原创智能手机脊柱侧弯筛查APP测量青少年特发性脊柱侧凸Cobb角的可靠性研究北大核心CSCD

目的探讨使用团队原创智能手机脊柱侧弯筛查APP测量青少年特发性脊柱侧凸(AIS)Cobb角的准确性与可重复性。方法回顾性分析2020年8月至2021年2月河南省人民医院脊柱脊髓外科收治的60例AIS患儿的临床资料。3名测量者分别采用量角器、脊柱侧弯筛查APP及电脑图像存档和通信系统(PACS)3种方法对60例AIS患儿的脊柱全长正侧位X线片上的冠状位主弯Cobb角、矢状位上的胸椎后凸角(TK)、胸腰椎后凸角(TLK)及腰椎前凸角(LL)进行测量,记录每次测量的时间及结果,间隔2周后重复测量1次,采用配对t检验比较APP法与量角器法的测量时间。以PACS系统的Cobb角测量结果作为参考标准,通过配对t检验分析APP法测量Cobb角的准确性。使用组内相关系数(ICC)比较测量者内的可重复性及测量者间的一致性。结果60例AIS患儿中,男17例,女43例;年龄(12.2±2.4)岁(10~16岁);主弯为胸弯(LenkeⅠ型)23例、LenkeⅡ型18例、胸腰弯/腰弯(LenkeⅤ型)19例。APP法测量Cobb角的时间明显较量角器法短,二者比较差异有统计学意义(P<0.05)。APP法与PACS法测量的Cobb角结果比较差异无统计学意义(P>0.05)。3名测量者使用APP法测量冠状位主弯Cobb角及TK、TLK、LL的结果均有极佳的一致性(ICC分别为0.990、0.988、0.986、0.987),APP法前后2次测量冠状位主弯Cobb角及TK、TLK、LL的可重复性(ICC为0.973~0.982)均高于量角器法(ICC为0.933~0.954)。结论智能手机脊柱侧弯筛查APP较传统量角器测量AIS患儿Cobb角的时间短、效率高,准确性及可重复性高。     

Axial rotation of the pelvis and its influencing factors in adolescent idiopathic scoliosis with primary thoracic curve

目的 揭示青少年特发性主胸弯脊柱侧弯( adolescent idiopathic scoliosis,AIS)患者骨盆旋转的规律及影响因素,探讨其可能的旋转机制.方法 回顾性分析91例主胸弯AIS患儿,平均年龄(14.5±1.7)岁,平均主弯Cobb角(48±8.6)°.在站立位前后位片上测量髂前上棘与同侧骶髂关节下缘之间的水平距离(ASIS-SI),用左右侧ASIS-SI的比值(L/R比值)表示骨盆水平面旋转度.根据L/R比值将患儿分为A(L/R比值≤1)、B(L/R比值＞1)两组.同时测量胸弯、腰弯(或胸腰弯)的Cobb角、顶椎旋转度和柔韧度.对两组间各参数进行比较,以及将L/R比值与胸弯和腰(胸腰)弯Cobb角、柔韧度及顶椎旋转度做相关和回归分析.结果 75.8％(69例)的主胸弯AIS患儿的骨盆向主弯凸侧旋转,与胸弯方向一致;腰弯柔韧性和顶椎旋转度分别影响骨盆旋转的方向和大小.L/R比值与腰弯顶椎旋转度(P=0.003)、腰弯Cobb角(P=0.002)之间存在正相关;腰弯与胸弯Cobb角之间也存在正相关(P＜0.001),但胸弯Cobb角与L/R比值之间不存在相关性.结论 本研究证明了主胸弯AIS患儿的骨盆存在旋转,且大部分患儿的骨盆旋转方向与胸弯方向相同,向凸侧旋转;此外,由于骨盆旋转与腰弯存在相关性,同时腰弯与胸弯之间也存在相关性,因此我们认为骨盆可能通过腰弯参与代偿主胸弯AIS患儿胸椎侧弯畸形.     

