支具治疗青少年特发性脊柱侧凸

目的介绍青少年特发性脊柱侧凸支具治疗,并评价其临床疗效。方法22例骨骼发育未成熟的青少年特发性脊柱侧凸进行Milwaukee支具或Boston支具矫正,其中男6例,女16例;年龄10～15岁,平均13．2岁。胸腰双主弯7例,单胸弯9例,单胸腰弯或腰弯6例。Risser征0度10例,Ⅰ度5例,Ⅱ度4例,Ⅲ度3例。原发弯Cobb角20°～52°,平均32．9°,20°～35°者10例,大于35。者12例。每3—6个月定期复查,摄片,测量初次就诊及末次随诊时Cobb角、顶椎旋转度及Risser征。结果全部病例随诊3～5年,32．3％的病例出现脊柱侧凸进展,不同类型脊柱侧凸中胸腰双主弯进展率最低,Risser征越小,初步支具矫正率越大,测凸进展越高。结论不同类型脊柱侧凸中胸腰双主弯的支具治疗失败率最低,原发弯Cobb角越大,测凸进展的可能性越大。     

颗粒植骨后路固定治疗胸腰段脊柱结核

目的 探讨颗粒植骨、后路固定治疗胸段、腰段脊柱结核的方法,并分析其疗效.方法 在抗结核药物治疗的前提下,运用侧前方或前方病灶清除及颗粒状自体骨植骨、后路固定的手术方法治疗56例胸腰椎结核患者,全部病例均采用后正中切口,侧前方病灶清除,颗粒状植骨,合并腰大肌脓肿者则先采用前路腰大肌脓肿清除,术中矫正后凸畸形,术后卧床及支具保护一年.结果 56例患者手术时间95 ～ 235(126.3 ± 66.7)min,出血量400 ～ 1450(616.4 ±370.8)ml,术后2～3个月均发生植骨区骨性融合,术后脊柱后凸成角(14.50±4.87)°.结论 颗粒植骨、后路固定是治疗胸段、腰段脊柱结核的有效方法.     

核心肌力训练法治疗青少年特发性脊柱侧弯的疗效

目的：观察核心肌力训练法治疗青少年特发性脊柱侧弯的疗效。方法：选取2012年6月-2012年12月笔者在北京博爱医院进修期间收治的30例青少年特发性脊柱侧弯患者,按随机数字表法分为治疗组和对照组各15例,治疗组采用核心肌力训练法治疗,对照组采用传统胸腰骶支具治疗。观察治疗前后2组患者站立位X线片主弯段Cobb’s角度的变化。结果：两组治疗前Cobb’s角度比较差异无统计学意义（P〈0.01）,治疗后两组之间Cobb’s角度比较差异有统计学意义（P〈0.01）。结论：核心肌力训练法治疗青少年特发性脊柱侧弯优于传统胸腰骶支具疗法。     

儿童青少年脊柱侧凸筛查与保守治疗的研究进展

近年来中国儿童青少年脊柱侧凸总体发病率呈上升趋势,已成为影响中国儿童青少年身体健康的第三大“杀手”。脊柱畸形所引起的功能障碍,在儿童青少年时期并无明显的病理表现或临床症状(严重脊柱侧凸者除外),早期容易被忽略,但如果不及时加以干预,将对患者的长期预后和生活质量造成严重损害。因此,通过早期开展脊柱侧凸筛查工作,可有效监测中国儿童青少年脊柱健康状况,确保疾病的及时确诊、及时干预(支具等保守治疗方式),起到早期预防的作用,避免侧凸的进一步恶化与手术介入。研究将围绕脊柱侧凸的筛查和保守治疗的相关研究进展进行阐述。     

