脊柱侧凸旋转畸形矫正的实验研究

目的：研究转旋畸形矫正在脊柱侧凸手术中的意义、矫正中脊髓的耐受程度以及ＭＥＰ监测的作用。方法：制作４组（每组１０只）大鼠脊柱侧凸模型,ＭＥＰ监测下矫下旋转。Ａ组矫正５０％,固定１２ｈ;Ｂ组矫正１００％,固定１２ｈ;Ｃ组矫正到ＭＥＰ潜伏期延长１０％,即松开固定;Ｄ组矫正至潜伏期延长１０％后继续固定１２ｈ。结果：Ａ组及Ｃ组神经功能正常;Ｂ组２只神经损伤,脊柱侧凸随旋转的矫正也是基本矫正;Ｄ组４只神经损     

脊柱侧凸前路去旋转椎体融合手术矫形的生物力学研究

目的利用三维有限元模型研究减小前路去旋转椎体融合手术（VDS）中螺钉拔出风险的手术策略。方法CT扫描AIS患者的脊柱，用图像处理软件读取CT数据文件，转入有限元软件，建成侧凸脊柱三维有限元分析模型，继而将矫形内植人物加入模型中。利用模型模拟7种不同矫形力分布的VDS的矫形方案对矫形效果和螺钉受力的影响。结果在所有矫形方案中，头端椎体和中间椎体上固定的螺钉受到轴向拉伸力（140～480N），其余螺钉上产生轴向压力（20～140N）；头端和尾端的螺钉受较大的剪力（200～1480N）。在头端运动节段的强力矫形方案导致轴向拉伸的和横向剪切的力量最大（440N和1480N），从而增加了头端螺钉拔出的风险。结论宜采用中间运动节段强力矫形，而头端运动节段适度矫形的矫形策略，来取得理想的矫形效果，同时降低螺钉拔出的风险。     

应用脊椎操纵器顶椎双侧去旋转技术治疗特发性脊柱侧凸的早期疗效

目的评估应用脊椎操纵器（vertebral column manipulation,VCM）顶椎双侧去旋转技术治疗特发性脊柱侧凸（idiopathic scoliosis,IS）的早期疗效。方法 2011年2～9月使用VCM去旋转技术治疗IS患者17例（VCM组）,其中男6例,女11例,平均年龄14.3岁;Lenke 1型10例,2型7例;术前主弯Cobb角平均57.5°。2010年7月～2011年2月采用旋棒技术治疗IS患者18例（旋棒组）,男6例,女12例,年龄平均14.5岁;Lenke 1型10例,2型8例;术前主弯Cobb角平均58.1°。手术采用后路椎弓根螺钉固定、VCM矫形或旋棒技术矫形以及同种异体骨植骨融合。以主弯Cobb角矫正率、胸椎后凸角、腰椎前凸角及顶椎椎体旋转角（rotation angle sagittal,RAsag）矫正率评价矫形情况。结果所有患者成功完成手术,无严重并发症发生。VCM组Cobb角矫正率为（85.3±7.2）%,旋棒组为（79.4±11.4）%,差异无统计学意义（P〉0.05）。矫形后胸椎后凸角及腰椎前凸角2组之间差别无统计学意义（P〉0.05）。VCM组顶椎RAsag矫正率为（61.4±12.9）%,旋棒组为（26.1±20.6）%,差异有统计学意义（P〈0.05）。VCM组随访8.7个月,旋棒组13.4个月,随访期间未见明显的失代偿和矫形度数丢失（P〉0.05）。结论 VCM顶椎双侧去旋转技术是一种有效的IS矫形方法,三维矫形效果满意,去旋转矫形方面矫形效果明显。     

基于EOS系统和CT系统测量青少年特发性脊柱侧凸顶椎旋转角度的对比观察

目的 使用EOS影像系统与CT影像系统分别评估椎体旋转以探究顶椎位置对EOS测量结果的影响。方法 2018年3月至2022年6月于北京积水潭医院住院治疗的青少年特发性脊柱侧凸(AIS)患者87例,年龄11～18(14.7±2.3)岁。共112个弯;其中胸弯61个,腰弯51个。统计一般资料,并进行影像学测量。在EOS影像中,三维拟合重建后获得Cobb角、顶椎旋转度(AVR)等参数。在CT影像中,采用Aaro-Dahlborn法测量AVR。根据侧凸位置的不同将所有侧凸分为胸椎组和腰椎组,并进行亚组分析,比较两组AVR的差异和相关性。结果 87例AIS患者总体CT与EOS的测量结果差异无统计学意义(P=0.096);两者高度相关(r=0.771,P<0.001)。在胸椎组,EOS测量结果明显大于CT测量结果(P<0.001),两者中等相关(r=0.536,P<0.001)。在腰椎组,CT测量结果与EOS测量结果差异无统计学意义(P=0.193),两者高度相关(r=0.789,P<0.001),且其相关系数高于总体的相关系数。结论 在顶椎旋转度的测量中,EOS全身影像系...     