后路椎弓根钉系统治疗Ⅰ型神经纤维瘤病合并小儿脊柱畸形

目的 回顾性研究16例神经纤维瘤病性脊柱畸形患儿的外科治疗结果,分析侧后弯分类与手术效果的关系.方法 2004至2008年资料完整的NF-1型脊柱畸形患儿16例,男12例,女4例,平均年龄8.4岁,平均随访时间2.6年.16例均为营养不良型.按照顶椎位置分为3组:胸弯组、胸腰弯组、单纯腰弯组.根据畸形类型和位置选择后路椎弓根钉系统矫形同定脊柱融合或前后路脊柱融合.所有病例行完整的影像学检查,并进行侧弯角度与手术效果之间关系的评估.结果 观察指标为脊柱冠状面及矢状面Cobb角的变化.冠状面和矢状面的矫形率分别达到65.3%和51.2%,侧弯最大矫正率89.8%,最小20%,后弯最大矫正率89.6%,最小25.9%,随访中丢失角度为5.8°和2.7°.无断棒、断钉、融合不良及内固定失败,随访期间未发现假关节存在,1例应用MOSS-MIAMI器械患儿手术半年后返院,因需增加融合范围再次行后路植骨手术.结论 神经纤维瘤病性脊柱畸形治疗较为复杂,难度较大,应用椎弓根钉系统后路矫形固定治疗此类畸形尤其是营养不良型NF-1型侧弯及后弯可获得较好的治疗效果.     

3D打印预置钉道模型辅助置钉治疗单发性完全分节型先天性半椎体的临床疗效

目的探讨3D打印预置钉道模型在单发性完全分节型先天性半椎体切除术中的临床疗效。方法回顾性分析2016年8月至2019年1月河南省人民医院脊柱脊髓外科收治的13例单发性完全分节型先天性半椎体患儿的临床资料, 其中男5例, 女8例;年龄5～14岁, 平均9.9岁。病变位置在T9 3例、T10 2例、T11 5例、T12 1例、L1 2例。术中使用3D打印预置钉道模型辅助置入椎弓根螺钉, 通过术后CT评估置钉的准确性。所有患儿术前、术后常规拍摄站立位脊柱全长正侧位X线片, 测量冠状面及矢状面Cobb角, 术后及随访时计算脊柱侧、后凸矫正率。术前、术后及随访时脊柱侧、后凸Cobb角的比较采用单因素重复测量方差分析。结果 13例患儿共置入椎弓根螺钉85枚, 置钉准确率为95.3%。手术时间(216.9±28.3) min;出血量(478.5±132.6) mL。术前侧凸Cobb角为(57.1±12.7)°, 术后为(12.7±4.7)°, 矫正率为(78.4±5.9)%, 末次随访时为(14.2±7.0)°;术前后凸Cobb角为(46.2±8.4)°, 术后为(13.2±4.4)°, 矫正率为(...     

女性青少年特发性胸椎侧弯的胸椎矢状面形态对支具治疗效果的影响

目的 探讨女性青少年特发性胸椎侧弯患儿初诊时胸椎矢状面形态对支具治疗期间侧弯进展的预测价值.方法 回顾性分析2002年1月至2008年12月70例接受规范化支具治疗的女性青少年特发性胸椎侧弯患儿资料.测量初诊和末次随访时的Cobb角、初诊胸椎后凸角,并记录初诊时的年龄、Risser征、月经状态等参数.分析末次随访时的侧弯变化情况,末次随访Cobb角大于初诊5°以上或治疗期间接受矫形手术者定义为支具治疗失败,其余为治疗成功.运用卡方检验和Logistic回归分析探讨影响支具治疗效果的因素.结果 患儿初诊时年龄平均为(12.6±1.2)岁,主弯Cobb角平均为30.2°±5.5°,随访时间平均为(2.7±1.1)年,末次随访主弯Cobb角平均为29.6°±8.0°.支具治疗失败患儿19例(27.1％),成功51例(72.9％).卡方检验发现支具治疗失败组以月经初潮未至、低Risser 征(0～1级)以及低初诊年龄(10～13岁)居多.Logistic同归分析表明月经初潮未至(OR=21.162,P=0.007)是支具治疗后侧弯进展的独立预测因素,而胸椎后凸形态与侧弯进展无明显相关性.结论 通过早期规范化支具治疗,大部分脊柱侧弯进展可得到控制.患儿的生长发育状态是影响支具疗效的重要因素,而初诊时胸椎矢状面形态与支具治疗期间侧弯的进展无明显相关性.     

