青少年脊柱侧凸畸形患者超声心动图异常分析:特发性脊柱侧凸与先天性脊柱侧凸的比较

背景:脊柱畸形患者可合并有超声心动图(ultrasonic cardiography,UCG)结果异常,但文献中缺乏特发性脊柱侧凸(idiopathic scoliosis,IS)与先天性脊柱侧凸(congenital scoliosis,CS)患者UCG异常的比较.目的:比较青少年IS患者与CS患者UCG结果异常的发...     

青少年特发性脊柱侧凸患者骨密度变化的分析

目的 :探 讨青 少年 特 发性 脊柱 侧 凸患 者的 骨 密度 变化 规 律。方 法:应用 双 能 X 线骨 密 度吸 收仪 测 定 101例特 发 性 脊 柱侧 凸 患 者 腰椎 (L2￣L4)和 股 骨 近 端 (股 骨 颈 、大 转 子 、W ard's 三 角 )的 骨 密 度 ,结 合 脊 柱 侧 凸 严 重程度 进行 分 析,并 与 62名 同 年龄 段正 常 青少 年骨 密 度进 行比 较 。结 果:特发 性脊 柱 侧凸 患者 所 测各 部位 的 骨密度均 明显 低 于正 常对 照 组(P<0.05),腰 椎 骨 密 度的 降 低 比 股骨 明 显 ,股 骨 近 端 的三 个 部 位 ,以 W ard's 三 角的 骨密度 降低 尤 为显 著。有 75.2% 的 特发 性脊 柱 侧凸 患者 发生 骨 密度 降低 ,其 中 26.7% 发 生骨 量 减少 , 48.5% 符 合骨质疏 松症 的 诊断 标准 ;但 其骨 密 度的 降低 程 度与 侧凸 严 重程 度无 明 显相 关性 。 结论 :青 少年 特 发性 脊 柱 侧凸 患者存 在着 骨 密度 的降 低 ,其与 侧 凸的 严重 程 度无 关,可能 与 特发 性脊 柱 侧凸 的发 病 机理 有关 。     

后路矫形手术对青少年特发性脊柱侧凸患者脊柱高度的影响

要】 目的：评估后路矫形手术对青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）患者脊柱高度的矫正程度及其影响因素。方法：2010年1月~2011年6月接受后路矫形内固定术的AIS患者277例,单弯（single curve,SC）173例,双弯（double curve,DC）104例,站立位主弯Cobb角平均53.63°±15.38°（40°~140°）,仰卧位主弯Cobb角43.87°±15.01°（20°~124°）。脊柱高度（spinal height,SH）定义为仰卧位全脊柱正位X线片上T1椎体上终板中点至S1椎体上终板中点之间的垂直距离。测量术前、术后SH,ΔSH为手术矫正SH值。评估不同Cobb角侧凸患者的ΔSH,并采用偏相关分析评估脊柱侧凸术前Cobb角、Cobb角矫正值、Cobb角矫正率、术前SH及术后SH与ΔSH的相关性。结果：SC组仰卧位Cobb角术后矫正至15.69°±9.21°（4°~79°）,DC组仰卧位主弯Cobb角术后矫正至19.50°±13.07°（3°~95°）,矫正率分别为69.7%和65.5%。SC组和DC组术前SH分别为41.29±2.96cm和39.97±3.26cm,术后SH分别为43.77±2.71cm和42.86±3.04cm。SC组术前仰卧位Cobb角分别为≤30°、31°~40°、41°~50°、51°~60°、61°~70°、71°~80°、>80°时,ΔSH分别为1.97±0.79cm、2.14±0.63cm、2.52±0.65cm、2.77±0.51cm、3.92±0.61cm、4.33±0.22cm、4.85±0.22cm;而在DC组中,ΔSH分别为2.37±0.60cm、2.35±0.69cm、2.56±0.53cm、3.27±0.40cm、3.79±0.94cm、3.89±1.11cm、5.46±0.91cm。ΔSH与术前Cobb角[SC：r=0.702,P<0.001;DC（主弯+次发弯）：r=0.718,P<0.001]、Cobb角矫正值[SC：r=0.659,P<0.001;DC（主弯+次发弯）：r=0.698,P<0.001]和术后SH[SC：r=0.182,P=0.017;DC（主弯+次发弯）：r=0.213,P=0.033]呈显著相关性,但与Cobb角矫正率[SC：r=0.083,P>0.05;DC（主弯+次发弯）：r=0.039,P>0.05]和术前SH[SC：r=-0.082,P>0.05;DC（主弯+次发弯）：r=-0.047,P>0.05]无明显相关性。结论：后路矫形手术可显著改善AIS患者的SH,术前Cobb角和Cobb角矫正值是影响SH矫正程度的主要因素,术后SH是次要影响因素,而Cobb角矫正率则影响不大。     

