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手术治疗进展

特发性脊柱侧凸（idiopathic scoliosis,IS）是一种原因不明的最常见的脊柱畸形。根据其发病年龄又分婴儿型（0～3岁）、少儿型（4～10岁）及青少年型（10岁后）。其中青少年型最常见,约占青少年人口的2%～3%,占整个脊柱侧凸发病率的80%,严重危害着青少年的健康。青少年特发性脊柱侧凸（adolecent idiopathic scoliosis,AIS）发病机理及发展过程非常复杂,表现形式多种多样。轻度的畸形可以通过支具等保守方法治疗,而对于畸形较重、畸形发展较快或支具治疗不能控制的患者,必须针对脊柱畸形的特点采用相应的手术治疗。     

青少年特发性脊柱侧凸外科治疗进展

1青少年特发性脊柱侧凸概念青少年特发性脊柱侧凸(adolescentidiopathicscoliosis,AIS)是青春前期或骨骼成熟前发生的脊柱侧凸,占整个脊柱侧凸的80%,形成带有弧度的脊柱畸形。常伴有脊柱的旋转畸形和矢状面上生理弯度的变化,胸廓、肋骨、骨盆、下肢的长度、双侧肩胛高度也会随之变化,并常伴有骨质疏松,严重的病例(Cobbs角>80°)会影响到呼吸功能、心脏变位,甚至发生截瘫。在生理和心理上给患者造成很大的负担。早期通过云纹背影实验普查脊柱侧凸的发生率,根据对脊柱侧凸概念认识的不同:Cobbs角>10°侧凸发生率为1.5%～3%,Cobbs角>20°侧…     

特发性脊柱侧凸患者肺功能临床研究进展

脊柱侧凸是指脊柱的一个或数个节段在冠状面上偏离中线，向侧方弯曲，形成带有弧度的脊柱畸形，通常伴有脊柱的旋转和矢状面上生理性前凸和后凸的增加或减少。我国特发性脊柱侧凸的发生率约为1．06％（北京协和医院），且多在青少年时期发病，不仅影响患者外观，而且胸段侧凸还不同程度地限制了肺容积和肺扩张，从而影响肺功能。Smith等研究发现，脊柱侧凸患者早期一般不表现症状．     

人工智能技术在脊柱侧凸诊疗中的应用进展

人工智能(artificial intelligence, AI)为计算机学科的一个分支, 是一门用于研究、开发能够模拟人类智能的理论、方法、技术及应用系统的新兴科学, 主要目标是使机器能够完成需要人类智能的复杂任务。随着大数据时代的到来, AI技术已广泛应用于机器视觉、语言识别、图像理解、遗传编程、机器人工厂和专家系统等专业领域。脊柱侧凸是最常见的脊柱三维畸形, 不仅会引起患者外观与体型的改变, 还会影响心理健康。临床中, 由于脊柱解剖结构复杂、具有维持姿势的重要功能、脊柱外科手术有较长的学习曲线, 使得脊柱侧凸的诊疗具有一定的挑战性。脊柱侧凸的临床大规模诊筛工作中易出现工作量大、易疲劳、高误诊率及漏诊率等现实问题。近年来, 学者们发现AI技术具有的对样本数据内在规律和表征的深度学习能力, 可应用于脊柱侧凸的诊断、筛查、手术决策、术中操作、预测预后和保守治疗等专业领域。然而, AI技术在现阶段仍有一定的局限性, 在脊柱侧凸临床诊疗应用中存在诸多不足, 包括数据采集不规范、技术研发难度大、技术固有缺陷、过度依赖及法律伦理等问题。借助文献数据库和相关数据共享网络, 对近年来国内外AI技术...     

特发性脊柱侧凸的分型与手术治疗进展

在不同类型的脊柱侧凸中，特发性脊柱侧凸畸形最为常见，近40年来随着脊柱内固定器械的改进、分型方法的完善、麻醉技术的提高和术中诱发电位的监测及三维概念的引进等，使得特发性脊柱侧凸的外科治疗取得了迅速的发展。现就特发性脊柱侧凸的分型和外科治疗综述如下。     

青少年特发性脊柱侧凸进展的预测因素

青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）是脊柱侧凸的最常见类型,目前病因尚不明确.对AIS自然史的研究表明,未经治疗的侧凸可能会进展,尤其是侧凸被发现时已经较严重者;而侧凸高速进展发生在骨骼发育成熟之前的青春期.侧凸进展不仅会导致外观畸形加重,从而影响患者的心理健康,还会产生持续性腰背痛、肺功能下降而影响患者生活质量,甚至引起瘫痪、呼吸衰竭等严重并发症.目前对脊柱侧凸的治疗主要是通过对其自然史的评估,选择合适的治疗方案来矫正侧凸或阻止侧凸的进一步进展.而精确评估侧凸进展的趋势是制定正确治疗方案的前提条件,故需要对脊柱侧凸进展的预测因素有充分的了解.     

