Corrective force analysis for scoliosis from implant rod deformation

Background

Scoliosis is a serious disease in which a human spine is abnormally deformed in three dimensions with vertebral rotation. Surgical treatment is attained when the scoliotic spine is corrected into its normal shape by implant rods and screws fixed into the vertebrae. The three-dimensional corrective forces acting at the screws deformed the implant rod during the surgical treatment of scoliosis. The objective of this study was to propose a method to analyze the three-dimensional forces acting at the rod using the changes of implant rod geometry before and after the surgical treatment.

Methods

An inverse method based on Finite Element Analysis is proposed. The geometries of implant rod before and after the surgical treatment were measured three dimensionally. The implant rod before the surgical treatment was reconstructed using an elasto-plastic finite element model. The three-dimensional forces were applied iteratively to the rod through the screws such that the rod is deformed the same after the surgical treatment of scoliosis.

Findings

The maximum force acting at the screw of each patient ranged from 198 N to 439 N. The magnitude of forces was clinically acceptable. The maximum forces occurred at the lowest fixation level of vertebra of each patient.

Interpretation

The three-dimensional forces distribution that deformed the rod can be evaluated using the changes of implant geometry. Although the current clinical cases are still few, this study demonstrated the feasibility of measuring the forces that deformed the implant rod after the surgical treatment of scoliosis.     

The influence of thoracolumbosacral orthoses on standing balance in patients with adolescent idiopathic scoliosis: a pilot study

Background and aim: The objective of this study was to assess the effect of thoracolumbosacral orthoses (TLSOs) on antero-posterior (AP) sway, medio-lateral (ML) sway and displacement of the center of pressure (COP) during a longitudinal study in patients with adolescent idiopathic scoliosis (AIS). Methods: Eight females aged between 12 and 14.5 years participated in this study. Evaluations were performed prior to the TLSO intervention as a baseline condition, after 1 month, and after 4 months of orthosis use by assessing balance when standing statically on different surfaces. Results: When standing on both lower limbs on a solid surface there were significant differences in ML sway with the eyes both open and closed, and also in A/P sway but only when standing on a solid surface with the eyes open and also when standing on a foam surface with the eyes closed with TLSO use. When standing on the dominant leg, ML sway significantly improved, but AP sway only improved with a foam base surface with the eyes open. Conclusion: This study demonstrated positive effects of wearing a TLSO in improving quiet standing balance and standing on the dominant lower extremity in subjects with AIS after 4 months of brace use.

• Implications for Rehabilitation

• Due to a change in body shape such as that caused by scoliosis, human posture changes and spinal deformities affect the position of the center of support, and thus balance ability may change.

• AIS subjects have poor standing stability compared to a healthy matched control group.

• Brace wearing had positive effect in improving quiet standing balance and standing on the dominant lower extremity in subjects with AIS undergoing brace treatment after 4 months of TLSO use.

     

肺功能正常的46例青少年特发性脊柱侧凸患者心肺运动试验结果分析

目的 分析肺功能正常的青少年特发性脊柱侧凸（AIS）患者心肺运动试验（CPET）结果,并探讨运动耐力的相关影响因素。 方法 回顾性分析2016年6月至2017年3月本院收治的临床资料完整、肺功能正常的AIS患者术前CPET结果,分析侧凸部位、侧凸程度对CPET结果的影响,并探讨肺功能、体重指数（BMI）、年龄与运动耐力的相关性。 结果 共纳入病例46例,其中单胸弯组17例,单胸腰弯组11例,胸弯+胸腰弯组18例。①46例患者中10例（21.74%）患者运动耐力正常,轻、中、重度运动耐力减退者分别有24例（52.17%）、11例（23.92%）、1例（2.17%）。②单胸弯组峰值每分钟通气量（peak VE）为［（43.11±8.47）L/min］,显著低于单胸腰弯组的［（50.81±10.11）L/min］,差异有统计学意义（P<0.05）。胸弯+胸腰弯组无氧阈值公斤摄氧量（VO2AT/kg）显著低于单胸弯组和单胸腰弯组,差异均有统计学意义（P<0.05）。③单胸弯患者中,中度侧凸7例（中度胸弯组）、重度侧凸10例（重度胸弯组）,2组CPET相关指标组间比较,差异均无统计学意义（P>0.05）。④peakVO2%pred与肺功能各指标、年龄均无相关性（P均>0.05）,与BMI呈负相关（r=-0.326,P=0.027）。 结论 肺功能正常的AIS患者普遍存在运动耐力下降;胸弯同胸腰弯患者相较,peak VE下降;胸弯+胸腰弯者同单胸弯、单胸腰弯者相较,VO2AT/kg下降;运动耐力同侧凸程度、肺功能、年龄无关,而与BMI相关。     