青少年特发性脊柱侧凸患者的心理特征分析

目的:分析青少年特发性脊柱侧凸(AIS)患者的心理特征,并与普通人群进行比较,为AIS患者的心理干预提供依据.方法:对2006年9月～2008年10月门诊或住院的46例AIS患者进行心理学评分,并和同年龄段的50例健康青少年志愿者(对照组)的评分进行比较,同时比较男女患者之间以及轻度(10°～40°)、中度(41°～90°)和重度(>90°)脊柱侧凸患者之间评分的差异.评分采用第四军医大学心理学教研室推荐的症状自评量表(symptom checklist 90,SCL-90)、抑郁自评量表(self-rating depressive scale,SDS)和焦虑自评量表(self-ratinganxiety scale,SAS),所有量表均由患者及志愿者本人独立完成,由我校心理学教研室进行统一分析.结果:AIS患者SCL-90躯体化、人际敏感、抑郁症状、焦虑症状、偏执症状评分均显著高于对照组(P<0.05),而强迫症状、敌对症状、恐怖症状和精神病性评分与对照组比较无显著性差异(P>0.05).对照组中男性的SDS和SAS评分与女性比较无显著性差异(P>0.05),AIS组女性患者的SDS和SAS评分均显著高于男性患者(P<0.05),AIS组女性患者的SDS和SAS评分与对照组女性比较有显著性差异(P<0.05),男性患者与对照组男性比较有显著性差异(P<0.05).重度脊柱侧凸患者的SDS和SAS评分明显高于轻、中度脊柱侧凸患者(P<0.05),但轻、中度患者间评分无显著性差异(P>0.05).结论:AIS患者的心理特征为躯体化、敏感、偏执、抑郁和焦虑,女性患者较男性更易发生抑郁和焦虑,重度脊柱侧凸患者心理异常较中、轻度脊柱侧凸患者更为明显.     

青少年特发性脊柱侧凸患者的中枢神经异常

目的 :检查青少年特发性脊柱侧凸 (AIS)患者的后脑及脊髓的结构和功能异常 ,探讨两者间的相关性及与Cobb角的关系。方法 :用MRI探查AIS患者的后脑及脊髓的解剖结构 ,用体感诱发电位 (SEP)检查体感传导通路功能 ,并对两者结果作相关性检验。结果 :MRI见小脑扁桃体脱垂或脊髓空洞和SEP显示体感传导通路功能异常病例在Cobb角 >45°患者中依次占 31%和 2 7 6 % ,而 <45°患者中分别只占 3 7%和 11 9% ,结构异常和功能异常有显著相关性。结论 :对严重脊柱侧凸或合并SEP异常患者应常规行全脊髓MRI检查 ,以便及早发现后脑及脊髓病变     

