Horizontal body and trunk center of mass offset and standing balance in scoliotic girls

In adolescent idiopathic scoliotic girls, postural imbalance is attributed to a sensory rearrangement of the motor system on the representation of the body in space. The objectives of this study were to test if the anteroposterior (AP), mediolateral (ML) and resultant body–head and trunk center of mass (COM) horizontal offsets were similar in able-bodied and scoliotic girls and if these offsets were related to the center of pressure displacements. A total of 21 adolescent idiopathic scoliosis girls and 20 able-bodied girls participated in this study. Their body COM position and that of the head and trunk were estimated according to Damavandi et al. (Med Eng Phys 31:1187–1194, 2009). The COP range and speed in both AP and ML axes were calculated from force plate measurements in quiet standing. The AP offset of the able-bodied group was anterior to the body COM by 11.0 ± 15.9 mm, while that of the scoliotic group was posterior to it by −17.3 ± 11.2 mm. The able-bodied group maintained their head–trunk segment COM more to the right by 14.1 ± 13.1 mm, while that of the scoliotic group was nearly over their body centerline. The scoliotic girls presented higher values for COP range and COP speed than the able-bodied girls. The resultant COM offset was correlated with both the ML COP range and speed only for the scoliotic girls. The small ML COM offset in the scoliotic girls was attributed to a compensatory action of the spinal deformity in the frontal plane resulting in a backward resultant COM offset to regain postural balance concomitant to an increase in the ML neuromuscular demand.     

Intrinsic muscle contribution to the metacarpophalangeal joint flexion moment of the middle, ring, and small fingers

PURPOSE: To analyze the relative contribution of the intrinsic muscles to the flexion moment potential of the metacarpophalangeal (MCP) joints of the middle, ring, and small fingers and to calculate the moment potential loss occurring with deep motor branch, low, or high ulnar nerve palsy or low median nerve palsy. METHODS: Eleven fresh cadaver hands were used. A small wire sutured to each tendon was connected to an excursion transducer containing a constant-tension spring. The tendon excursion and the MCP joint rotation were measured simultaneously during 10 to 16 cycles of passive flexion/extension cyclic motion. The moment arm was calculated from the tendon excursion-joint rotation curve as the derivative of the curve. The flexion moment potential was calculated by multiplying the moment arm with the known tension fractions of the muscles. RESULTS: When the MCP joint was at 0 degrees of flexion the relative moment potential contributions of the intrinsic muscles to MCP joint flexion were 8%, 13%, and 28% in the middle, ring, and small fingers, respectively. Moment potential losses were 7%, 13%, and 6% in the middle, ring, and small fingers, respectively, in deep motor branch ulnar nerve palsy. In low ulnar nerve palsy the losses were 7%, 13%, and 28%, respectively. In high ulnar nerve palsy they were 7%, 64%, and 82%, respectively. Low median nerve palsy, however, resulted in a moment potential loss at the middle finger MCP joint of less than 2%. CONCLUSIONS: The relative contribution of the intrinsic muscles to the total flexion moment at the MCP joint was different for each finger. The small finger had a large intrinsic contribution, primarily because of the larger moment arms of the hypothenar muscles.     

Classification system of the sagittal standing alignment in young adolescent girls

Purpose

The purpose of this cohort study was to classify sagittal standing alignment of pre-peak height velocity (pre-PHV) girls, and to evaluate whether identified subgroups were associated with measures of spinal pain. This study further aimed at drawing attention to similarities and differences between the current postural classification and a previous system determined among pre-PHV boys.

Methods

557 pre-PHV girls [mean age, 10.6 years (SD, 0.47 years)] participated in the study. Three gross body segment orientation parameters and five specific lumbopelvic characteristics were quantified during habitual standing. Postural subgroups were determined by cluster analysis. Logistic regression was applied to assess the relationship between postural subgroups and spinal pain measures (pain and seeking care, assessed by self-administered questionnaire). Chi-square statistics, independent samples T test, and distribution-based methods were used for comparison with postural categorization in pre-PHV boys.