Inter- and intratester reliability values of ultrasound imaging measurements of diaphragm movement in the thoracic and thoracolumbar curves in adolescent idiopathic scoliosis

Purpose: The purpose of this study was to determine intertester and intratester reliability of ultrasound measurements of bilateral diaphragm excursions in the thoracic and thoracolumbar spinal curves of 31 females with adolescent idiopathic scoliosis (AIS) (mean age = 14.1 ± 1.8 years). Method: Subjects were tested during tidal breathing using real-time ultrasound imaging with a 3.5 MHz curvilinear transducer. Results: There were no significant differences in intratester and intertester reliability values in bilateral diaphragmatic excursions measured at the thoracolumbar spinal curve, whereas significant differences were observed in measurements taken at the thoracic spinal curve (p < 0.05). Overall, the intertester and intratester reliabilities of the thoracic and thoracolumbar curves in AIS ranged from 0.764 to 0.998. Conclusions: These findings suggest that ultrasound imaging is highly reliable between and within testers and is useful to precisely discriminate pathological diaphragm movement in idiopathic thoracic scoliosis and idiopathic thoracolumbar scoliosis.     

Altered physiology of mesenchymal stem cells in the pathogenesis of adolescent idiopathic scoliosis

Adolescent idiopathic scoliosis is the most common spinal deformity during puberty, especially in females. It is characterized by aberrant skeletal growth and generalized reduced bone density, which is associated with impaired bone mineral metabolism. Despite recent progress in multidisciplinary research to support various hypotheses, the pathogenesis of Adolescent idiopathic scoliosis is still not clearly understood. One of the hypothesis is to study the role of mesenchymal stem cells due to its involvement in the above-mentioned bone metabolic abnormalities. In this review, we will summarize reported literatures on the role of mesenchymal stem cells, particularly in the pathogenesis of Adolescent idiopathic scoliosis. In addition, we will describe the research on mesenchymal stem cells of Adolescent idiopathic scoliosis performed using bioinformatics tools.     

核心肌力训练对轻中度青少年特发性脊柱侧弯患儿肌群肌力改善及Cobb角的影响

目的 探讨核心肌力训练对轻中度青少年特发性脊柱侧弯(AIS)患儿肌群肌力改善及Cobb角的影响.方法 选取2018年1月—2019年12月于医院接受治疗的青少年特发性脊柱侧弯(AIS)患儿98例,按照组间基本特征匹配的原则分为对照组与观察组,各49例.对照组采用常规支具治疗与护理,观察组在此基础上采用核心肌力训练干预,...     

色奴矫形器结合运动疗法治疗青少年特发性脊柱侧突疗效分析

目的观察分析色奴矫形器结合运动疗法治疗青少年特发性脊柱侧突的疗效。方法为特发性脊柱侧突患者制作和配戴色奴矫形器,并指导患者做矫正体操。结果配戴色奴矫形器2年后,患者的脊柱侧突Cobb角平均改善16.6°,与治疗前相比,差异有统计学意义(P<0.01)。结论坚持配戴色奴矫形器和进行运动疗法是矫治特发性脊柱侧突的较好方法。     

特定运动疗法对特发性脊柱侧弯的效果

目的 观察特定运动疗法对特发性脊柱侧弯畸形和关节松弛的疗效。方法 2021年4月至10月在新华医院脊柱侧弯康复中心就诊的特发性脊柱侧弯患儿100例,根据患儿意愿分为对照组和试验组各50例,分别接受常规运动疗法和特定运动疗法,共6个月。治疗前后,测量侧弯最大Cobb角和骨密度,采用Beighton量表和中文版脊柱侧凸研究学会22项问卷(SRS-22)进行评定。结果 治疗后,试验组最大Cobb角变化量大于对照组(Z=-2.202, P <0.05),改善率高于对照组(χ2=-2.405, P <0.05);试验组骨密度显著下降(|Z|> 2.127, P <0.05);两组SRS-22总分均提高(F时间=106.57, P <0.001),试验组高于对照组(F=4.969, P <0.05);试验组功能活动和自我形象分提高(|Z|> 2.149, P <0.05),对照组心理健康分降低(Z=-2.096, P <0.05);试验组心理健康分高于对照组(Z=-2.260, P <0.05)。结论 特定运动疗法有利于改善患儿脊柱畸形和...     