后路交叉置钉技术在青少年脊柱侧凸治疗中的应用

目的探讨后路交叉置钉技术对于治疗青少年脊柱侧凸的临床疗效。方法 2010年1月至2014年1月,68例青少年脊柱侧凸病例,男10例,女58例,年龄11~16岁,平均13.5岁;其中4例为神经肌肉型脊柱侧凸,其余为特发性脊柱侧凸;术前冠状面主弯Cobb角平均56.2°,胸椎(T5~T12)后凸角度平均17.7°,手术方法为后路交叉置入椎弓根螺钉对脊柱侧凸进行矫正,对术后Cobb角、主弯Cobb角矫正率结果进行评价。结果术后随访12~40个月,平均22.5个月。术后主弯Cobb角矫正到18.5°,与术前比较有差异(t=3.705,P0.01),末次随访时平均20.2°,与术后比无差异(t=1.053,P0.05)。胸椎(T5~T12)后凸角术后平均22.8°,末次随访时平均23.2°,术前与术后、术后与末次随访相比较均无差异(P0.05)。术后主弯Cobb角矫正率为70.5%,而末次随访时虽然主弯矫正率(69.4%)有一定丢失,但和术后比较无差异(t=0.126,P0.05)。术后无患者出现脊髓或神经根损伤。末次随访时无内固定松动及断钉断棒,植骨融合牢固,均未出现明显的矫正丢失。结论对于青少年脊柱侧凸后路手术矫正,采用交叉置钉技术是一项值得推广的低费用、高安全的脊柱侧凸矫正技术。     

Halo重力牵引辅助治疗重度先天性脊柱侧弯的临床研究

目的评估术前Halo重力牵引(halo gravity traction, HGT)辅助治疗重度先天性脊柱侧弯(congenital scoliosis, CS)的临床效果。方法回顾性分析2016年10月至2021年12月首都医科大学附属北京儿童医院骨科收治的55例重度脊柱侧弯患儿临床资料, 其中男28例, 女27例, 年龄(9.4±3.8)岁。根据病因分为先天性脊柱侧弯组(28例)和非先天性脊柱侧弯组(27例)。两组均接受HGT治疗。收集两组牵引前、牵引后及术后站立位全脊柱正侧位X线片, 测量主弯、代偿弯、胸椎后凸、腰椎前凸、冠状面及矢状面躯干平衡、肩高度、T1-S1高度, 评估两组患儿畸形矫正情况及治疗效果差异。结果先天性脊柱侧弯组和非先天性脊柱侧弯组术前主弯Cobb角分别为(88.9±14.1)°和(89.5±17.4)°;代偿弯Cobb角分别为(28.8±12.9)°和(33.3±12.9)°;胸椎后凸分别为(74.1±21.0)°和(69.9±20.8)°;腰椎前凸分别为(47.9±13.4)°和(38.9±6.6)°;冠状面躯干平衡分别为(43.2±15.5)mm和(38....     