Results and conclusion

Among pre-PHV girls, clinically meaningful posture clusters emerged both on the gross body segment and specific lumbopelvic level. The postural subtypes identified among pre-PHV girls closely corresponded to those previously described in pre-PHV boys, thereby allowing the use of the same, working nomenclature. In contrast to previous findings among pre-PHV boys, no associations between posture clusters and spinal pain measures were significant in girls at pre-PHV age. When comparing discrete ‘global’ alignment scores across corresponding posture types, some intriguing differences were found between genders which might involve different biomechanical loading patterns. Whether habitual posture forms a risk factor for developing spinal pain up to adulthood needs evaluation in prospective multifactorial follow-up research.     

选择性融合对Lenke 1型青少年特发性脊柱侧凸患者站立和坐位腰椎与骨盆矢状面平衡的影响

目的 :探讨选择性融合对Lenke 1型青少年特发性脊柱侧凸(AIS)患者站立位和坐位腰椎与骨盆矢状面平衡的影响。方法:2013年4月～2015年4月在我院行后路矫形融合术的24例Lenke 1型AIS患者作为研究对象,年龄11～15岁(13.0±1.8岁)。Lenke 1A型12例,Lenke 1B型5例,Lenke 1C型7例。根据手术融合节段将患者分为选择性融合组(STF组,n=13,下端融合至L1 8例,L2 5例)和非选择性融合组(NSTF组,n=11,下端融合至L3)。随访6～17个月(14.0±4.2个月),所有患者均拍摄术前、术后及末次随访时的站立位和坐位全脊柱正侧位X线片,并测量L3/4、L4/5及L5/S1的椎间角、骶椎倾斜角(SS)、骨盆入射角(PI)以及骨盆倾斜角(PT)等影像学参数,分别比较手术前后和末次随访时站立位和坐位的矢状面参数变化。所有患者均在手术前和末次随访时填写22项脊柱侧凸研究学会调查问卷(SRS-22)评估其生活质量。结果:所有患者在手术前、手术后及末次随访由站立位改为坐位时,L3/4、L4/5、L5/S1椎间角以及SS均减小,而PT增加(P0.05);手术前后及末次随访时PI基本不变(P0.05);术后与末次随访时相应的矢状面参数无显著性差异(P0.05)。STF组手术前、手术后及末次随时站立位与坐位PT和SS均有显著性差异(P0.05);NSTF组中手术前站立位与坐位PT和SS有显著性差异(P0.05),而在术后及末次随访时无显著性差异(P0.05)。手术前,STF组与NSTF组患者SRS-22评分在四个项目中均无显著性差异(P0.05);末次随访时,STF组与NSTF组患者在功能与疼痛两个项目中存在显著性差异(P0.05),在自我形象、心理状况及术后满意度上均无显著性差异(P0.05)。结论:对于Lenke 1型AIS患者,与非选择性融合相比,选择性融合不仅在维持腰椎活动性方面具有重要价值,而且保留了从站位到坐位时骨盆后旋的代偿功能。     

The effects of semi-immersive virtual reality therapy on standing balance and upright mobility function in individuals with chronic incomplete spinal cord injury: A preliminary study

Background: Individuals with chronic incomplete spinal cord injury (iSCI) commonly face persistent balance or mobility impairments. Virtual reality (VR) therapy is a useful rehabilitation approach; however, little is known about its effects in individuals with chronic iSCI.

Objective: To investigate the effects of semi-immersive VR therapy on standing balance and upright mobility function in individuals with chronic iSCI.

Methods: Ten subjects with chronic iSCI underwent VR therapy 30 minutes a day, 3 days a week, for 6 weeks. Limit of stability (LOS) and the Berg Balance Scale (BBS) were used to evaluate standing balance function. The Timed Up & Go (TUG) test, Activities-specific Balance Confidence (ABS) Scale, and Walking Index for Spinal Cord Injury-II (WISCI-II) were used to measure the subject’s upright mobility function. Outcomes were assessed and recorded pre- and post-intervention.

Results: After semi-immersive VR therapy, LOS and BBS scores were significantly increased. In addition, the TUG test results increased significantly over time, while ABC scale scores and WSCI-II levels improved significantly.