选择性节段椎弓根螺钉固定治疗青少年特发性脊柱侧凸的疗效及并发症

目的分析后路选择性节段椎弓根螺钉固定治疗特发性脊柱侧凸的的临床疗效及并发症。方法自2011年3月~2014年10月共行后路三维矫形术治疗52例青少年特发性脊柱侧凸患者,男20例,女32例;年龄13~18岁,平均16.5岁;52例患者均获得3~60个月的随访,平均随访30个月,统计手术并发症的发生情况。结果术前冠状面主胸弯Cobb角分别为86.67°±10.31°（74.32°~96.5l°）,手术时间为200.59±38.12 min,术中出血量838.10±197.90 mL,术后l周冠状面主胸弯畸形矫正率为（72.07±10.80）%,冠状面Cobb角平均残留21.37°±10.31°（11.32°~31.38°）;终末随访平均丢失21.37°±10.31°（11.32°~31.38°）;顶椎偏距平均残留2.37±1.25 cm,矫正率为（50.07±9.80）%,终末随访时平均丢失0.51±1.05 cm,丢失率为（8.07±3.11）%。4例中1例因侧凸进展而采用延长融合范围治疗;l例因近端交界后凸加剧而需向近端延长融合范围;1例感染患者接受了抗生素治疗;l例假关节形成患者采用更换断裂内固定及局部植骨治疗。结论选择性节段椎弓根螺钉固定手术能有效改善AIS畸形,但存在相关并发症。     

特发性脊柱侧凸的自然转归和对体操治疗的评价

本文通过对81例7～15岁特发性脊柱侧凸1.5～2年的随诊,分析了年龄、性别、侧凸程度及类型,脊柱旋转程度等对其自然转归的影响。结果表明,脊柱旋转度对自然转归的影响最显著,其次为年龄、性别及侧凸类型。旋转度大、年龄小的右胸型女性患者进展快,预后差。本文还介绍了脊柱侧凸及后凸畸形的体操治疗方法、适应证及注意事项。资料表明,对10°～19°轻型侧凸患者,体操治疗比单纯观察更为积极。     

Comparison of respiratory muscles activity and exercise capacity in patients with idiopathic scoliosis and healthy individuals

Abstract

Purpose: Idiopathic scoliosis causes respiratory muscles weakness and reduced exercise capacity. However, the mechanism of these symptoms is still unknown. The main objective of this study was to determine the intensity of respiratory muscle activity and exercise capacity in patients with idiopathic scoliosis in comparison with healthy people. Subjects: In this study, 20 female patients with adult idiopathic scoliosis (10 mild and 10 moderate) as well as 10 healthy matched individuals with characteristics of the patients were selected. Methods: The subjects were fatigued through a maximal incremental cycle ergometry protocol. Meanwhile, the electromyography values of the external intercostal muscles and diaphragm were recorded bilaterally, and fatigue duration was determined. Results: The root mean square of concave external intercostal muscles and concave diaphragm in patients with idiopathic scoliosis was significantly reduced during the fatiguing exercise protocol compared with healthy individuals. The median frequencies of the two sides differed significantly and were lower in patients with moderate scoliosis than healthy subjects. Fatigue duration (minutes) also was lower in patients with moderate scoliosis than healthy subjects. Conclusions: Scoliosis causes respiratory muscle weakness and reduced fatigue duration in response to mild physical activity compared with healthy subjects and these dysfunctions appear to be related to the severity of scoliosis curvature (moderate > mild).     

青少年特发性脊柱侧凸康复治疗卫生经济学初步研究

目的:对青少年特发性脊柱侧凸患者康复治疗进行成本-效果分析.方法:24例青少年特发性脊柱侧凸患者分为康复治疗组和手术治疗组.康复治疗组12例,采取运动疗法、关节松动、支具治疗;手术治疗组12例,采取手术治疗.治疗前后均应用中文版脊柱侧凸研究学会患者问卷(SRS-22)进行生存质量调查,并在治疗6个月后进行费用调查.结果:治疗6个月后,康复治疗组患者SRS-22问卷自我形象、心理健康维度得分高于治疗前,康复治疗组患者自我形象、对治疗的满意程度维度得分高于手术治疗组(P＜0.05).康复治疗组自我形象维度得分每增加1分所需要的总直接医疗费用为人民币14561.07元,手术治疗组每增加1分所需要的总直接医疗费用为人民币74776.44元.结论:康复治疗是青少年特发性脊柱侧凸经济有效的治疗方案.     

