生长棒近端锚定点数量对早发性脊柱侧凸疗效及并发症的影响

目的探究生长棒技术治疗早发性脊柱侧凸时近端不同锚定点数量对疗效及并发症的影响。方法以2016年1月至2020年3月首都医科大学附属北京儿童医院收治的33例采用传统双侧生长棒技术治疗的早发性脊柱侧凸患者为研究对象,所有患者随访时间≥2年,撑开次数≥2次,术前、术后及末次随访时影像学资料完整。按照近端锚定点数量不同将患者分为2组:A组近端远端各4个锚定点,共8个锚定点(15例);B组近端6个锚定点,远端4个锚定点,共10个锚定点(18例)。记录患者年龄、性别、随访时间、术前和末次随访时主侧弯Cobb角、T1-S1高度、冠状面偏移程度、影像学肩关节高度差、胸椎后凸Cobb角、矢状面偏移情况,以及随访期间椎弓根螺钉松动、移位、拔出、断棒、翻修情况。结果两组患者术前年龄、不同性别例数、随访时间、撑开次数的差异无统计学意义(P>0.05)。两组末次随访时主侧弯Cobb角均较术前减小,末次随访时T1-S1高度均较术前增大,差异有统计学意义(P<0.05)。A组术前与末次随访时相比,胸椎后凸Cobb角差异无统计学意义(P>0.05)。B组末次随访时胸椎后凸Cobb角较术前减小,差异有统计学意义(P<0.05)。末次随访与术前比较,主侧弯Cobb角的变化值及胸椎后凸Cobb角的变化值,B组均大于A组,差异有统计学意义(P<0.05)。结论传统双侧生长棒技术治疗EOS时,采用近端4个锚定点与6个锚定点均能取得冠状面侧弯的矫正,同时保持脊柱的生长;但采用近端6个锚定点可获得更大的冠状面主侧弯矫形力度和矢状面胸椎后凸的改善,同时锚定点相关并发症发生率更低。对于大的冠状面主侧弯(Cobb角>70°),尤其是合并较大胸椎后凸畸形(Cobb角>40°)的EOS,可以考虑增加锚定点。     

椎体-肋骨撑开术及椎体-椎体撑开术治疗早发性脊柱侧凸的疗效比较

目的针对椎体-肋骨撑开术与椎体-椎体撑开术两种不同术式治疗早发性脊柱侧凸患儿的疗效进行对比分析。方法以首都医科大学附属北京儿童医院2005—2010年接受椎体-肋骨撑开术(为椎体-肋骨撑开组)或椎体-椎体撑开术(为椎体-椎体撑开组)治疗的早发性脊柱侧凸患儿为研究对象。比较两组初次手术前后及末次随访时冠状位主弯Cobb角、胸椎后凸角、胸廓(T1至T12)椎体高度及肺功能变化,并记录两组患儿术后并发症情况。结果本研究共纳入28例患儿(椎体-肋骨撑开组和椎体-椎体撑开组各14例)。两组患儿脊柱侧凸类型构成比、初次手术年龄和平均随访时间均无统计学差异(P 0. 05)。椎体-肋骨撑开组主弯Cobb角的初次手术矫正率及末次手术矫正率均低于椎体-椎体撑开组(P 0. 05)。椎体-肋骨撑开组和椎体-椎体撑开组患儿初次手术前的平均胸廓(T1至T12)高度无统计学差异(P 0. 05),但两组患儿末次随访时的胸廓(T1至T12)高度与各自初次术前的胸廓高度相比均有明显增加(P 0. 05)。末次随访时,两组患儿的胸廓(T1至T12)高度存在统计学差异(P 0. 05)。两组末次随访时FVC、FEV1值均高于初次手术前水平(P 0. 05)。椎体-肋骨撑开组的并发症发生率大于椎体-椎体撑开组(P 0. 05)。结论椎体-肋骨撑开术与传统生长棒椎体-椎体撑开术矫形效果相同,均可有效地矫正早发性脊柱侧凸患儿的脊柱畸形并改善术后肺功能。对于胸廓畸形严重、椎体发育较差的EOS患儿是首选的手术治疗方法。     

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。     

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.     