Conclusion: This study is the first to assess the effects of semi-immersive VR therapy for patients with chronic iSCI and limited functional abilities. These results indicated that semi-immersive VR therapy has a positive effect and is a useful intervention for standing balance and upright mobility function in patients with chronic iSCI.     

孕前站立时间对妊娠并发症影响的调查研究

目的调查研究孕早期的职业站立时间以及长时间站立对妊娠并发症的影响。方法分别对我市妇幼保健院2010年1月-2013年5月间建卡并分娩的460例妊娠妇女怀孕早期、中期和晚期进行相关问卷调查并进行统计学分析。结果（1）孕妇在孕早期的持续站立和坐着的时间均较孕前显著降低,其人群分布在不同年龄、文化程度和经济收入方面具有明显差异（P〈0．05）。（2）孕妇文化程度高是妊娠期高血压的保护因素;孕妇文化程度和家庭经济收入是妊娠贫血的保护因素;年龄较大是妊娠糖尿病的危险因素。（3）妊娠高血压和贫血的发病率与孕妇久坐久站呈正相关。结论孕前久站久坐可增加孕妇病发高血压、糖尿病和贫血的危险。     

青少年特发性脊柱侧凸术后肩部外观可塑性与融合策略

【摘要】 目的：本研究旨在探讨青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）术后肩部外观可塑性,分析基于该现象的胸弯融合上端椎选择策略。方法：对56例Lenke Ⅰ型AIS患者进行回顾性研究,术后随访2～5年。术前Cobb角主胸弯57.65°±12.28°、上胸弯20.34°±9.52°。根据术前肩部平衡、上胸弯柔韧度情况,主胸弯融合上端椎选择方案为：术前右肩抬高非僵硬性上胸弯（柔韧度＞30%）患者10例,选择端椎下位椎（端椎－1）;僵硬性上胸弯（柔韧度≤30%）患者7例,选择端椎。术前双肩平衡非僵硬性上胸弯患者,7例选择端椎上位椎（端椎＋1）,7例选择T3;僵硬性上胸弯患者,5例选择T4,6例选择T3。术前左肩抬高非僵硬性上胸弯患者4例,选择端椎上位椎（端椎＋1）;僵硬性上胸弯患者,1例选择T4,9例选择T3。配对t检验比较术后即刻、末次随访外观肩高（CSD）,评估术后肩部外观可塑性。并对术后肩部平衡进行主观评价,其中患者和家属一方或双方认为肩部外观未恢复平衡,为主观评价不满意。通过分析外观CSD变化,影像学冠状面平衡及T2～T5后凸角,患者及家属主观评价,总结基于肩部外观可塑性的上端椎选择策略。结果：末次随访Cobb角主胸弯19.16°±10.34°、上胸弯11.83°±8.65°,冠状面平衡0.67±0.56cm,T2～T5后凸角17.23°±7.28°。1例患者2年内随访主观评价左肩抬高,其余患者无并发症发生。术前、术后即刻、末次随访时,CSD值：1.04±0.24cm、0.92±0.22cm、0.63±0.16cm;CSD≥1cm患者例数：31例、23例、5例。术后即刻与末次随访CSD存在显著差异（t=7.98,P＜0.001）,最大肩部外观可塑值ΔCSD为1.69cm。随访中肩部恢复平衡的上端椎选择方案：术前右肩抬高非僵硬性上胸弯患者选择端椎－1,右肩抬高僵硬性上胸弯患者选择端椎,双肩平衡非僵硬性上胸弯患者选择端椎＋1或T3,双肩平衡僵硬性上胸弯患者选择T3后,患者末次随访CSD均＜1cm,主观评价满意;术前左肩抬高非僵硬性上胸弯患者选择端椎＋1后1例末次随访CSD为1.06cm,左肩抬高僵硬性上胸弯患者选择T3后1例末次随访CSD为1.02cm,主观评价满意。随访中肩部未恢复平衡的上端椎选择方案：术前双肩平衡僵硬性上胸弯患者选择T4后,2例CSD分别为1.45cm、1.54cm,其中1例随访2年内主观评价左肩抬高;术前左肩高僵硬性上胸弯患者选择T4,1例CSD较大为1.52cm。结论：AIS患者术后肩部外观存在可塑性,基于该特性Lenke Ⅰ型AIS患者胸弯融合上端椎策略为：术前右肩抬高非僵硬性上胸弯患者选择端椎－1,僵硬性上胸弯患者选择端椎;双肩平衡非僵硬性上胸弯患者选择端椎＋1,僵硬性上胸弯患者选择T3;左肩抬高非僵硬性上胸弯患者选择端椎＋1,僵硬性上胸弯患者选择T3。     