后路半椎体切除短节段固定治疗儿童不平衡型多发半椎体的效果分析

目的 评价后路半椎体切除术短节段固定治疗儿童不平衡型多发半椎体的临床效果.方法 回顾性分析2003年6月至2013年6月行后路半椎体切除短节段固定术,治疗不平衡型多发半椎体(≥2个)22例的临床资料.其中,男12例,女10例;初次手术年龄3.0～7.5岁,平均4.2岁.手术前、后及末次随访时所有患儿均行站立位全脊柱正侧位X线检查.对比手术前、后冠状面Cobb角、顶椎偏距、冠状面平衡及矢状面局部后凸角、矢状面平衡变化;测量并比较胸椎(T1 ～T12)及脊柱高度(T1～S1)变化.结果 随访时间36～156个月,平均86.1个月.22例共51个半椎体,手术切除41个;平均每例有2.3个半椎体,平均切除1.9个;平均每例固定3个节段.术后侧凸Cobb角12.6°±7.2°明显小于术前45.8°±12.7°,侧凸矫形率为72.5％;术后局部后凸角11.2°±7.5°明显小于术前23.6°±18.0°,后凸矫形率为52.5％,差异均有统计学意义(P均＜0.05),末次随访时无明显丢失.冠状面平衡由术前(14.0±6.7)mm降至术后(8.5±4.0)mm,差异有统计学意义(P＜0.05).胸椎高度术前为(18.5±1.9)cm,末次随访时增至(24.4±3.0)cm;脊柱高度术前为(29.3±3.7)cm,末次随访时增至(38.7±4.4)cm,差异均有统计学意义(P均＜0.05).结论 对于3.0～7.5岁儿童双侧不平衡型多发半椎体畸形,后路选择性半椎体切除短节段固定矫形效果较好,同时可维持躯干整体平衡,保留脊柱生长潜能.     

儿童腰骶部半椎体一期后路切除短节段固定治疗效果分析

目的评价儿童先天性腰骶部畸形一期后路半椎体切除、短节段固定治疗的手术效果。方法回顾性分析2014年1月至2017年12月首都医科大学附属北京儿童医院诊治的21例腰骶部半椎体患儿的临床资料,均行腰骶部一期后路半椎体切除术以及短节段固定融合术,随访至少24个月。术前、术后及末次随访时患儿均行站立位全脊柱正侧位X线检查。对比术前、术后以及末次随访时结构性侧凸、近端代偿弯、胸椎后凸、腰椎前凸的Cobb角、躯干偏移、矢状面平衡以及骨盆入射角、骨盆倾斜角、骶骨倾斜角。结果 21例中男12例,女9例;手术年龄2.17～13.00岁,平均(6.50±3.22)岁;术后随访24～84个月,平均(48.10±17.72)个月;融合固定2～4个椎体,平均(2.67±0.91)个椎体;手术时间120～300 min,平均(168.57±46.18) min;术中出血量100～1 000 m L,平均(368.04±234.58)m L;侧凸Cobb角由术前的(28.9±6.3)°降至术后的(8.5±3.0)°,末次随访时为(7.0±3.4)°,矫正率为75.8%。冠状面近端代偿弯Cobb角由术前(25.8±11.7)°自发性矫正为末次随访时(13.7±8.3)°,矫正率为46.9%。术后躯干偏移较术前均有明显改善,末次随访冠状面及矢状面的矫正率分别为53.1%和56.3%,且随访过程中躯干趋于平衡和稳定。所有病例术前、术后脊柱-骨盆序列均保持平衡,术后无脊髓神经功能损伤、感染等并发症。结论儿童腰骶部半椎体畸形一期后路半椎体切除、短节段固定可获得较好的侧凸矫正并改善躯干偏移,同时可保留一定的活动节段,有效控制畸形的加重和近端代偿弯的进展,避免腰椎长节段的固定融合。     