双侧生长棒技术治疗早发性脊柱侧凸的疗效分析

目的初步分析采用双侧生长棒技术治疗早发性脊柱侧凸的临床价值。方法选取首都医科大学附属北京儿童医院2012年4月至2015年4月收治的早发性脊柱侧凸患者110例为研究对象,均实施双侧生长棒治疗,随访5年,对比110例患者治疗前、治疗后脊柱影像学参数变化、肺功能指标及并发症情况。结果110例均顺利完成手术,平均手术用时(181.25±9.14)min,术中出血量(132.41±10.72)mL,平均住院时间(10.94±2.13)d;手术治疗前后TK比较差异无统计学意义(P>0.05);治疗后主弯侧凸Cobb角均明显减小,与手术治疗前相比,差异有统计学意义(P<0.05);术后随访显示患者FVC、FEV1/FVC、FEV1预估值等各项肺功能指标水平均高于术前,差异有统计学意义(P<0.05);并发症发生率为10.91%(12/110)。结论双侧生长棒可有效纠正脊柱侧凸畸形并同步改善肺功能,术后并发症较少,具有一定的临床应用价值。     

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北大核心CSCD

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T_(9)3例、T_(10)2例、T_(11)5例、T_(12)1例、L_(1)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(72.6±7.0)%,末次随访为(14.0±3.4)°。患儿均未出现严重血管及神经损伤等并发症。术后随访12.3个月(6-18个月),随访期间未见明显角度丢失。术后与末次随访时,侧、后凸角度与术前比较,差异均有统计学意义(均P<0.05);术后侧、后凸角度与末次随访时比较,差异均无统计学意义(均P>0.05)。结论在单发性完全分节型先天性半椎体切除术过程中,3D打印预置钉道模型可提高螺钉置入的精准性,改善脊柱侧后凸畸形的矫形效果。     

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.     

不同术式早期治疗半椎体型先天性脊柱侧弯的临床疗效比较

目的比较前后路半椎体切除、后路短节段内固定术与单纯前后路凸侧骺阻滞术早期治疗半椎体型先天性脊柱侧弯的疗效。方法选择2000年9月～2005年6月收治的5岁以下完全分节半椎体型先天性脊柱侧弯患儿17例,男11例,女6例,平均年龄3岁2个月,均为T10～L4半椎体畸形,根据术式将17例患儿分为A、B两组,A组10例,采取前后路半椎体切除、后路短节段内固定术,B组7例,采用单纯凸侧前后路骺阻滞术。结果A组平均年龄3岁1个月,术前侧弯平均Cobb角为44°,术后平均随访时间3年3个月,随访时平均Cobb角为17°,平均矫正率为61.4%;B组平均年龄2岁11个月,术前侧弯平均Cobb角为46°,术后平均随访时间3年5个月,随访时平均Cobb角为21°,平均矫正率为54.4%。两组伴后凸畸形者术后无加重。两组侧弯矫形效果比较,差异无统计学意义(P=0.107)。结论两种术式在治疗5岁以下一定弧度内的半椎体型先天性脊柱畸形方面,均可达到限制畸形进展或矫形的目的,但凸侧骨骺阻滞术无需切除半椎体和内固定器械矫形,具有手术时间短、术中出血少、相对安全、治疗费用低的优点。     

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。     

半椎体切除短节段融合治疗先天性脊柱侧弯

目的 评估半椎体切除和短节段椎弓根钉系统固定融合治疗先天性脊柱侧弯的疗效.方法 34例经前后路联合半椎体切除并同时行后路短节段椎弓根螺钉矫形内固定脊柱融合术的先天性脊柱侧弯的患儿,随访术前、术后和最后一次脊柱全长正侧位X线片,测量并记录脊柱侧弯及后凸的Cobb角.结果 除1例因(T11-12)半椎体畸形术后因术后5个月椎弓根钉脱出、假关节形成、侧弯加重外,其余病例冠状面半椎体节段侧弯术前平均45.3°,术后14.9°,矫正67.1%;最后一次随访时平均13.5°,矫正70.2%;冠状面主侧弯术前平均47.6°,术后18.2°,矫正61.8%;最后一次随访时平均16.0°,矫正66.4%;矢状面半椎体节段术前有10.1°后凸畸形,术后恢复至正常生理曲度范围.手术后头侧和尾侧代偿弯也得到明显改善.结论 前后入路联合切除半椎体后,使用短节段的椎弓根螺钉系统可满意地矫正先天性脊柱侧弯,在骨骼成熟之前进行治疗可有效地预防脊柱的继发性改变.     

