．８％．顶椎在Ｔ１～Ｌ２的１８例的矫正率为５５．８％。文中对采用顶椎切除术的原因、方法、合并症和预防意外的要点进行了讨论。结果提示：顶椎在Ｔ１以下、畸形度８０°～１２０°的僵硬型脊柱侧凸，采用此法可以提高矫正率。     

Muscle study in experimental scoliosis in rabbits with costotransversectomy: evidence of ischemic process

Scoliosis involves the central nervous system diseases, ligaments, articulations and skeletal muscles, but there is no consensus on its pathogeny and progression of muscle abnormalities. In this study, we investigate the morphologic changes in the muscle of rabbit submitted to experimental scoliosis, with special emphasis on abnormalities related to blood supply. We studied 26 rabbits subjected to costotransversectomy by pulling out six transverse processes at thoracic level and six rabbits were used as controls. All the animals operated upon developed scoliosis showing an average angle of 29.1° on the 60th day, with its apices located at T4 and T12 when they were subjected to paraspinal muscle biopsy on both sides. The muscle biopsies were subjected to histological stains and histochemical reactions, as well as to a morphometric study. On the concave side, the changes were not statistically significant regarding the control group. On the convex side conjunctive tissue proliferation, infiltration by adipose tissue, central nucleus excess, inflammatory reaction, segmental fibrosis, type 1 fiber hypertrophy, type 2 fiber hypertrophy and atrophic angular dark fibers in the unspecific esterase were statistically significant. The segmental fibrosis reached a circumscribed muscle segment, compatible with an ischemic phenomenon. The histological diagnoses on the concave side of the animals had unspecific alterations (atrophy and hypertrophy) in 13, myopathy in 3, denervation in 3 and normal in 7. The convex side diagnoses were myopathy in 14, denervation in 8, mixed in 3 and normal in 1. The procedure determined morphologic changes on the convex side indicating possible denervation or myopathy of ischemic origin.     

后路半椎体切除椎弓根器械固定治疗小儿先天性脊柱侧凸

目的评价单纯后路半椎体切除椎弓根器械固定治疗小儿先天性脊柱侧凸的疗效。方法12例半椎体所致的先天性脊柱侧凸病例均行单纯后路半椎体切除椎弓根器械内固定术。结果12例均获得随访,时间6~42个月(平均18个月)。脊柱侧凸Cobb角由42.5°±6.7°纠正到16.2°±3.2°,纠正率64.7%。5例明显后凸的Cobb角由33.5°±5.2°纠正到13.3°±5.6°,纠正率53.2%。最后随访时侧凸和后凸分别为15.6°±5.8°和14.2°±3.3°,与术后相比无纠正丢失。无神经损伤、感染等并发症。结论单纯后路半椎体切除椎弓根器械内固定是早期治疗小儿先天性脊柱侧凸的有效术式,能够通过较短节段的融合获得满意的矫正,并且对小儿是一种相对简单、安全、微创的手术方法。     

Postoperative Respiratory Complications in Non-Idiopathic Scoliosis

The medical records of 303 patients undergoing fusions for scoliosis correction were retrospectively reviewed. The frequency and type of postoperative respiratory complications were compared in idiopathic versus non-idiopathic scoliosis patients in relation to age, type of spinal fusion procedure, pulmonary function test (PFT) results and preoperative diagnoses. The following factors were found to increase the incidence of problems in the postoperative period: a non-idiopathic type of scoliosis, mental retardation, anterior spinal fusion procedures, age of 20 or more years, a relative arterial hypoxemia and an obstructive component to the PFT's. Topics for further investigation are suggested.     

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.     

Serial elongation-derotation-flexion casting for children with early-onset scoliosis

Various early-onset spinal deformities, particularly infantile and juvenile scoliosis (JS), still pose challenges to pediatric orthopedic surgeons. The ideal treatment of these deformities has yet to emerge, as both clinicians and surgeons still face multiple challenges including preservation of thoracic motion, spine and cage, and protection of cardiac and lung growth and function. Elongation-derotation-flexion (EDF) casting is a technique that uses a custom-made thoracolumbar cast based on a three-dimensional correction concept. EDF can control progression of the deformity and - in some cases-coax the initially-curved spine to grow straighter by acting simultaneously in the frontal, sagittal and coronal planes. Here we provide a comprehensive review of how infantile and JS can affect normal spine and thorax and how serial EDF casting can be used to manage these spinal deformities. A fresh review of the literature helps fully understand the principles of the serial EDF casting technique and the effectiveness of conservative treatment in patients with early-onset spinal deformities, particularly infantile and juvenile scolisois.     

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.     

滑动环式椎弓根螺钉脊柱侧凸矫形系统的研制及动物实验研究

目的 通过生长期大型动物实验,考察滑动环式椎弓根钉脊柱侧凸矫形系统随脊柱生长的自动滑动性能及其对脊柱生长的影响.方法 将12只3个月龄幼山羊随机分为少锚定点组、多锚定点组及空白对照组.术前及术后1个月、3个月采用X线片、三维CT重建测量各组脊柱生长和环式椎弓根钉棒系统的滑动情况.实验结束后取手术节段脊柱进行大体标本观察.结果 各实验组三维CT重建及大体标本观察见椎体结构良好,发育正常;少锚定点组L5～T10脊柱生长长度为平均43.0 mm,钉棒滑动41.2 mm;多锚定点组L5～T10脊柱生长长度为平均43.5 mm,钉棒滑动39.4 mm;空白对照组L5～T10脊柱生长长度为平均40.9 mm.结论 滑动环式椎弓根钉脊柱侧凸矫形系统能够随脊柱生长而实现钉棒间的滑动.     

Degenerative Scoliosis: A Review

Degenerative lumbar scoliosis is a coronal deviation of the spine that is prevalent in the elderly population. Although the etiology is unclear, it is associated with progressive and asymmetric degeneration of the disc, facet joints, and other structural spinal elements typically leading to neural element compression. Clinical presentation varies and is frequently associated with axial back pain and neurogenic claudication. Indications for treatment include pain, neurogenic symptoms, and progressive cosmetic deformity. Non-operative treatment includes physical conditioning and exercise, pharmacological agents for pain control, and use of orthotics and invasive modalities like epidural and facet injections. Operative treatment should be contemplated after multi-factorial and multidisciplinary evaluation of the risks and the benefits. Options include decompression, instrumented stabilization with posterior or anterior fusion, correction of deformity, or a combination of these that are tailored to each patient. Incidence of perioperative complications is substantial and must be considered when deciding appropriate operative treatment. The primary goal of surgical treatment is to provide pain relief and to improve the quality of life with minimum risk of complications.