磁共振成像评估先天性马蹄内翻足经Ponseti方法治疗跗骨病理解剖关系

目的应用核磁共振评估经Ponseti方法治疗的先天性马蹄内翻足(congenital talipes equinovarus, CTEV)的跗骨病理解剖的恢复程度。方法收集2014年3月至2022年3月首都儿科研究所附属儿童医院收治的经Ponseti系列石膏矫形技术治疗先天性马蹄内翻足12例(15足)患儿的临床资料, 其中男10例, 女2例;做MRI扫描时患儿平均年龄为47.7个月, 范围是8～96个月;单侧9例(9足), 双侧3例(6足)。采用3.0T核磁共振成像扫描双足, 获得标准的解剖矢状面、冠状面和横轴面的T1加权和T2加权图像。选择能够清晰显示解剖结构的最佳切面进行角度测量, 包括矢状面:胫骨-跟骨角, 距骨-跟骨角;冠状面:胫骨-跟骨角;横轴面:距骨颈角, 距骨-舟骨角, 距骨-跟骨角。Ponseti方法治疗的CTEV作为观察组, 其余正常足作为对照组。采用t检验或非参数检验对CTEV观察组和对照组的数据进行统计学分析。同时采用Pirani评分系统对经Ponseti方法治疗后的CTEV进行临床评估。结果全部患足均达到柔软、无痛、灵活、功能正常的跖行足。Pirani评分:治疗...     

支具治疗进展型早发性脊柱侧弯的临床研究

目的分析进展型早发性脊柱侧弯(early onset scoliosis,EOS)经支具保守治疗后畸形发展情况,并探讨支具矫形在此类患者中的疗效。方法以战略支援部队特色医学中心脊柱外科接受支具治疗至少2年且影像资料完整的19例EOS患者为研究对象,其中男12例,女7例。根据随访结果分为有效组和无效组,末次随访Cobb角与治疗前相比改善超过10°为治疗有效,未超过10°为治疗无效。支具治疗前、初次治疗后、末次随访时拍摄站立位全脊柱正(侧)位X线片,分别测量冠状位及矢状位畸形角度及平衡。结果19例支具治疗前平均Cobb角(40±10.4)°(20°~55°)、初次治疗后主弯Cobb角(28.15±14.78)°,末次随访主弯Cobb角(31.63±18.04)°,初次治疗后及末次随访均较治疗前明显好转(P<0.05)。两组末次随访时的胸廓宽度及胸椎高度均较支具治疗前明显增加,特发性EOS较先天性EOS治疗效果更好(P<0.05)。另外,顶椎位于胸腰段或腰段较顶椎位于胸段者效果更好(P<0.05)。初次治疗后两组间主弯矫正率差异无统计学意义(P>0.05),末次随访时差异具有统计学意义(P<0.05)。结论对于部分进展型早发性脊柱侧弯,支具治疗可作为保守治疗的选择之一,其中一些病例可得到满意矫形,即使部分病例不能避免手术,支具治疗也可在不影响胸廓发育的前提下适当延后手术时间。     

The effect of a modified Boston brace with anti-rotatory blades on the progression of curves in idiopathic scoliosis: aetiologic implications

The effect of a modified Boston brace with anti-rotatory blades on idiopathic scoliotic curves, mainly right thoracic with a compensatory left lumbar, was studied. METHOD AND MATERIAL: Twenty-eight scoliotic children divided into three sub-groups according to the curve type were included in the study. Cobb angle and rotation was measured on posteroanterior spinal radiographs taken during the first examination and also during the follow-up with the children in and out of the brace. RESULTS: Ten curves improved, 13 remained stable and 5 increased (Cobb angle change >5 degrees compared with the initial measurement). The brace treatment had more affect on the double curves, while single curves remained unaffected. Rotation remained unchanged in all curve types except in the lumbar component of double (right thoracic-left lumbar) curves. DISCUSSION: These findings indicate that in curves with a compensatory component (e.g. main thoracic with compensatory lumbar curve), a deforming rotatory force, which is blocked by the de-rotatory action of the blades of the above-modified Boston brace, is present and seems to be more active in the lumbar spine. It is hypothesized that this deforming rotatory force seems to be a major aetiological factor for double curves. In conclusion the conservative treatment using this brace is beneficially affecting the natural history of IS in children.     