腰椎短节段融合术后坐-立位相邻节段序列变化研究

目的:观察腰椎短节段融合术后不同功能体位脊柱-骨盆矢状位序列的变化,探讨坐位下相邻未融合节段矢状位序列的调节机制。方法:2010年9月～2012年2月行腰椎短节段融合术的63例患者纳入研究,其中男30例,女33例,末次随访时年龄为61.6±11.0岁(31.0～81.0岁),随访时间为82.0±7.3个月(68.0～94.0个月)。共39例患者融合至S1,其中3例为L5～S1固定融合,20例为L4～S1固定融合,15例为L3～S1固定融合,1例为L2～S1固定融合;24例未融合至S1,其中13例为L3～L5固定融合,5例为L4～L5固定融合,6例为L2～L5固定融合。均行术前站立位、末次随访站立位-端坐位-自然坐位全脊柱正侧位X线片检查,通过院内PACS系统,测量术前、末次随访时的脊柱-骨盆矢状位参数,包括骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)、腰椎前凸角(LL)、固定节段前凸角(FSL)、胸椎后凸角(TK)、上相邻前凸角(URL)、下相邻前凸角(LRL)及T1骨盆角(TPA)。采用单因素方差分析,对比不同体位脊柱-骨盆矢状位参数变化;运用Pearson相关分析,分...     

Matrilin-1基因多态性与青少年特发性脊柱侧凸支具疗效的相关性

目的 探讨matrilin-1基因多态性与青少年特发性脊柱侧凸(AIS)患者支具治疗效果的相关性.方法 自2005年1月至2008年12月,对门诊行规范化支具治疗的AIS患者进行前瞻性研究.入选对象要求:女性患者;骨骼发育为未成熟状态(Risser征0～3级);月经初潮未至或来潮1.5年以内;标准站立位全脊柱X线片上侧凸Cobb角为20°～40°;排除了先天性和神经肌源性以及其他原因引起的侧凸;无已知的可影响骨塑型和钙代谢的病史和药物使用史;初诊前无支具治疗史;接受支具治疗(Boston支具或Milwaukee支具)期间每3个月复诊1次,随访时间超过2年.符合下述条件之一者,则予以剔除:最终随访不足2年;支具治疗过程中依从性(每日实际佩戴时间与建议佩戴时间的比值)较差(<75%);支具治疗期间未按照医嘱自行更换支具.根据患者侧凸类型选择相应的支具进行治疗.记录初次就诊及末次随访的原发弯的Cobb角.支具治疗失败的标准为原发弯增加>5°.选取matrilin-1基因启动子区域位点rs1149048进行PCR-RFLP基因分型.按支具疗效分为治疗失败和治疗成功两组,比较两组之间的初诊年龄、Risser征、侧凸类型、初诊Cobb角及基因型分布的差异并进行统计学分析.结果 共有77例AIS女孩入选并完成本研究.初诊时平均年龄为(13.0±1.5)年,平均主弯Cobb角为29.5°±7.8°.在平均(2.6±0.3)年随访后,平均主弯Cobb角为30.3°±11.9°.支具治疗失败总共19例(24.7%),支具治疗成功58例(75.3%).支具治疗失败组的初诊Cobb角较大(P>0.05).在不同的侧凸类型中,胸腰双主弯的支具治疗失败率最低(19.4%).基因型GG个体支具治疗失败率(66.7%)明显高于基因型为从或AG的个体.结论 通过早期规范化支具治疗,大部分脊柱侧凸进展可得到控制.初诊Cobb角较大及基因型GG的AIS患者支具疗效较差.     