青春期特发性脊柱侧凸的外科治疗进展

在不同类型的脊柱侧凸畸形中,以青春期特发性脊柱侧凸（ａｄｏｌｅｓｃｅｎｔｉｄｉｏｐａｔｈｉｃｓｃｏｌｉｏｓｉｓ,ＡＩＳ）最为常见。近３０年来,随着脊柱畸形三维概念的引入、随着内固定系统的不断改进及麻醉技术的提高,对ＡＩＳ的手术矫正治疗已取得了显著进步。由于对其病因尚不了解,故目前临床所用的各种治疗方法均有不尽如人意之处。本文就ＡＩＳ的外科治疗及相关研究介绍如下。一、支具治疗ＡＩＳ的致残率相当高,严重危害着青少年的身心健康,其患病率在中国人群中可达０．６１%～１．９%［１］。采用三检筛选的普查方法可及时发…     

青少年特发性脊柱侧凸脊柱柔韧性的评价及进展

脊柱侧凸的脊柱柔韧性（flexibility）包括两个方面：脊柱的畸形塌陷和脊柱结构的还原性。还原性可以预测病变脊柱当时的可塑性和弹性，脊柱的塌陷程度是脊柱侧凸的进展程度和治疗效果的预测因素。在治疗和诊断中对患者脊柱柔韧性的评价尤为重要，特别是行手术治疗时，脊柱外科医生需要了解侧凸的严重程度、结构变化范围、融合范围、预期矫形度以其代偿弯曲是否固定融合等，这就必须需要评价脊柱柔韧度^[1]。主要的测量方法有一般体格检查、体表测量、影像学检查。     

特发性脊柱侧凸的动物模型

自20世纪40年代开始，各国学者对特发性脊柱侧凸（IS）的病因学研究集中在脊柱的解剖结构、椎旁肌、胶原结构、内分泌系统、中枢神经系统和遗传因素等，但IS的病因至今仍未明确。建立脊柱侧凸的动物模型是重要的病因学研究手段之一．同时也有益于探寻有效的治疗方法。笔者就近年来主要的特发性脊柱侧凸的动物模型做一综述。     

Current applications of artificial intelligence combined with urine detection in disease diagnosis and treatment

In recent years, the advantages of artificial intelligence (AI) in data processing and model analysis have emerged in the medical field, enabled by computer technology developments and the integration of multiple disciplines. The application of AI in the medical field has gradually deepened and broadened. Among them, the development of clinical medicine intelligent decision-making is the fastest. The advantage of clinical medicine intelligent decision-making is to make the diagnosis faster and more accurate on the basis of certain information. Urine detection technologies, such as urine proteomics, urine metabolomics, and urine RNomics, have developed rapidly with the advancements in omics and medical tests. Advances in urine testing have made it possible to obtain a wealth of information from easily accessible urine. However, it has always been a problem to extract effective information from this information and use it. AI technology provides the possibility to process and use the information in urine. AI, combined with urine detection, not only provides new possibilities for precise and individual diagnosis and disease treatment, but also helps promote non-invasive diagnosis and treatment. This article reviews the research and applications of AI combined with urine detection for disease diagnosis and treatment and discusses its existing problems and future development.     

Differential diagnosis of early scoliosis in Scheuermann's disease and idiopathic scoliosis (author's transl)

In order to avoid overtreatment or undertreatment of a beginning scoliosis early differentiation of the clinically unimportant concomitant scoliosis of Scheuermann's disease is essential as against early idiopathic scoliosis, spondyloepiphyseal dysplasia and the fixed round back deformity of adolescents. Scheuermann's scoliosis as opposed to idiopathic scoliosis is characterised by the almost complete lack of vertebral rotation (as with spondyloepiphyseal dysplasia), by a localized unilateral narrowing of the intervertebral space in the a.p. x-ray, as well as by a slight Z- or E-pattern, and a relative shortness of the curves. Simultaneous dorsal kyphosis may be absent. Indispensable is furthermore, the familiarity with the early x-ray signs of Scheuermann's disease in the lateral view as compared with the X-ray of the fixed roundback.     