河南漯河地区儿童先天性脊柱侧弯患病率调查

目的 了解河南省漯河地区儿童先天性脊柱侧弯患病率及治疗现状.方法 采用分层抽样的方法从漯河地区36所公立幼儿园及小学3～10岁84 325儿童中随机选出15 000名,在其父母签署知情同意书后进行体检,初步筛选出疑似病例.再对疑似病例进行影像学检查确诊为先天性脊柱侧弯.结果 最终有14 326名儿童参与调查,应答率为95.51％.其中,236例儿童被物理体检出脊柱侧弯,233例进行了全脊柱X线正、侧位片检查,38例进行了MRI和CT检查,确诊先天性脊柱侧弯患儿29例(女21例、男8例).先天性脊柱侧弯患病率为2‰(29/14 326),其中女童患病率为2.9‰(21/7 095),男童患病率为1.1‰(8/7 231),两者比较,差异有统计学意义(P＜0.05).筛查出先天性脊柱侧弯的年龄主要集中在3～4岁(58.62％).畸形类型:半椎体畸形15例、单侧骨桥畸形9例、一侧骨桥合并对侧多节段半椎体畸形4例、L1-4椎体分节不全1例,以半椎体畸形最为多见(51.72％).畸形部位:中上胸椎(T1-8)5例、胸腰段(T9～L2)21例、腰段(L3-5)3例,畸形主要位于胸腰结合部72.41％(21/29).侧凸Cobb角:10～19度16例,20～39度8例,≥40度5例,脊柱侧弯Cobb角以10～19度最多(55.17％).该人群先天性脊柱侧弯知晓率31.03％(9/29),有效治疗率6.90％(2/29).结论 漯河地区儿童先天性脊柱侧弯发病率为0.2％,高于目前报道的全国平均水平(0.1％),女童发病显著高于男童,畸形类型以半椎体多见,部位以胸腰段最多.知晓率、治疗率偏低,先天性脊柱侧弯得到正确治疗的情况不容乐观.     

Sagittal counter forces (SCF) in the treatment of idiopathic scoliosis: a preliminary report

BACKGROUND: In patients with idiopathic scoliosis (IS), reduced thoracic kyphosis and reduced lumbar lordosis frequently occur in correlation with the lateral spinal curvature. Normalization of the sagittal profile and hyper-correction of the deviation in frontal and coronal plane are the main issues of the latest concept of bracing. The purpose of this study was to investigate the influence of of sagittal counter forces (SCF) on the scoliotic deformity. STUDY DESIGN: A case series of four patients with IS treated with two braces designed to improve the sagittal profile (Rigo-System-Chêneau-brace and with a sagittal counter force brace, SCF-brace). METHODS: The short-term effect (30 min) of both braces was evaluated using surface topography (Formetric surface topography system, Diers International, Wiesbaden). RESULTS: One patient (Cobb angle 92 degrees ) showed no short-term correction in the frontal and coronal planes; others (Cobb angles between 39 and 48 degrees ) exhibited valuable correction in frontal and coronal planes. There was no short-term correction in the sagittal plane for either brace. CONCLUSION: The application of sagittal counter forces (SCF) seems to have similar short-term effects as 3D correction and should be addressed more in future concepts of scoliosis bracing.     

Long-term follow-up of lung function and standing height following scoliosis surgery in children and adolescents

Previous investigations have reported conflicting results on the development of lung function and body height after operative correction of scoliosis at young age. Partly the number of patients or the duration of observation were relatively small. 120 patients were followed for at least 10 years (10-14, average 12 years) after surgical correction of scoliosis at the age of 18.2 +/- 6.8 years. Standing height and vital capacity were measured 1, 2, 5 and 10 years after operation. Height was expressed as percentile for age and vital capacity as % expected for actual height. The primary diagnoses were idiopathic scoliosis (n = 84, average Cobb angle 90 degrees), congenital scoliosis (n = 20, 83 degrees), poliomyelitis (n = 10, 128 degrees), neurofibromatosis (n = 6, 101 degrees). We found an initial decrease in lung function after 1 year, which was probably due to post-operative immobilization and increased by the gain in body height achieved by the operation. During the rest of the observation period a significant (p less than 0.05) increase of vital capacity (% of expected for actual height) was observed. The gain was maximal for idiopathic scoliosis (+6%). In congenital scoliosis body height %ile and relative vital capacity appeared fixed at the preoperative level. Interestingly patients with an initial vital capacity below 50% expected (n = 29) or preoperative Cobb angle above 90 degrees showed the best results. They also lacked the initial deterioration of lung function in the first postoperative year and had a significant gain of vital capacity (+14%) over 10 years.(ABSTRACT TRUNCATED AT 250 WORDS)     