Stimulation parameter optimization for FES supported standing up and walking in SCI patients

Functional Electrical Stimulation (FES) to restore leg movement for standing up and walking (stepping) in SCI patients with intact lower motor neuron is used by several groups. Usually quadriceps muscles are stimulated for hip and knee extension, gluteus muscles for hip stabilization, and the common peroneal nerve to elicit the flexion reflex. The requirement to get a natural movement would need a huge number of stimulation channels--a request that could be easily fulfillled from the engineer's point of view but not from the point of practicability since each stimulated muscle requires two skin-attached electrodes resulting in a prolonged time for donning and doffing. In the described project a newly developed eight channel stimulator that can vary the stimulation parameters in many ways and over a wide range is used. The goal is to achieve a natural movement with a minimum of surface electrodes by optimizing the stimulation parameters. Seven experienced FES users and five unexperienced persons (all between Th4-Th11) participate in this study. Standing up can be significantly improved by optimizing the time delay between the onset of quadriceps and gluteus muscles (0.2-0.4 s) and the duration of the ramp. A 0.2 s delay gives good results in heavy patients while slower ramps (0.4 s) are required in slim patients. During stepping, gluteus muscle timing is not very crucial. Gluteus stimulation is turned off 0.1-0.2 s before quadriceps muscle and with the same delay turned on again. Of major influence on the gait quality is the timing during heel strike when peroneal stimulation is switched off and quadriceps stimulation is turned on. Six patients require 0.0-0.1 s where neither peroneal nor quadriceps stimulation is applied, the others require an overlap of 0.1-0.2 s. Activation of adductor muscles during standing up and during the swing phase helps to avoid hip abduction and improves knee trajectories.     

Iliac crest orientation and geometry in able-bodied and non-treated adolescent idiopathic scoliosis girls with moderate and severe spinal deformity

Purpose

To identify pelvic rotation and/or distortion in able-bodied and untreated AIS girls with moderate and severe scoliosis and verify association of pelvic morphological changes with Cobb angle increase.

Methods

The 3D coordinates of nine anatomic bony landmarks were identified to estimate pelvic orientation using a Flock of Birds system. The distances between the first sacral vertebral body (S1) and each of the eight iliac spine landmarks in all three planes were calculated to identify pelvic distortion. Analysis of variance was used to assess pelvic orientation and determine pelvic distortion. Pearson coefficients of correlation were used to identify any relationships between Cobb angle and pelvic morphological parameters.

Results

Pelvic orientation was similar in able-bodied and scoliotic girls regardless of the severity of the spinal deformity. Significant differences were observed in pelvic morphology between AIS with severe untreated scoliosis and those with a moderate scoliosis for the right anterosuperior iliac spines (ASIS), the tip of the superior iliac crest (TSIC) and the widest tip of the iliac crest (WTIC) widths from S1. Statistically significant correlations were observed between the Cobb angles and the iliac crest distances measured from S1.

Conclusions

Differences in iliac spine geometries occurred in the transverse plane correlating to Cobb angles which suggest altered bone growth in AIS girls. Such findings could indicate right thoracic spinal deformity as a result of pelvic torsion.

     

Scoliosis and lung function in spinal muscular atrophy

Summary The notes and radiographs of 43 patients with a confirmed diagnosis of spinal muscular atrophy were reviewed. A significant inverse linear relationship between the severity of scoliosis and the percentage of predicted vital capacity and peak flow was found. The patients who stood had a significantly better lung function than patients who were confined to a wheelchair, and their scoliosis deteriorated significantly more slowly. Sixteen patients underwent surgical spinal stabilisation, 4 with Harrington instrumentation and 12 with segmental spinal instrumentation, at an average age of 12 years and 11 months. The average curve correction achieved was 40%. The decline in lung function seen pre-operatively was not only reversed, but a significant improvement was found at final follow-up.Paper read at the ESDS meeting, Birmingham, 1994, and selected for full publication.     

Sagittal spinopelvic alignment in adolescent thoracic scoliosis secondary to Chiari I malformation: a comparison between the left and the right curves

Purpose

To investigate whether the sagittal morphology differs between the left and right thoracic curves in patients with Chiari malformation-associated scoliosis (CMS).