人工智能辅助X线识别对骨科的应用价值研究进展

成像作为评估肌肉骨骼病情的重要工具,从对疾病的患病风险评估到对疾病及病情进展的判断以及预后评分等均起到重要作用,伴随人工智能(artificial intellegence,AI)在图像检测和图像解释领域中的迅速发展,一些涉及肌肉骨骼X射线成像的AI辅助识别研究已经检验并显示了很高的潜在价值,可增强X射线成像价值链的各个部分,可通过提高成像效率、成像质量和诊断准确性对临床医生起指导性作用。目前,AI辅助成像识别技术发展仍处在早期阶段,AI算法需要进一步的提升和发展,影像数据仍不足且质量存在较大异质性,技术性能的长期准确性和稳定性需要进一步观察研究。     

Early diagnosis of scoliosis based on school-screening

A total of 8165 schoolchildren were screened for scoliosis by two teams of orthopaedic surgeons using the same procedures and criteria. Of 790 children who had positive physical signs, 689 were examined roentgenographically. Using 5 and 10 degrees as cut-off points, the prevalence of scoliosis was 6.58 and 2.4 per cent, respectively. A follow-up study of children who had been reported to have scoliosis at the age of eleven months showed that only half of them actually had scoliosis.     

深度学习在青少年特发性脊柱侧凸诊疗中应用的研究进展

青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）是指4~18岁青少年所发生的不明原因的Cobb≥10°的脊柱三维结构畸形,是青少年脊柱畸形中最常见的类型。近年来AIS发病率呈逐年上升的趋势,已成为青少年时期的第五大常见病。有研究表明,AIS除与骨密度、激素水平和基因表达等因素有关外,还与儿童和青少年不正确的姿势行为有关。1%~4%[3]的青少年生长发育受到了AIS影响,在影响外观的同时也容易导致青少年心理疾病。因此对于AIS的早发现、早干预、早诊断、早治疗显得尤为重要。如何利用目前的影像学技术清晰显示病变结构的同时,并对大量的图像数据做出快速诊断和风险评估给医生们带来了巨大的挑战。发生侧凸的脊柱在形态学上有其独有的特征,有一定规律可循,这些特征为人工智能的介入提供了切入点。近年来,在我国乃至全世界,以深度学习为基础的人工智能发展迅速,已经成为脊柱医学领域的研究热点。虽然目前深度学习在脊柱疾病诊断及创伤内固定方面的报道层出不穷,但是针对AIS的深度学习仍缺乏综述性报道。笔者就AIS诊疗的不同方面,综述深度学习在其筛查、诊断、治疗及预后评估领域的应用现状和发展趋势。     

Three artificial intelligence data challenges based on CT and ultrasound

Purpose: The 2020 edition of these Data Challenges was organized by the French Society of Radiology (SFR), from September 28 to September 30, 2020. The goals were to propose innovative artificial intelligence solutions for the current relevant problems in radiology and to build a large database of multimodal medical images of ultrasound and computed tomography (CT) on these subjects from several French radiology centers. Materials and methods: This year the attempt was to create data challenge objectives in line with the clinical routine of radiologists, with less preprocessing of data and annotation, leaving a large part of the preprocessing task to the participating teams. The objectives were proposed by the different organizations depending on their core areas of expertise. A dedicated platform was used to upload the medical image data, to automatically anonymize the uploaded data. Results: Three challenges were proposed including classification of benign or malignant breast nodules on ultrasound examinations, detection and contouring of pathological neck lymph nodes from cervical CT examinations and classification of calcium score on coronary calcifications from thoracic CT examinations. A total of 2076 medical examinations were included in the database for the three challenges, in three months, by 18 different centers, of which 12% were excluded. The 39 participants were divided into six multidisciplinary teams among which the coronary calcification score challenge was solved with a concordance index > 95%, and the other two with scores of 67% (breast nodule classification) and 63% (neck lymph node calcifications).