脊柱侧凸畸形脊椎旋转的影像学测量及临床意义

脊柱侧凸是一种在三维空间发生和发展的畸形 ,脊椎的轴向旋转是脊柱侧凸的基本畸形之一。Ａｄａｍｓ在 186 5年就指出脊柱后凸伴一侧旋转是脊柱侧凸的主要发生机理。Ｓｏｍｅｒｖｉｌｌｅ(195 2年 )及Ｒｏａｆ(196 6年 )也认为脊椎的轴向旋转是脊柱侧凸的首要因素。Ｄｉｃｋｓｏｎ(1986年 )和Ａｒｃｈｅｒ(1987年 )更提出脊柱前柱生长快于后柱造成的不平衡必然导致脊柱旋转 ,后者可能是脊柱侧凸发生的始动因素。虽然脊椎旋转在脊柱侧凸的发病机理中的具体机制还不十分清楚 ,但脊柱侧凸的进展、胸廓的继发畸形及外观的改变都与脊椎的旋转有着…     

青少年特发性脊柱侧凸患者顶椎区脊髓位置变化及其临床意义

目的:分析青少年特发性脊柱侧凸(AIS)患者顶椎区脊髓偏移和旋转情况,并探讨其临床意义.方法:在28例AIS患者横断面MRI图像上测量顶椎区脊髓中心到椎管前、后内壁及凹、凸侧内壁的距离和脊髓、椎体的旋转角度,将脊髓旋转与椎体旋转的关系按Maruta分型分为O型、U型和R型,并分析脊髓在椎管内的位置及脊髓位置与Cobb角、脊髓旋转角度、椎体旋转角度之间的相关性.结果:顶椎区脊髓中心距脊柱凹侧、凸侧椎管内壁距离分别为7.13±1.89mm、13.68±2.93mm,距凹侧距离明显小于距凸侧距离(t=-9.56,P<0.01);距椎管内壁前、后缘距离分别为7.50±1.63mm、6.99±1.61mm,两者比较无显著性差异(t=1.22.p=0.23).椎体旋转角度为17,53°±6.70°,脊髓旋转角度为16.46°±9.16°,O型8例,U型13例,R型7例.脊髓旋转角度与椎体旋转角度、Cobb角及脊髓中心到凸凹侧椎管内壁的差值之间均呈正相关(分别为r=0.45,P=0.01;r=0.43,P=0.02;r:0.64,P<0.01),与脊髓中心列椎管内壁前后缘的差值之间无显著相关性(r=0.28,P=0.15).结论:AIS患者顶椎区脊髓向凹侧偏移,椎体与脊髓都存在旋转,脊髓的旋转方向因人而异.在行后路脊柱矫形椎弓根螺钉置入时,应特别注意凹侧脊髓及神经根,避免损伤.     

成人退行性脊柱侧凸患者椎旁肌肉退变与顶椎旋转的关系

目的 :分析成人退行性脊柱侧凸(adult degenerative scoliosis,ADS)患者多裂肌、竖脊肌和腰大肌的退变与顶椎旋转的关系。方法:收集2017年1月～2019年7月在我院门诊就诊的ADS患者的临床资料,在顶椎层面MRI影像上测量并计算患者多裂肌、竖脊肌和腰大肌的横截面积(cross-sectional area,CSA)、脂肪化比例(fat saturation fraction,FSF)、凹侧与凸侧横截面积之比(rCSA)、凹侧与凸侧脂肪化比例之比(rFSF)和顶椎旋转度(apical vertebra rotation,AVR)。采用配对样本t检验分析顶椎层面凹凸两侧多裂肌、竖脊肌和腰大肌CSA和FSF的差异,Pearson相关分析分析肌肉影像学参数与AVR之间的相关性。结果:共纳入96例ADS患者,男18例,女78例;年龄64.64±7.18岁;腰椎前凸角20.19°±17.61°;Cobb角24.70°±10.41°;AVR 10.94°±6.47°,旋转方向均偏向侧凸凸侧。在顶椎层面,多裂肌、竖脊肌、腰大肌凹侧CSA均显著性大于凸侧(P<0.05...     