青少年特发性脊柱侧凸与伏案时长的相关性研究及其足底压力分析

目的:探讨青少年特发性脊柱侧凸(AIS)的发展与伏案时长的相关性及足底压力测试在AIS患者康复诊疗中的应用可行性。方法:选取17例AIS患者为观察组,另选取17名同年龄健康人为对照组。问卷调查观察组伏案时间等信息数据,分析观察组内不同伏案时长与侧凸角度的相关性;使用三维步态分析系统测量受试者的静态足底压力、峰值压力(PP)和触地面积(CA)。结果:伏案总时长>5h较1～3h和3～5h的脊柱侧凸角度均明显增大(均P<0. 05);连续伏案2～3h较1～2h的脊柱侧凸角度明显增大(P<0. 05),且连续伏案>3h较1～2h和2～3h的脊柱侧凸角度均显著显增大(均P<0. 05)。观察组在步行周期中足弓、第1跖骨头、第2～5趾骨处较对照组PP值均更大(P<0. 01,0. 05),且在足弓和足跖的CA均较对照组更大(P<0. 01,0. 05),而足跟和足趾的CA均小于对照组(均P<0. 01)。观察组"C"型凸侧足底M2区及前足压力均显著大于凹侧(均P<0. 05)。结论:伏案时长会对AIS患者脊柱侧凸角度造成一定影响,脊柱侧凸角度大...     

青少年特发性脊柱侧弯患者术后生活质量和健康需求的调查

目的了解青少年特发陛脊柱侧弯（AIS）术后患者的生活质量及健康需求。方法采用健康状况问卷（SF-36）及自设的矫形术后健康需求问卷对104例AIS术后患者进行问卷调查。结果MS术后患者的生活质量各维度的得分均低于正常人群,其中生理机能得分为（72．07±12．95）分,正常人群得分为（90．62±15．40）分,组间比较差异具有统计学意义（t=-14．607,P〈0．05）。相关分析发现,术后时间与生理机能、生理职能、躯体疼痛、一般健康状况、精力、情感职能的得分呈正相关（r分别为0．734,0．302,0．277,0．363,0．318,0．417;P〈0．05）。患者术后健康需求主要集中在手术后参加体育运动的时机和活动类型,手术后是否有后遗症,以及脊柱侧弯是否影响高考体检高考填报志愿和结婚生子等方面。结论本组MS术后患者的生活质量低于正常人群,患者的健康需求主要集中在术后运动、手术效果、日常生活学习影响等方面。     

青少年特发性脊柱侧弯病人生活质量及其影响因素的研究进展

青少年特发性脊柱侧弯是青少年常见的一种疾病,严重影响青少年的生活质量.作者总结了其生活质量的评估工具,应用这几种工具评估结果认为,目前我国AIS病人的生活质量较正常人群低,与文化差异、种族差异、性别以及治疗方法的选择有关.     

基于同一中心257例青少年特发性脊柱侧弯术后病人父母的家庭护理认知调查及常见问题分析

[目的]调查青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)术后病人父母的家庭护理认知情况及常见问题。[方法]对257例接受手术治疗AIS病人的父母进行问卷调查,了解其对AIS病人术后家庭护理知识的认知情况以及护理过程中常见问题,并分析其发生的影响因素。[结果]95例病人父母在出院前家庭护理知识未达标,这些病人多为非独生子女、居住于农村、家庭收入及父母受教育程度均较低(P均<0.05)。257例病人父母家庭护理认知平均分为(23.8±5.6)分,其中在功能锻炼方面得分较低。术后家庭护理知识未达标组病人父母在功能锻炼、生活护理及切口护理评分上均低于达标组(P均<0.05)。AIS病人父母在术后家庭护理过程中常见的问题为术后相关问题。相比于达标组,未达标组病人父母在失眠、担心照顾病人方式不当、病人恢复不佳以及病人无法独自处理问题方面的发生率较高,差异具有统计学意义(P均<0.05)。[结论]术后病人父母的家庭护理认知受多方面因素影响,护理知识宣教在提高病人父母家庭护理认知程度中起重要作用,应加强术后功能锻炼方面的知识宣教。     