Estimating the final outcome of brace treatment for idiopathic thoracic scoliosis at 6-month follow-up

OBJECTIVE: The study was conducted on the possibility of predicting the final outcome of bracing for idiopathic scoliosis at a follow-up period of 6 months. METHODS: In a retrospective study, 62 adolescent female patients with right thoracic scoliosis (20-40 degrees Cobb angle) treated with a brace were examined. A new compliance score was developed. The sample was divided into four groups based on compliance (compliance score) and initial correction (half-year after start bracing): group A, good compliance/high initial correction; group B, good compliance/low initial correction; group C, bad compliance/high initial correction; group D, bad compliance/low initial correction. The final outcome (1 year after weaning) was defined as successful if a curve correction of at least 5 degrees was achieved. The influence of factors on final outcome was analysed by ANOVA. Differences between continuous data were analysed by a two-sample Wilcoxon test. RESULTS: The overall final outcome was not successful (thoracic curve -3 degrees). However, the average outcome of the compliant group was successful (-5 degrees), while no success was achieved without good compliance (+5 degrees). High initial correction of more than 40% (p < 0.002) and good compliance (p< 0.004) were of significant impact for the outcome. Patients showing good compliance and high initial correction presented a successful outcome of 7 degrees Cobb angle. CONCLUSION: Compliant patients with a high initial correction can expect a final correction of around 7 degrees, while compliant patients with low initial correction may maintain the curve extent. Bad compliance is always associated with curve progression.     

Conservative treatment for adolescent idiopathic scoliosis: can it reduce the incidence of surgical treatment?

Since 1986, the authors have been conducting conservative treatment for idiopathic scoliosis with the combination of brace treatment and physical treatment (side shift exercise and hitch exercise). A total of 328 female patients with adolescent idiopathic scoliosis who were at least 10 years of age at the first visit, with Cobb angle of 10 degrees at the minimum and followed until after 15 years of age or skeletal maturity were included. The average Cobb angle was 32.4 degrees and the average age was 13.8 years at the first visit. Surgery was recommended when curvature progressed to >50 degrees. Twenty of 328 patients (6.1%) with more severe curves to begin with (mean Cobb angle at admission of 48.5 +/- 9.3 degrees ) progressed to 62.2 +/- 8.5 degrees and were treated with spinal fusion by the age of 16.0 +/- 2.6 years. The remaining 308 patients, of comparable age at inception of treatment but with a smaller original mean Cobb angle (32.4 +/- 11.1 degrees ), showed no significant increase in magnitude of curvature (mean 33.6 +/- 11.5 degrees ) by the time of discharge (18.6 +/- 3.1 years). The fact that curvature magnitude was maintained at <35 degrees means that these patients will have a good prognosis for avoiding dramatic progression during adulthood.     

石膏矫形治疗幼儿特发性脊柱侧弯的临床研究

目的介绍简易石膏床方法行石膏矫形治疗幼儿特发性脊柱侧弯,并进行效果评价。方法选取2014年9月至2016年9月于河北省儿童医院住院治疗的25例幼儿特发性脊柱侧弯病例作为研究对象,平均年龄29.7个月(17~53个月),其中男童10例,女童15例,共行石膏矫形105次。应用去旋转石膏矫形方法并结合我院实际情况采用简易石膏床对患儿进行石膏矫形,测量并记录石膏矫形前后脊柱正位X线片上Cobb角改变情况,并对所有患儿按照性别及年龄是否≤2岁进行分组分析。结果 25例患儿石膏矫形治疗前脊柱侧弯Cobb角平均角度为(39.1±9.1)°,经过第1次石膏矫形后平均角度为(22.3±5.0)°,末次随访时平均角度为(20.3±4.3)°。第1次石膏矫形后Cobb角与矫形前相比差异有统计学意义(t=8.825,P<0.05)。随访终点时Cobb角与矫形前相比差异有统计学意义(t=9.653,P<0.05)。不同性别分组随访终点时Cobb角矫正度数差异无统计学意义(t=0.070,P=0.945)。不同年龄分组随访终点时Cobb角矫正度数差异无统计学意义(t=-0.733,P=0.471)。结论我们采用的简易石膏床方法结合去旋转技术进行石膏矫形可以纠正幼儿特发性脊柱侧弯患儿的Cobb角,性别和年龄因素未对矫正效果产生影响。     