青少年特发性脊柱侧凸的治疗进展

青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)是指年龄在10¹8岁,冠状面上Cobb角>10°伴有椎体的旋转而无其他器质性病变的一种常见病。该疾病能够导致身体外观畸形、疼痛,甚至心肺功能受损,严重影响了患者的身心健康及生活质量。在治疗上,对于轻中度的AIS患者常用定期观察、支具等保守治疗方法,能够有效的延缓侧凸的进展;对于保守治疗无效,达到手术阈值的AIS患者,则建议手术治疗,目前较为常用的手术方法是以椎弓根螺钉内固定系统为代表的后路椎体融合术,往往能够达到较好的临床疗效。近年来,由于物理治疗性脊柱侧凸特异性运动(PSSE)疗法安全有效,越来越受欢迎。目前对于AIS患者治疗的具体适应证正逐渐完善,治疗理念与技术在不断更新,临床疗效也不断得到改善。本文将从保守治疗和手术治疗两方面展开,主要阐述常用的治疗方法在临床上的进展和应用以及所面临的问题,为临床治疗的选择提供参考。     

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骨密度的研究进展

青少年特发性脊柱侧凸(adolescent idiopathic scol-iosis,AIS)是发生于青春发育期前后的脊柱结构性侧凸畸形,是一种最常见的脊柱侧凸畸形,     

青少年特发性脊柱侧凸的选择性融合

手术治疗青少年特发性脊柱侧凸（adolescentidiopathicscoliosis,AIS）的目的是矫正脊柱畸形、稳定侧凸、重建或保持脊柱的平衡。临床上通常根据冠状面的Cobb角、骨骼发育情况、矢状面变化、椎体旋转程度以及侧凸的自然史来判断是否需手术治疗。一般认为,对处于生长期、Cobb角＞５０°、非手术治疗无效、疼痛、胸椎前凸及伴有明显外观畸形的患儿应选择手术治疗。自１９１４年首例采用脊椎融合术治疗侧凸以来,确定AIS手术合适的融合节段一直是众多学者争论的焦点;AIS手术是否成功有赖于对融合节段的正确选择,选择不当易引起脊柱侧…     

青少年特发性脊柱侧凸治疗研究进展

青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)是指脊柱的一个或数个节段在冠状面上偏离身体中线向侧方弯曲形成一个弧度(国际脊柱侧凸研究学会,Scoliosis Research Society,SRS,认为Cobb角＞10°),通常还伴有脊柱的旋转和矢状面上后凸或前凸的增加或减少的一种脊柱结构性三维畸形.     

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.     

Lenke 3型青少年特发性脊柱侧凸后路矫形术后身高增长的相关影响因素分析

目的:探讨Lenke 3型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患儿脊柱后路矫形术后身高增长(ΔSH)的相关影响因素。方法:选取2014年1月~2016年6月于我院行脊柱后路矫形手术的女性Lenke 3型AIS患儿90例,年龄15.0±2.6岁。于站立位全脊柱正侧位X线片上测量术前、术后的主弯侧凸Cobb角1(最大侧凸Cobb角)、侧凸Cobb角2(次之侧凸Cobb角)、脊柱高度(spinal height,SH)、胸椎后凸角(thoracic kyphosis,TK)及腰椎前凸角(lumbar lordosis,LL)。应用Pearson相关分析ΔSH与其他参数之间的相关性,应用线性回归探讨ΔSH的相关影响因素。结果:ΔSH为2.9±1.0cm。Pearson相关性分析示ΔSH与术前的侧凸Cobb角1(P=0.000)、侧凸Cobb角2(P=0.000)及TK(P=0.023)均呈显著相关性,与术后的侧凸Cobb角1(P=0.000)、侧凸Cobb角2(P=0.000)、LL(P=0.025)、侧凸Cobb角1变化(P=0.000)、侧凸Cobb角2变化(P=0.000)及TK变化(P=0.032)均呈显著相关性。线性回归分析示ΔSH与侧凸Cobb角1变化(P=0.017)、侧凸Cobb角2变化(P=0.001)均呈显著线性相关(R~2=0.333);另外,ΔSH与术前侧凸Cobb角1(P=0.006)、侧凸Cobb角2(P=0.007)、术前TK(P=0.038)亦呈显著线性相关(R~2=0.595)。结论:Lenke 3型AIS患儿脊柱后路矫形术后身高增长的相关影响因素包括术前、术后的主弯侧凸Cobb角、术前TK及其术后变化值。主弯Cobb角矫正是Lenke 3型AIS术后身高增加的最主要影响因素。Lenke 3型AIS患儿的术前侧凸Cobb角及术前TK可以较好地预测患儿术后身高恢复情况。     

