Lumbar pedicle morphology in adolescent idiopathic scoliosis

Using computed tomography of lumbar spine pedicles, pedicle morphology was documented in 30 patients with adolescent idiopathic scoliosis. Lumbar pedicles are relatively symmetrical in patients with adolescent idiopathic scoliosis; however, a statistically significant difference was found between males and females at L2-L4. A trend for increased transverse pedicle width was observed on the concavity versus the convexity. At levels L3-L5, 90% of the pedicles were >5.5 mm but pedicles Li and 12 were smaller, only >5.5 mm in 34% and 42%, respectively. Safe insertion of 5.5-mm screws is possible at 13-15, but more cephalic pedicles necessitate caution.     

Lenke5型青少年特发性脊柱侧凸手术矫形的有限元研究

目的 通过建立有限元模型探讨Lenke 5型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)的最佳手术方案.方法 建立Lenke 5型AIS的有限元模型,模拟4种不同方案的90°去旋转和压缩序贯矫形,比较矫形效果及矫形后脊椎的应力水平.结果 4种方案有限元模型模拟矫形后的...     

女性青少年特发性脊柱侧凸患者的椎体形态学测量

突距离进行对比,并进行统计学分析.结果 AIS组10～14岁患者前柱椎体高度大于后柱,椎体前后中心径相对较长,椎体存在楔形变,凸凹侧椎弓根及凸凹侧上下关节突距离均不对称,胸腰椎前后柱的比例明显不同于对照组(P<0.01):而15～18岁患者两组前后柱比例比较差异无统计学意义.结论 AIS椎体冠状面存在楔形变,10～14岁AIS患者椎体高度较高,后方结构相对较小,椎体前后径相对较长,椎体相对细长,这可能是导致侧凸的形成以及发展的原因.     

Lenke1BN型青少年特发性脊柱侧凸后路三维矫形有限元模拟研究

[目的]利用建立的Lenke1BN型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)三维有限元模型,模拟后路三维矫形手术,并探讨选择不同下固定椎对矫形效果的影响.[方法]应用建立的Lenke1BN型AIS有限元模型,模拟后路全椎弓根螺钉固定三维矫形手术.具体约束加载如下:约束骶骨整体水平固定,参照文献在T1～L5各椎节分别施加模拟自身重力和肌肉因素的向下载荷,在固定节段凹侧模拟植入"椎弓根螺钉",并放入"预弯"矫形钛棒,在棒末端施加向凹侧的旋转力矩,使棒向凹侧旋转90°,模拟旋棒矫形;旋棒同时在顶椎区(T7～10)固定螺钉施加10 Nm的扭矩,模拟椎体直接去旋转矫形.上固定椎选择T4(上端椎+2),下固定椎分别选择T12(中立椎)、L1(稳定椎)和L2(稳定椎+1),比较三种固定方案的矫形效果.[结果]顺利完成加载模拟矫形,选择T12(中立椎)、L1(稳定椎)和L2(稳定椎+1)作为下固定椎模拟矫形后,上胸弯、主胸弯和腰分别矫正为:7.1°、7.4°、9.2°,6.4°、6.8°、8.3°和6.5°、7.2°、8.6°;矢状面胸椎后凸(T5～12)分别为21.3°、20.7°和20.5°;三种矫形方案,矫形效果无显著差异.[结论]首次通过有限元模拟研究表明:对于中度Lenke1BN型AIS,选择性融合主胸弯可获得满意的腰弯自发矫正;应用全椎弓根螺钉固定结合顶椎区椎体去旋转技术,可将下固定椎从稳定椎上移至中立椎,减少远端融合节段.     

三维矫形手术治疗青少年特发性脊柱侧凸

目的：回顾分析三维矫形内固定手术治疗青少年特发性脊柱侧凸（AIS）的临床效果。探讨手术相关融合区的选择问题。方法：2001年-2006年在我院行三维矫形内固定手术的AIS患者78例。男27例，女51例，年龄10～18岁，平均15．6岁，其中LenkeI型38例，Lenke Ⅱ型6例，LenkeⅢ型11例．LenkeⅣ型1例，LenkeV型14例，LenkeVI型8例。术前冠状面Cobb角平均560，顶椎偏距平均5．9cm。躯干偏移距离平均2．8cm。根据患者畸形类型和柔韧性选择融合范围。术后及随访时在X线片上测量主弯冠状面的Cobb角、顶椎偏距、躯干偏移距离。结果：术后随访1～5年，平均28个月，冠状面Cobb角平均残留230，矫正率为59％；终末随访平均丢失4．5^o，丢失率为8％；顶椎偏距平均残留2．7cm，矫正率为55％，终末随访时平均丢失0．5cm。丢失率为8．5％；终末随访时躯干偏移距离平均1．4cm。结论：三维矫形内固定手术能有效改善AIS畸形。根据畸形特点选择正确的融合区进行适度的矫正是手术成功的关键。     