特发性脊柱侧凸远端融合椎的选择

目的 探讨青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)远端融合椎(low-est instrumented vertebra,LIV)的选择标准.方法 前瞻性分析按LIV标准进行融合的随访2年以上(24～36个月,平均29个月)的AIS患者共33例,男4例,女29例.按照北京协和医学院(Peking Union Medical College Hospital)分型Ⅰ b 2例,Ⅰ c 2例,Ⅱa 3例,Ⅱb2 3例,Ⅱc1 3例,Ⅱd1 17例和Ⅲb 3例.患者手术时年龄11～16岁,平均14.2岁.LIV的选择标准:术前站立前后位像上被骶正中线触及的最近端椎体,即触及椎体,其旋转范围在Ⅰ度以内,并在凹侧Bending像上2/3以上椎体落在Harrington稳定区内,不伴腰段或胸腰段后凸畸形.所有患者均采用椎弓根螺钉固定.观测指标包括躯干偏移、LIV倾斜度和LIV尾侧椎间盘开角,并分析LIV与稳定椎之间的关系.结果 术前和末次随访时躯干偏移由(1.87±1.18)cm矫正至(0.97±0.69)cm(t=3.24,P=0.004);术前和末次随访时LIV倾斜度由20.95°±7.51°矫正至4.57°±2.80°(矫正率为76.2%,t=10.10,P<0.001);术前和末次随访时的LIV尾侧椎间盘开角分别为4.90°±3.83°和5.43°±2.23°(t=0.14,P=0.626).选择触及椎体作为LIV比选择稳定椎平均节省(1.14±0.73)个椎体.结论 按此触及椎体标准选择LIV可获得良好的矫形效果并可保留更多的运动节段.     

脊柱侧凸中脊椎旋转的测量方法及临床意义

脊柱侧凸是一种在三维空间发生和发展的畸形,脊椎的轴向旋转是脊柱侧凸的基本畸形之一。虽然脊椎旋转在脊柱侧凸的发病机理中的具体机制还不十分清楚,但脊柱     

Rib deformity in scoliosis

Rib deformity in scoliosis is of interest because it may help in the diagnosis, and also, in some pronounced cases, it may need correction by costoplasty. There are, however, debates about its use in diagnosis, because some authors think that rib deformity is not closely related to either the magnitude or the extent of rotation of the curve. In order to define the relation between rib deformity and scoliosis, 11 patients were recruited who were to undergo scoliosis surgery and thoracoplasty, and anteroposterior (AP) T1-S1 standing radiographs, computerized tomography (CT) scans, and three-dimensional (3D) reconstructions were obtained. From the radiographs, the most rotated vertebra, the Cobb angle, the apex and the type of the curve were determined. From the CT scans and 3D reconstructions, the exact level of the rib deformity measured was matched with the corresponding vertebral level. In this way, the most rotated vertebra and the most prominent part of the rib cage deformity were identified. The most rotated vertebra was found to be at the same level in both radiographs and CT scans in only five patients. In the rest of the patients, CT scans showed it either one level higher or lower than it appeared on the radiograph. The most prominent part of the rib cage deformity was at the same level as the most rotated vertebra in two patients, and in the rest of the patients it was one, two or three vertebral levels lower. There was no association between the Cobb angle, vertebral rotation and rib deformity. A CT scan is necessary preoperatively in patients who will undergo a costoplasty, to determine the exact levels of the prominence. However, a scanogram or a 3D reconstruction is required for exactly matching the most prominent part of the rib cage deformity to the corresponding vertebral level.     

Segmental vertebral rotation in early scoliosis

Summary In order to investigate the development of the vertebral axial rotation in patients with early scoliosis, the vertebral rotation angle (VRA) was quantified on the basis of 132 anteroposterior radiographs obtained from patients with diagnosed or suspected scoliosis. The rotation was measured in the apical vertebra and in the two suprajacent and two subjacent vertebrae. The radiographic material was divided into a control reference group and three scoliotic groups with varying Cobb angle from 4° up to 30°. In the reference group a slight vertebral rotation was significantly more often seen to the right. In the scoliotic groups, the rotation was most pronounced in the apical segments. The mean VRA toward the convex side was significantly increased in the vertebrae just suprajacent to the apex in curves with a Cobb angle of 8°–15° and in the cranial four vetebrae in curves with a Cobb angle of 16°–30°. Atypical vertebral rotation to the opposite side of the major curve was observed in 12.8% of the cases. There was a significant positive correlation between the VRA and the Cobb angle. These results show that a slight VRA to the right is a common feature in the normal spine, and that the VRA increases with progressive lateral deviation of the spine. It is concluded that the coronal plane deformity in early idiopathic scoliosis is accompanied and probably coupled to vertebral rotation in the horizontal plane.     