脊柱内固定器AF后路复位固定治疗无神经功能障碍的脊柱胸腰段骨折

目的观察采用脊柱内固定器AF钉棒系统后路复位固定及植骨融合治疗无神经功能障碍的脊柱胸腰段骨折的临床疗效。方法11例不稳定及畸形较重而无神经功能障碍的脊柱胸腰段骨折患者接受后路脊柱内固定器AF钉棒系统复位固定及植骨融合术治疗。术后15d佩带胸腰支具下床行走。通过影像学检查脊柱畸形角(cobb’s角)的纠正、内固定的位置及骨愈合情况。结果10例随访6~18个月,平均10.0个月。手术7d后均逐渐恢复穿衣、起卧床、步行、大小便及洗漱等生活自理能力,术后1个月逐渐恢复非弯腰的轻体力工作。所有病例骨折复位良好,后凸及侧凸畸形均获得满意的矫正,缩小的椎管管径完全得到恢复。随访均无畸形矫正丢失和伤椎及椎间高度下降,且未出现钉棒松动及断裂。结论脊柱内固定器AF钉棒系统后路复位胸腰椎骨折的性能良好,并具有牢稳的固定强度,对无神经功能障碍舶脊柱胸腰段骨折复位固定融合治疗具有良好的临床疗效。     

青少年特发性脊柱侧凸病因学的研究进展

青少年特发性脊柱侧凸(AIS)给青少年患者的身心健康带来困扰,关于AIS的病因研究也经历了曲折的发展.这是一种多因素、多系统的疾病演变过程.轻度侧凸患者可以选择支具保守治疗并定期随访观察,一旦侧凸进展则往往需要通过手术进行矫正治疗,随着外科椎弓根螺钉技术的发展,外科矫形取得了不错的效果,但是长期随访脊柱侧弯的其他病理改...     

江阴市青少年人群脊柱侧凸的流行病学调查

目的了解江苏省江阴市青少年人群脊柱侧凸流行情况,为临床治疗和预防提供依据。方法 2015年9-12月,采用脊柱侧凸的三检筛查法,对江阴市76所学校的67 322名中小学生进行脊柱侧凸调查。结果检出脊柱侧凸患者200例,患病率为0.98%;其中女生(1.25%)高于男生(0.74%),初中生(1.37%)高于小学生(0.63%),差异均有统计学意义(P值均<0.05);城市和农村学生患病率分别为1.06%、0.97%,差异无统计学意义(P>0.05)。200例患者中,特发性脊柱侧凸195例,先天性侧凸4例神经肌肉源性1例;轻度侧凸172例,中度侧凸23例,重度侧凸5例,均为初中生,其中男生1例,女生4例。结论江阴市青少年脊柱侧凸患病率为0.98%,初中女生是重点监控人群。     

3例青少年严重脊柱侧弯矫形术后并发乳糜胸的护理

乳糜胸(chylothorax)是脊柱外科的少见并发症,若忽视可致严重后果。笔者回顾了3例青少年严重脊柱侧弯矫形术后并发乳糜胸的护理方法。通过术后采取半卧位及保护脊柱凸侧切口处皮肤等护理措施可明显提高乳糜胸的治疗效果。     

广东省肇庆市城区幼儿脊柱侧凸普查及防治

目的:了解脊柱侧凸症在广东省肇庆市城区的患病率,做到及时发现、有效防治。方法:2003年1月～2004年12月对广东省肇庆市城区15所幼儿园8210例4～7岁幼儿进行了脊柱侧凸的普查,采用一检体检、二检云纹照像、三检X线摄片三检筛查普查方法。结果:体检阳性者321例,云纹照像阳性者116例,X线摄片发现10°以上脊柱侧凸患者72例,患病率为0.87%(72/8210),72例进行早期体操疗法、悬吊牵引治疗或支具治疗等。结论:在幼儿时期开展脊柱侧凸的群体普查是早期发现、及时防治脊柱侧凸的一种有效方法。     

广州市中小学生特发性脊柱侧弯患病率的调查

目的研究广东省广州市中小学生特发性脊柱侧凸患病率情况,以指导临床治疗和预防。方法 2012年3月至2014年6月对广州市29 532名中小学生进行特发性脊柱侧凸普查。结果检出特发性脊柱侧凸240例(患病率0.81%),其中男104例、女136例,男性患病率显著低于女性(P<0.01)。240例特发性脊柱侧凸中,小学、初中、高中组分别为60例、155例、25例,初中组和高中组的患病率明显高于小学组(P均<0.01),但初中组与高中组的患病率无显著性差异(P>0.05)。结论广州市青少年特发性脊柱侧凸患病率为0.81%,女性患病率显著高于男性,进入初中后尤为明显,应重点进行监测。     