早发型脊柱侧凸保守治疗的研究进展

早发型脊柱侧凸(early onset scoliosis,EOS)具有发病年龄小、进展迅速的特点,易造成患者脊柱生长异常及心肺功能障碍,是脊柱疾病领域的研究热点之一。EOS的治疗方法主要包括保守治疗与手术治疗,前者因创伤小、并发症少,且有利于患者的身心发展,常推荐作为治疗的第一步。保守治疗包括石膏治疗、支具治疗、脊柱侧凸特定运动疗法与Halo重力牵引等。对于特发性EOS,保守治疗可有效改善脊柱畸形,而对其他类型EOS则主要起到延缓畸形进展、推迟手术时间的作用。本文拟针对EOS常见的保守治疗方法进行深入阐述。     

Radiological and cosmetic improvement 2 years after brace weaning--a case report

In the early international literature, up to now only very few cases are reported with adolescent idiopathic scoliosis (AIS) and a significant improvement of Cobb angle after conservative management. In the recent literature the possibility of an improvement of Cobb angle at skeletal maturity after brace treatment is mentioned no more. The application of physiotherapy and braces is widely rejected while the standards of conservative measures differ greatly worldwide. So it seems necessary more than ever to present the possibility of successful conservative measures nowadays. More detailed case reports with long-term follow-up using defined protocols are needed to provide appropriate standards for replication by others. The purpose of this presentation is to demonstrate the possibility of significant improvement of curvature angle and cosmesis after the application of long-term physiotherapy and brace treatment in a girl with a curve of more than 50 degrees where spontaneous resolving is not usual. A pre-menarchial girl (although being Risser 2) with a Cobb angle of 53 degrees was treated by exercises and curve-specific bracing for more than 3 years. Two years after the start of the weaning period, the Cobb angle was 36 degrees with a marked and stable cosmetic improvement at the age of 18 years. This case report shows that conservative treatment can improve both cosmesis and curvature in immature patients with AIS. The results of such treatment is appreciated by the patients because of the significant reduction of the truncal deformity as documented by surface topography.     

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.     

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.     

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.     

Brace treatment during pubertal growth spurt in girls with idiopathic scoliosis (IS): a prospective trial comparing two different concepts

STUDY DESIGN: Prospective comparison of the survival rates of two different bracing concepts with respect to curve progression and duration of treatment during pubertal growth spurt in two cohorts of patients followed up prospectively. OBJECTIVES: To determine whether the results obtained by the use of a soft brace (SpineCor) is comparable to the results of the Chêneau derived TLSO during pubertal growth spurt. BACKGROUND DATA: In recent peer reviewed literature, the SpineCor is described as an effective method of treatment for patients with scoliosis. However, until now, no controlled study has been presented comparing the results obtained with this soft brace to a sample treated with other bracing concepts proven effective. METHODS: Twelve patients with Cobb angles between 16-32 degrees during pubertal growth spurt are presented as a case series treated with the SpineCor. The survival rate of this sample is described and compared to a matched group of patients treated with the Chêneau brace of the same age group. All girls treated in both studies were pre-menarchial with the first clinical signs of maturation (Tanner 1-3). RESULTS: During the pubertal growth spurt, most of the patients (11/12) with SpineCor progressed clinicly and radiologicly as well (at least 5 degrees ). Progression could be stopped changing SpineCor to the Chêneau brace in most of the samples described (7/10). The avarage Cobb angle at the start of treatment with the SpineCor was 21.3 degrees , after an avarage observation time of 21.5 months, 31 degrees. The control sample, primarily treated with the Chêneau brace (n=15), showed at average no progression. Cobb angle at the start of treatment was 33.7 degrees and after the observation time of 37 months, 33.9 degrees . Radiological improvements can be reported for some of the cases (3/15) as well as progressions (3/15). At 24 months of treatment time, 73% of the patients with a Chêneau brace and 33% of the patients with the SpineCor where still under treatment with their original bracing concept, at 42 month follow-up time 80% of the patients with Chêneau braces and 8% of the patients with the SpineCor survived with respect to curvature progression. The differences of the proportions statisticly where highly significant. CONCLUSIONS: The SpineCor does not change natural history of idiopathic scoliosis during the pubertal growth spurt. The use of the Chêneau brace seems to do so. Oncoming studies with the aim to test the efficiency of braces should be based on samples at immediate risk for progression (only girls with first signs of maturation but pre-menarchial).