Comparison of somatosensory evoked potentials between adolescent idiopathic scoliosis and congenital scoliosis without neural axis abnormalities

Background contextAbnormal somatosensory evoked potentials (SEPs) have been documented in patients with adolescent idiopathic scoliosis (AIS) with different cure severity. However, few studies investigated whether abnormal SEPs were the cause or effect of idiopathic scoliosis.PurposeThe purpose of this study was to investigate the significance of abnormal SEPs in patients with AIS, and to explore its effect on the etiopathogenesis of AIS.Study design/SettingThis study evaluated SEPs in patients with AIS and congenital scoliosis (CS) with similar curve pattern and severity both in coronal and sagittal planes.Patient sampleFemale patients with AIS and CS in our spine surgery center from 2000 to 2009 were recruited for this study.Outcome measuresRate of abnormal SEPs.MethodsPosterior tibial nerve SEPs (PTN-SEPs) were performed on female patients with AIS and CS. The inclusion criteria were patients with AIS with a Lenke type 1 curve and patients with CS with right thoracic curve (apex between T5 and T12) and normal sagittal profile (kyphosis less than 50° measured from T2 to T12). All patients were evaluated with total spine magnetic resonance imaging, and those with neural axis abnormalities were excluded. The patients with neurological deficits on detailed physical examination were also excluded. Absence of SEPs waveforms or prolongation of peak latency or asymmetrical peak latency were defined as pathological change. The incidence of pathological SEPs and clinical characteristics were compared between patients with AIS and patients with CS.ResultsForty-six patients with AIS and 33 patients with CS were included in this study. There was no significant difference in coronal and sagittal Cobb angle between the two groups. The rate of abnormal SEPs was 32.6% (15/46) and 12.1% (4/33) in AIS and CS groups, respectively, and the difference was statistically significant (p<.05).ConclusionSomatosensory pathway dysfunction could be found in both AIS and CS without neural axis abnormalities, and the patients with AIS tended to have higher rates of somatosensory disorders than patients with CS with similar scoliosis curve, which indicates that both scoliosis curve and primary etiopathogenic factor contribute to the sensory deficit in patients with AIS.     

M-CSF在青少年特发性脊柱侧凸患者成骨细胞中的表达及意义

目的从成骨细胞（osteoblast,OB）水平探讨巨噬细胞集落因子（macrophage colony stimulating factor,MCSF）与青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）患者骨量降低的关系。方法AIS患者27例,其中男25例,女2例;年龄12～18岁,平均14.9岁;Cobb角40°～94°,平均57.3°。将所有AIS患者分为两组：A组14例,为骨量正常患者;B组13例,为骨量减低患者。正常对照组8例（定为C组）,年龄12～18岁,平均15.3岁。3组均采用双能X线吸收测量仪（dual-energy X-ray absorptiometry,DEXA）测量骨密度（bone mineral density,BMD）,测量部位包括非优势侧股骨近端及腰椎。所有受试者术中取适量髂前上嵴的松质骨,运用植块法培养成骨细胞。培养至P3代后行表型鉴定,用RT-PCR检测AIS组和正常对照组中M-CSF mRNA的表达水平。结果B组中M-CSFmRNA的表达量均较A组（P〈0.05）和C组高（P〈0.05）,A组与C组M-CSFmRNA的表达量无显著统计学差异（P〉0.05）。结论M-CSF在OB水平mRNA表达强度的异常可能与AIS骨量降低的分子机制相关。     