经前路短节段固定矫形治疗青少年特发性脊柱侧弯的探讨

目的 探讨经前路手术短节段矫形治疗青少年特发性胸/腰段脊柱侧弯的临床疗效,总结分析其并发症.方法 回顾性分析我院2000年1月～2007年12月行前路手术矫形治疗的62例青少年特发性胸\腰段脊柱侧弯.胸段特发性脊柱侧弯39例,术前Cobb角45°～75°(平均53.6°);腰段特发性脊柱侧弯23例,术前Cobb角43°～72°,平均51.7°.术前均进行详细的临床和影像学检查评估.胸段脊柱侧弯患儿均行肺功能测定,对于最大肺活量小于50%的患儿行吹气球等肺功能锻炼达手术要求.按影像学资料拟定同定节段及融合范围.结果 62例患儿均顺利完成手术.胸段脊柱侧弯平均融合4.2个,Cobb角矫正至术后的3°～18°,平均8.5°,平均矫正率为84.1%;腰段脊柱侧弯平均融合4.5个,Cobb角矫正至术后的1°～16°,平均7.9°,平均矫正率为84.7%.发生自发性血胸1例,交感神经损伤8例,医源性平背畸形1例,肠系膜上动脉综合征1例.结论 青少年特发性胸/腰段脊柱侧弯经前路短节段同定可取得良好的矫形效果,充分的术前计划及认真的术中操作可有效减少围手术期和远期并发症的发生.     

New treatment concept for children with thoracic insufficiency syndrome due to congenital spine deformity

BACKGROUND: Children with congenital thoracic scoliosis associated with fused ribs and unilateral unsegmented bars adjacent to convex hemivertebrae will inevitably develop thoracic insufficiency syndrome and curve progression with hemithorax compression without treatment. It is assumed that the concave side of such curves and their unilateral unsegmented bars do not grow. In the past early spinal fusion was performed with consecutive short thoracic spines and loss of lung volume. Little attention has been paid to lung function. These patients often suffered from lung failure and early death due to a small thorax. METHOD: A new surgical technique is based on an indirect deformity correction and enlargement of the thorax due to a longitudinal implant, the vertical expandable prosthetic titanium rib (VEPTR). The spine is not fused, thus promoting growth of the spine, the thorax and the lungs. Elongation of the implant is done every six months. Since 2002 this method has been performed on fifteen children in Basel as the first European center. RESULTS: Patients (mean age 6 years; 11 months to 12 years) were suffering from thoracic insufficiency syndrome due to unilateral unsegmented bars with fused ribs (n = 4), absent ribs (n = 2), bilaterally fused ribs (n = 2), hemivertebrae (n = 3) or neuromuscular scoliosis (n = 6). Doing fifteen primarily implantations and thirteen elongations there were three complications (two hook dislocations, one skin breakage). All patients improved cosmetically, functionally and radiologically which was shown on X-rays as a reduction of the Cobb angle from an average of 76 degrees (40-110 degrees ) to 55 degrees (30-67 degrees ). CONCLUSIONS: Expansion thoracoplasty and VEPTR implantation is a new treatment concept for children with thoracic insufficiency syndrome due to spinal deformities, which is based on distraction and expansion of the thorax thus allowing growth of the spine, the thorax and probably lungs. Presently it seems to be superior to any other method for the treatment of small children with progressive scoliosis and thoracic insufficiency syndrome.