Results of Milwaukee and Boston braces with or without metal marker around pads in patients with idiopathic scoliosis

Bracing is the non-operative treatment of choice for adolescent idiopathic scoliosis (AIS) and careful application of pads on apical segment of curve is very important for correction. Control of pads` appropriate site in brace is not easy by clinical evaluation. Therefore, we decided to compare results of braces which for better control of pads by radiographs, metal marker inserted around pads with those without metal marker. We evaluated 215 consecutive cases (182 female, 33 male) of AIS with 342 major curves from 1993 to 2003. Mean initial age was, 13.2 ± 1.8 years (9-16) and mean duration of follow-up was, 16.1 ± 16.4 months (0-114) that treated by 4 type of brace; 89 with type 1(Milwaukee with metal pads), 87 with type 2 (Milwaukee with simple pads), 17 with type 3 (Boston with metal pads) and 22 with type 4(Boston with simple pads). Cobb angle recorded at 5 stages (initial, best, wean, stop and final follow-up). Mean initial Cobb was 36.2°, at stop stage, 35.2° and reached 38° at final follow-up. Overall, 21.3% improved, 42.2% were the same and 36.5% failed. Failure for braces type 1 to 4 were, 40.5%, 34%, 38% and 24% at final follow-up. A total of 59 patients (27.4%) underwent spinal fusion that for brace type 1 to 4 , was, 33, 21, 2 and 3 patients respectively. From 16 cases with initial Cobb of 50°, at follow-up, 12 were ≥50° or had spinal fusion. Correction of lumbar (P=0.008) and main thoracic curves (P=0.002) was better by Boston than Milwaukee, however, In general difference between 4 types of braces was not significant and metal marker had no significant effect on results. Two important predictors of brace failure were, initial curve magnitude and brace type, but using metal marker around pads had no effect in results. It seems that bracing did not alter the natural history of scoliosis in early Risser stages with large magnitude of initial curves. Insertion of metal marker around pads is easy and cheap way that facilitate control of pad sites well, so, we recommend to use.     

Scoliosis

The most common form of scoliosis (lateral curvature of the spine) is adolescent idiopathic scoliosis (AIS). The prevalence of AIS is 10-20 individuals per 1,000 population screened. Progressive AIS affects females more frequently than males. Only 1-2 per 1 ,000 individuals have progressive AIS and need brace or surgical treatment. Early screening programs for scoliosis and other spinal deformities are instituted in schools in the fifth to ninth grades to achieve early detection of progressive AIS. If detected early, progressive AIS can in most cases be successfully treated by use of an external spinal brace. More severe scoliosis is successfully treated with surgical instrumentation and spinal fusion. Although much progress has been made in understanding the natural history of AIS, its cause remains unknown.     

Adolescent idiopathic scoliosis: epidemiology and treatment outcome in a large cohort of children six years after screening

A prospective study was carried out in a cohort of 6873 children to determine diagnosis and treatment rates for adolescent idiopathic scoliosis (AIS) and to establish the distribution of parameters related to bracing. The follow-up completion rate was 85%, and prevalence rates were adjusted accordingly. The prevalence of AIS of 6 degrees or more at time of diagnosis was 8.1%. The female to male ratio for curves of 6 degrees or more was 1.07:1 with an increase to 6:1 for curves greater than 21 degrees. The rate of brace treatment was 2.8 per 1000. Deterioration, defined as progression of a scoliosis curve to the point where a brace was prescribed, was found in 3.7% of the scoliosis group. Fifteen children were prescribed braces: eight did not follow the treatment plan adequately (non-compliers), and five among these abandoned the follow-up programme. However, none of the non-compliers deteriorated to the point where spinal fusion was required.     