Spinal growth and progression of adolescent idiopathic scoliosis

Summary The spinal growth in scoliotic segments (T4-L4) of 110 girls with untreated idiopathic scoliosis was measured from two successive radiographs taken at a mean interval of 1.1 years. At the first visit the mean age of the patients was 14 years (range 11–16 years), the mean magnitude of the major curves 24° (range 9°–38°) and that of the minor curves 14° (range 2°–38°). Spinal growth was most rapid at the age of 11–12 years. The progression of the curves (major plus minor) correlated with the spinal growth (r=0.384). The greater the initial curves were, the stronger the correlation was between the spinal growth and the progression of the curves (r=0.046–0.639), and the correlation was more significant in thoracic scoliosis (r=0.560) than in thoracolumbar and lumbar scoliosis (r=0.152).     

The natural history of adolescent idiopathic scoliosis

There have been great advances in the conservative and surgical treatment for adolescent idiopathic scoliosis in the last few decades. The challenge for the physician is the decision for the optimal time to institute therapy for the individual child. This makes an understanding of the natural history and risk factors for curve progression of significant importance. Reported rates of curve progression vary from 1.6% for skeletally mature children with a small curve magnitude to 68% for skeletally immature children with larger curve magnitudes. Although the patient''s age at presentation, the Risser sign, the patient''s menarchal status and the magnitude of the curve have been described as risk factors for curve progression, there is evidence that the absolute curve magnitude at presentation may be most predictive of progression in the long term. A curve magnitude of 25° at presentation may be predictive of a greater risk of curve progression. Advances in research may unlock novel predictive factors, which are based on the underlying pathogenesis of this disorder.     

青少年特发性脊柱侧凸患者褪黑素信号传导通路的初步研究

目的:了解青少年特发性脊柱侧凸(adolescentid iopathic scoliosis,AIS)患者褪黑素信号传导通路是否存在异常。方法:7例女性AIS患者,年龄13～17岁,平均14.7岁;最大Cobb角40°～80°,平均59.3°,行后路手术时取髂骨组织进行成骨细胞培养,并用碱性磷酸酶染色、骨钙素免疫荧光检测方法对培养细胞进行成骨细胞鉴定。取原代培养的成骨细胞,先采用福斯可林刺激成骨细胞内cAMP升高,然后用不同浓度褪黑素刺激细胞,检测细胞内cAMP水平。结果:碱性磷酸酶染色、骨钙素免疫荧光检测结果均证实所培养细胞表现为成骨细胞特性,所有AIS患者成骨细胞的cAMP的基础水平都很低,在给予福斯可林刺激以后cAMP的水平明显升高,此后再给予生理剂量的褪黑素后,cAMP的水平未见明显下降;给予药理剂量的褪黑素后同样没有观察到cAMP水平明显的下降。结论:AIS患者的褪黑素信号传导通路存在异常。     

Epidemiology of adolescent idiopathic scoliosis

Adolescent idiopathic scoliosis is a common disease with an overall prevalence of 0.47–5.2 % in the current literature. The female to male ratio ranges from 1.5:1 to 3:1 and increases substantially with increasing age. In particular, the prevalence of curves with higher Cobb angles is substantially higher in girls than in boys: The female to male ratio rises from 1.4:1 in curves from 10° to 20° up to 7.2:1 in curves >40°. Curve pattern and prevalence of scoliosis is not only influenced by gender, but also by genetic factors and age of onset. These data obtained from school screening programs have to be interpreted with caution, since methods and cohorts of the different studies are not comparable as age groups of the cohorts and diagnostic criteria differ substantially. We do need data from studies with clear standards of diagnostic criteria and study protocols that are comparable to each other.