Multiparameter pilot study of adolescent idiopathic scoliosis

Seventy-two adolescent females with idiopathic scoliosis were studied to determine the possible relationships between parameters previously studied by others, as well as several new parameters. Dichotic listening tests showed that patients with less right-ear advantage for language were more likely to have progressive curves than patients with greater right-ear advantage, implying a difference in hemispheral dominance between the two groups. This finding, if confirmed with larger populations, could lead to a prognostic test for the determination of therapeutic modality. Platelet aggregation was found to be lower than in a group of controls; however, similar findings were also obtained from a group of patients with chronic orthopaedic conditions. Mitral valve prolapse, the electroencephalogram and the mother's age at patient's birth were all found to be nonspecific for the patients as compared to control groups. The level of autonomic system activity in the patients was found to be higher than that observed in controls.     

Selection of methodology in surgical treatment of adolescent idiopathic scoliosis

Before contemplating any surgical procedure, one has to define the goals of the operative procedure. The patient should be evaluated thoroughly by physical examination and by adequate radiographs, including bending films. The surgeon should be familiar with different types of techniques and their qualities. The goals of surgery should be outlined clearly and understood between the physician and the patient. The patient should be provided with sufficient and easy-to-understand information (Table 1), and be encouraged to have an input in the decision-making process. For instance, is the goal of surgery to stop progression? To achieve cosmetic correction? To preserve maximal spinal mobility or to help improve pulmonary function? Is it important for the patient to be cast free postoperatively? Once the goal is defined, and we are aware of the abilities of each technique, then we can arrive at a realistic expectation. Again, it is of utmost importance that the surgeon select the procedure that he or she has adequate experience in performing.     

King Ⅱ型特发性脊柱侧凸的手术治疗

目的：探讨King Ⅱ型特发性脊柱侧凸患者三维矫形融合节段的选择。方法：1997年7月～2002年6月手术矫形治疗King Ⅱ型特发性脊柱侧凸患者79例，平均年龄14．3岁，其中King Ⅱ A型28例，均行选择性胸椎融合，平均融合椎体8．5个；King ⅡB型51例，均固定融合胸椎与腰椎，平均融合椎体11．8个。结果：术后平均随访35个月(12～57个月)，King ⅡA型胸弯矫正率为56％，King ⅡB型的胸弯矫正率为67％，腰弯矫正率为60％。共有5例躯干失平衡并发症，其余患者均获得较好的躯干平衡和矫形效果。结论：KingII型特发性脊柱侧凸进行选择性胸椎融合是可行的，但应慎重。     

King Ⅱ型特发性脊柱侧凸的手术治疗

目的:探讨KingⅡ型特发性脊柱侧凸的手术治疗效果。方法:将37例KingⅡ型脊柱侧凸分为两组,A组12例为KingⅡA型,行选择性胸椎融合;B组25例为KingⅡB型,行胸腰弯融合。手术均采用中华长城系统经后路矫形固定。结果:随访24～50个月,A组胸弯平均矫正率79.1%,腰弯矫正率71.4%,有2例发生躯干失平衡;B组胸弯平均矫正率70.8%,腰弯矫正率73.5%,1例发生躯干失平衡。结论:KingⅡA型行选择性胸弯融合,KingⅡB型融合胸腰弯,可获得良好的临床效果。     

经椎弓根固定三维矫形治疗青少年特发性脊柱侧凸

目的探讨经后路应用中华长城椎弓根螺钉三维旋转矫正系统治疗青少年特发性脊柱侧凸的可行性并观察其临床疗效。方法1999年1月~2004年1月应用中华长城椎弓根螺钉三维旋转矫正系统治疗青少年特发性脊柱侧凸患者12例,其中男4例,女8例;年龄11~15岁,平均13岁,通过比较术前术后的Cobb角、顶椎移位、顶椎旋转及身高的变化进行疗效的评价。结果术后所有病例经6~36个月,平均24个月随访。术前冠状面Cobb角平均66°,术后平均22°,平均矫正率为67.8%;顶椎移位术前平均4.16 cm,术后平均1.28 cm,平均矫正54.8%;旋转畸形(Nash~Moe法)术前为Ⅰ~Ⅲ度,平均矫正Ⅰ度。身高平均增加8 cm。所有病例术中、术后均无脊髓神经根损伤,浅表感染1例经清洁换药后痊愈。术后1年均获得满意的脊柱融合,并保留一定的脊柱活动度,术后并发症少。结论中华长城椎弓根螺钉系统具有三维矫正能力,效果可靠、操作简便、并发症少;固定节段椎弓根平面术前CT扫描有助于选择好进针点、方向及深度,便于椎弓根螺钉安全准确植入;精心准备植骨床、充足的植骨材料、熟练的三维矫正技术是取得良好疗效的保证。     