团体心理辅导对青少年特发性脊柱侧凸患者矫形器治疗期间自我外观评价和生活质量的影响

目的:探讨团队心理辅导干预对青少年特发性脊柱侧凸(Adolescent Idiopathic scoliosis,AIS)患者矫形器治疗期间自我外观评价和生活质量的影响。方法:将青少年特发性脊柱侧凸患者随机分为观察组和对照组各40例。对照组采用常规矫形器治疗与电话随访,观察组在此基础上采用团队心理辅导干预,干预时间均为12周。结果:干预结束时、干预结束3个月时,观察组的自我外观评价得分低于对照组,生存质量高于对照组,差异均有统计学意义(均P0.05)。结论:团队心理辅导有助于改善AIS患者的自我外观评价和生活质量,促进AIS患者身心健康成长。     

3MPR-IA/IB在青少年特发性脊柱侧凸骨髓间质干细胞中的异常表达及意义

目的：从骨髓间质干细胞（MSCs）水平探讨BMPR-IA/IB表达与青少年特发性脊柱侧凸（AIS）发病可能相关的分子机制。方法：30例12-18岁志愿者分为2组：AIS组20例，同年龄正常对照组10例。髂前上棘处穿刺抽取10mL骨髓，肝素抗凝。密度梯度离心法分离MSCs，体外培养并传至P3代行表型鉴定，采用RT-PCR法、Western-blotting法、免疫荧光法检测2组MSCs中BMPR-IA/IB的表达情况。结果：BMPR-IA/IB不论是核酸水平还是蛋白水平的表达，在AIS组均要显著高于正常对照组（P〈0．01）。结论：BMPs信号通路中重要的膜表面分子BMPR-IA/IB在MSCs水平表达的异常可能与AIS发病的分子机制相关。     

Effect of elbow flexion on upper extremity impact forces during a fall

Objective. The overall objectives are to develop a biomechanical model for a simulated fall with outstretched hand.

Design. Cross-sectional study involving young healthy volunteers in a university research laboratory setting.

Background. Little is known about the factors which influence fracture risk during a fall on outstretched hand.

Methods. A group of 11 male subjects volunteered for this investigation. A set of eight reflective markers was placed bilaterally on selected anatomic landmarks. Subjects were suspended with both elbows extended and wrists dorsiflexed, preparing to impact the ground and force plates from two different fall heights: 3 and 6 cm. Two different postures for the elbows were employed. In the elbow extension experiment, the elbows were extended at all times. In the elbow flexion experiment, the elbows were extended at impact, but then flexed immediately, as though in the initial downward phase of a push-up exercise.

Result. Increasing the fall height significantly increased the upper extremity axial forces by 10% and 5%. No significantly different differences were found in the axial forces applied to the wrist, elbow or shoulder between the elbow flexion and elbow extension trials, but the elbow mediolateral shear force was 68% larger (P=0.002) in the extension trials.

Conclusions. Performing an elbow flexion movement at impact reduces the first peak impact force value and postpones the maximum peak value. Although changing the fall arrest strategy from elbow extension to elbow flexion did not affect the peak impact force on the hand, it did require substantially greater elbow and shoulder muscle strengths.Relevance

This paper yields insights into how the physical demands of arresting mild falls may relate to upper extremity muscle capacity, joint dislocation and bony fracture.     

脊柱截骨矫形技术治疗青少年特发性脊柱侧后凸临床疗效和安全性分析

目的探讨脊柱截骨矫形技术用于治疗青少年特发性脊柱侧后凸(AIS)的临床疗效,并分析其安全性。方法回顾性分析2013年6月至2015年6月收治的AIS 64例患者的临床资料,根据手术方式将其分为研究组和对照组,接受脊柱截骨矫形技术的患者36例为研究组,接受棘突拉钩复位技术的患者28例为对照组。比较临床疗效和术后并发症发生情况。结果术前两组脊柱冠状面Cobb角和脊柱偏移距离比较差异无统计学意义(P0.05),术后均显著改善,且研究组的脊柱冠状面Cobb角和脊柱偏移距离均低于对照组(P0.05);术后研究组的并发症发生率2.78%,低于对照组的28.57%,差异有统计学意义(P0.05)。结论脊柱截骨矫形技术在AIS的治疗中临床疗效显著,有效缩短治疗时间,值得在骨科临床上推广。