广州市青少年脊柱侧凸患病率调查

目的 了解广州市青少年脊柱侧凸的患病率.方法 2007年11月至2009年7月对广州市30 142名在校学生进行脊柱侧凸普查.首先由普查体检医生在学校对学生进行初步体格检查,阳性或可疑阳性者再由骨科医生复查;对骨科医生检查阳性或可疑阳性者行X线摄片检查.结果 共检出脊柱侧凸患者211例(Cobb角≥10°),患病率为0.70%.其中特发性脊柱侧凸192例(91.00%),先天性脊柱侧凸19例(9.00%).女生180例,男生31例,女生患病率显著高于男生(x2=112.332,P＜0.001).结论 广州市中小学生脊柱侧凸的患病率为0.70%,女生患病率明显高于男性.对青少年进行脊柱侧凸普查可以早期发现、及时矫治,对防治脊柱侧凸具有积极意义.

Abstract：

Objective To investigate the prevalence of adolescent scoliosis in Guangzhou for development of effective prevention and treatment program to the disease. Methods From November2007 to July 2009, 30 142 students between 7 to 20 years old in primary and junior middle schools received physical check-up for detection of scoliosis through physical and radiographic examination.Results 211 cases were diagnosed as scoliosis (Cobb angle≥10°) , with the prevalence rate as 0.70%. 192 patients with idiopathic scoliosis (IS) were detected, accounting for 91.00%. There were 19 cases of congenital scoliosis, accounting for 9.00%. Sex ratio of scoliosis was 180/31. The prevalence of scoliosis was significantly lower in boys than that in girls (x2= 112.332, P＜0.001 ).Conclusion The crude prevalence of adolescent scoliosis was 0.70% in Guangzhou with majority of idiopathic scoliosis. Investigation on scoliosis among school-age population seemed to be important for the purposes of early diagnosis, selection of effective prevention and treatment.     

The effect of school screening on surgery for adolescent idiopathic scoliosis

The objective of the study was to examine the effect of screeningprogrammes for adolescent idiopathic scoliosis on populationrates for adolescent idiopathic scoliosis surgery. A case-controlstudy with data from The National Hospital Discharge Register,youth health care (YHC) departments in The Netherlands and arelevant census was used. The cases were 182 subjects aged 12–19years, admitted to hospital in The Netherlands for surgicaltreatment of adolescent idiopathic scoliosis between 1990 and1993. The total population of 12 or 13 year olds in the consecutiveyears of 1987–1992 in the regions of the participatingYHC departments served as controls. Of the 182 patients thathad surgery for adolescent idiopathic scoliosis in The Netherlandsin the years 1990–1993, 37.9% had at one time had a screeningfor spinal deformities at the age of 12 or 13 years as comparedto 37.9% of the control subjects. The odds ratio for cases thathad surgery was 1.00 (95% confidence interval: 0.74–1.35).This study does not support the view that screening for adolescentidiopathic scoliosis reduces the population rates for scoliosissurgery. As the primary aim of screening for adolescent idiopathicscoliosis is to prevent surgical intervention, this practiceshould be reconsidered.     

Perception of stress level, trunk appearance, body function and mental health in females with adolescent idiopathic scoliosis treated conservatively: a longitudinal analysis

Purpose

In the presented study, we aimed to assess changes over time in the perception of trunk deformity, body function, stress level and mental health in females with adolescent idiopathic scoliosis (AIS) who were treated conservatively with a Cheneau brace, taking the Trunk Appearance Perception Scale (TAPS), Scoliosis Research Society-22 (SRS-22) and Bad Sobberheim Stress Questionnaires (BSSQ) criteria of evaluation into consideration.

Methods

The study design was comprised of three questionnaire assessments, with the second and the third evaluation taking place 6 and 12 months after the beginning of the study, respectively. Thirty-six females treated conservatively were asked to fill in the TAPS, SRS-22 and BSSQ forms.