Electroencephalographic study of schoolchildren with adolescent idiopathic scoliosis

This study investigated the possible pathologic electroencephalographic (EEG) findings in scoliotic schoolchildren and their correlation to the degree and location of scoliosis. Sixty-seven scoliotic, healthy schoolchildren were investigated and 42 nonscoliotic, healthy schoolchildren served as controls. In the group of scoliotics the percentage of pathologic EEGs was higher than that of the control group (33% to 14%) P less than 0.05, being much higher in the EEGs taken after activation (57% to 22%) P less than 0.001. In the small curves, the percentage of pathologic EEGs was found to be higher only after activation in comparison with the percentage found in bigger curves, but without statistical significance. In lumbar, thoracolumbar, and double curves, focal EEG changes predominated. In contrast, in thoracic curves there was a higher incidence of bilaterally synchronous discharges.     

Management of adolescent idiopathic scoliosis

This article outlines several critical areas in the contemporary evaluation and treatment of the adolescent patient who has idiopathic scoliosis. Highlights of the physical examination combined with key radiographic measurements provide a framework for the algorithm of operative versus nonoperative treatment. The basics of the Lenke classification system are presented in a step-by-step outline, and the surgical treatment options based on this classification are summarized. This article provides a core knowledge base to facilitate a more thorough comprehension of adolescent scoliosis and allow readers to understand emerging publications more readily.     

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.     

青少年特发性脊柱侧凸外科治疗并发症回顾分析

自20世纪80年代Cotrel—Dubousset报道脊柱侧凸三维矫形以来,矫治效果比以往的Harrington、Luque时代有了显著提高。国内自1997年开展此类手术,病例数量不断积累,但关于青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）手术治疗的并发症报道相对较少。本文针对2个脊柱外科中心2000年2月～2005年12月间共收治的589例AIS患者的并发症发生情况进行回顾性研究,     

青少年特发性脊柱侧凸融合术后远端附加现象的研究进展

<正>随着矫形技术的发展以及临床医生对特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)研究的逐渐深入,AIS通过手术矫形的效果得到了显著提高。但脊柱外科医师~([1、2])在对AIS患者术后随访时发现,部分患者在术后融合节段下方出现了弯曲加重的表现,这就是脊柱侧凸矫形术后远端附加现象。远端附加现象是AIS患者行选择性胸弯融合术治疗后常见的一种冠状面失平衡现象,多见于行选择性胸弯融     

性别对青少年特发性脊柱侧凸患者手术疗效的影响

目的:比较男女性青少年特发性脊柱侧凸(AIS)患者后路内固定融合术后及1～3年随访的矫形效果,探讨性别对AIS手术疗效的影响。方法:1999年～2004年在我院手术治疗的LenkeⅠ型AIS患者56例,女性35例,平均年龄15.4岁,平均Cobb角58.0°,术后平均随访22个月;男性21例,平均年龄16.0岁,平均Cobb角63.2°,术后平均随访20个月。所有患者均在全麻下行后路矫形内固定融合术,分别记录手术时间、失血量、输血量、固定节段数及并发症,分别测量术前、术后早期及末次随访时主弯Cobb角,比较两组患者的差异。结果:男女性患者平均手术时间分别为266min和258min,术中平均失血量分别为1689ml和1343ml,输血量分别为1148ml和919ml,固定节段数分别为10.9个和10.7个,并发症发生率分别为8.6%和19.0%,两组间无明显差异;术后平均Cobb角分别为26.4°和27.5°,平均矫正率分别为54%和56%,末次随访时平均Cobb角为27.3°和29.5°,平均矫正率分别为46%和45%,矫正丢失分别为4.3°和6.2°,两组比较无统计学差异。结论:男女性AIS患者在术后及1～3年随访的矫形效果、手术相关参数及并发症发生率均无明显差异,性别对AIS患者手术疗效无明显影响。