Methods

Thirty-four patients with a left thoracic curve constituted the CM-L group, whereas 44 patients with a right thoracic curve were assigned into the CM-R group. Another cohort of 90 age- and gender-matched asymptomatic adolescents was enrolled to serve as the control group. Seven sagittal parameters were evaluated on standing lateral radiographs, including thoracic kyphosis (TK), lumbar lordosis (LL), thoracolumbar junctional kyphosis (TJK), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS).

Results

Compared to the normal controls, the TK, LL and SS were significantly greater in the CM-L group, along with a significantly decreased PT. Similar changes in SS and PT were also demonstrated in the CM-R group, while the TK and LL were found to be relatively normal compared with the control group. Concerning CMS patients with different curve directions, significantly increased TK and LL were observed in the CM-L group, whereas all three pelvic parameters were similar for the two groups. In addition, no significant differences were noted between the three groups in PI, TJK or SVA. Moreover, the LL was strongly related to the TK and SS in all three groups, but to the PI only in the control and CM-R groups. A significant correlation was also noted between TK and SS in the CM-L group.

Conclusions

Significant differences in sagittal profiles indeed exist between CMS patients and healthy adolescents, as well as between CMS patients with different curve directions. In CMI patients with a left thoracic curve, compensatory alterations appear to occur in LL in response to the increased TK to maintain a balanced posture.     

应用自体颗粒脂肪纯化及游离移植矫正面部外观缺陷

目的探讨简便的自体脂肪颗粒纯化的方法,总结自体脂肪颗粒游离移植矫正颜面部外观缺陷的经验。方法应用一种简便的脂肪颗粒纯化技术以及脂肪颗粒注射方法对患者面部外观缺陷进行治疗,术后进行随访。结果脂肪颗粒的成活率为20%～90%,其高低与脂肪颗粒的损伤程度、是否进行了提纯、术后加压制动、注射部位的活动程度以及局部血运是否良好有关。大部分患者对外观的改善满意。结论本研究中采用的颗粒脂肪纯化和移植技术能提升脂肪移植的成活率,可有效地矫正面部外观的缺陷。     

Colour Doppler Ultrasound Evaluation of Haemodynamic Changes in Free Tram Flaps and Their Donor Sites

Colour Doppler ultrasound (US) was used to measure the blood flow in the donor and recipient arteries as well as in the deep superior epigastric artery of 10 patients having free transverse rectus abdominis myocutaneous (TRAM) flaps. The peak, minimum and mean velocities, the diameter of the vessel, and the resistance index of both the deep superior and inferior epigastric arteries and thoracodorsal arteries were recorded preoperatively and at 4-6 and 15-30 days postoperatively. Colour Doppler US showed increased minimum velocity and decreased resistance index in the pedicle ( p < 0.05) throughout the follow-up when compared with the baseline. In the ipsilateral superior epigastric artery the mean and minimum velocities increased ( p < 0.05) while the resistance index decreased ( p < 0.05) during the first month postoperatively. No changes were recorded in the opposite epigastric arteries or in the control vessel (opposite thoracodorsal artery). In all patients the diameter of the deep inferior epigastric artery was larger than that of the superior epigastric and remained so after the transfer. From the fourth to the thirtieth postoperative day blood flow increased in the free TRAM flap, presumably because of decreased vascular resistance. Blood flow also increased in the superior epigastic artery on the donor side after free TRAM transfer as expected (indicating the delay phenomenon), but harvesting the flap did not affect the circulation in the opposite rectus abdominis muscle. The inferior epigastric arterial system was dominant in all patients.     

带蒂和游离脂肪移植预防椎板切除后硬膜外瘢痕形成与粘连

本文以ＳＤ大鼠为实验对象，研究了游离与带蒂脂肪组织在预防椎板切除后硬膜外瘢痕形成与粘连的作用。通过肉眼、光镜、电镜、ＭＲＩ及计算机图像处理，结果显示：游离与带蒂脂肪组织均可有效地减小硬膜外的瘢痕形成与硬膜的粘连；二者坏死吸收等组织的变化和感染率相同；抑制椎板再生能力一致；炎细胞浸润带蒂组重于游离脂肪移植组；并首次提出了脂肪移植后“异位移植”的排异现象