Results

In regards to TAPS, the results differed between the 1st and the 2nd assessment in Figure 2 only (p = 0.013). The difference between the 1st and the 3rd evaluation concerned Figure 3 and the total score (p = 0.011 and p = 0.005, respectively). The SRS-22 and BSSQ results of study participants did not differ significantly between the 1st and the 2nd, between the 2nd and the 3rd and between the 1st and the 3rd evaluations.

Conclusions

The study indicated that the assessment of girls with AIS concerning body function and mental health did not deteriorate in the course of orthosis treatment. Furthermore, they showed improvement in perceptions particularly in regards to trunk shape. We pointed out that the negative perceptions of mental health, self-image and low level of activity held by females with AIS coexisted with severe emotional distress. Moreover, factors that improved functioning or subjective physical appearance ratings in particular, such as level of activity, were indicated.     

膳食钙不足对香港青少年先天性脊柱侧凸全身骨质密度偏低的影响(英文)

青少年先天性脊柱侧凸 (AIS)是一种主要影响女孩的脊柱严重三维畸形病。在香港有 3 %～ 4%的发病率 ,AIS的病人同时发现患有全身性的骨密度偏低现象。本文试图研究是否低骨矿物质密度 (BMD)与AIS病人钙摄入量有关。以 11～ 16岁 582名AIS患者和 2 0 6名健康对照人群为研究对象。面积骨矿物质密度 (aBMD)和体积骨矿物质密度 (vBMD)分别用DXA(Norland XR 3 6)和PQCT(Densiscan 10 0 0 )检测。钙和其它营养素摄入量用食物频率法评价。受试者钙绝对摄入量低 (<50 0mg d)。患AIS少女平均钙摄入量显著高于对照组少女 [(441± 3 4 4 )mg dvs.(3 90± 2 81)mg d ,P =0 0 15] ,11～ 16岁AIS患者大多数骨骼测定点BMD显著低于同龄对照组 (P≤ 0 0 5)。AIS患者与对照组BMD的差异程度随着年龄的增长而增加。 15～ 16岁年龄组AIS患者中钙摄入量与在大多数骨骼测定点测得的BMD有显著相关性 ,而在对照组中没有发现这种相关性。经多因素分析 ,在控制干扰变量的情况下 ,预测BMD的变化 ,钙摄入量是一个非依从性决定因素。结果提示 ,AIS患者绝对钙摄入量低 ,在各年龄组青少年中各个骨骼测定点测得的BMD ,AIS患者组均低于对照组。只有在AIS患者中钙摄入量与BMD有相关性 ,而健康的对照中没有相关性。这表明钙摄入量对AIS患者     

Idiopathic scoliosis in adolescents; an inventory into the possibilities of studying the efficacy of screening and treatment

OBJECTIVE: To collect information for the purpose of establishing starting points and possibilities for a cost-effectiveness analysis of screening for adolescent idiopathic scoliosis (AIS). DESIGN: Interviews, literature review, questionnaires, an estimation of costs and discussions with experts and involved parties. METHOD: Following an initial interview with 16 orthopaedic surgeons and school doctors a literature study into the efficacy of treatment was carried out regarding the years 1989-1999. The variation in current practice was delineated by means of a questionnaire sent to all 51 municipal health services in the Netherlands. The costs of screening and treatment were estimated on the basis of health insurance premiums and a municipal health service cost model. All of the results were presented to five methodological experts and finally the study results and the recommendations of the five methodological experts were evaluated during a meeting of persons especially invited for this purpose. RESULTS: Screening for AIS was established to realise early diagnosis and treatment with a brace, so as to reduce unsatisfactory cosmetic outcomes and the need for surgery. Screening was performed using the bending test and was performed in 40/48 (83%) of the participating municipal health services. The overall costs of screening and treatment amount to 6 million euros per year. There was no convincing evidence that the screening programme was sufficiently sensitive and bracing sufficiently effective. Neither was there proof of the opposite. The following was recommended: obtain reliable data by carrying out a randomised controlled trial on the effectiveness of treating AIS with bracing in an early stage; carry out a case-control study combined with a retrospective patient follow-up study to evaluate the current screening practice; draw up a national standard for the screening of postural disorders in youth healthcare to ensure effective practice.