Development and assessment of a digital X-ray software tool to determine vertebral rotation in adolescent idiopathic scoliosis

Background Context

The amount of vertebral rotation in the axial plane is of key importance in the prognosis and treatment of adolescent idiopathic scoliosis (AIS). Current methods to determine vertebral rotation are either designed for use in analogue plain radiographs and not useful in digital images, or lack measurement precision and are therefore less suitable for the follow-up of rotation in AIS patients.

Measurement of vertebral rotation: Perdriolle versus Raimondi

Summary The measurement of vertebral rotation according to Perdriolle is widely used in the French-speaking and Anglo-American countries. Even in this measurement technique there may be a relatively high estimation error because of the not very accurate grading in steps of 5°. The measurement according to Raimondi seems to be easier to use and is more accurate, with 2° steps. The purpose of our study was to determine the technical error of both measuring methods. The apex vertebra of 40 curves on 20 anteroposterior (AP) radiographs were measured by using the Perdriolle torsion meter and the Regolo Raimondi. Interrater and intrarater reliability were computed. The thoracic Cobb angle was 43°, the lumbar Cobb angle 36°. The average rotation according to Perdriolle was 19.1° thoracic (SD 11.14), 12.7° lumbar (11.21). Measurement of vertebral rotation according to Raimondi showed an average rotation of 20.25° in the thoracic region (11.40) and 13.4° lumbar (10.92). The intrarater reliability was r=0.991 (Perdriolle) and r=0.997 (Raimondi). The average intrarater error was 1.025° in the Perdriolle measurement and 0.4° in the Raimondi measurement. Interrater error was on average 3.112° for the Perdriolle measurement and 3.630° for the Raimondi measurement. This shows that both methods are useful tools for the follow-up of vertebral rotation as projected on standard X-rays for the experienced clinicial. The Raimondi ruler is easier to use and is slightly more reliable.     

Axial rotation component of thoracic scoliosis

The axial rotation (rotation about a vertical axis) of the vertebrae, of the ribs, and of the back surface are components of the deformity recognized clinically as the "rib hump" in thoracic scoliosis. Relationships of these rotations to the lateral deviation and lateral curvature of the spine were studied in 40 patients with idiopathic scoliosis. Stereoradiographs of the spine and rib cage were used to measure three components of axial rotation: rotation of the vertebrae, of the rib cage, and of the plane of maximum curvature of the spine. Stereotopographs of the back surface were digitized to measure the axial rotation of the back surface. In individual patients, there were high correlations of all components of axial rotation at each spinal level with the corresponding vertebral lateral deviation from the spinal axis. By regression analyses of the maximum values of each rotation in each curve, the rotation of the apex vertebra was found to be generally of lesser magnitude than the rotation of the plane of maximum curvature of the spine and in an opposite sense in kyphotic curves. The rib cage rotation was generally of lesser magnitude than the vertebra rotation, and the back surface rotation was less than both of these skeletal rotations. Vertebra rotation correlated most closely with lateral deviation of the spine. Simple segmental coupling of axial rotation and lateral bending could not be responsible for this axial rotation.     

Three-dimensional spinal curvature in idiopathic scoliosis

Scoliosis is usually considered as a deformity of the spine in the frontal plane, without reference to curvatures in other planes. In this study, the three-dimensional shape of the spine of 104 patients with untreated idiopathic scoliosis (5-55 degrees Cobb) was studied by means of stereo radiographs to determine relationships between curvature of the spine in the frontal plane view, in the lateral view, and in the intermediate views. There was a weak but statistically significant correlation (r = 0.2) relating greater scoliosis with lesser kyphosis or greater lordosis. In the thoracic region, the sagittal plane spinal curvature was less than that measured in a population without scoliosis (mean difference, 7.72 +/- 9.9 degrees). Seventy-four of 76 scolioses in the upper region of the spine with lateral curvature greater than 5 degrees Cobb were kyphotic. Sixty-four of 84 curves greater than 5 degrees Cobb in the lower region were lordotic. Measuring curvatures in the plane of symmetry of the rotated apical vertebra altered these ratios to 69 of 76 kyphotic in the upper region and 68 of 84 lordotic in the lower region. The plane of maximum curvature of sections of the spine with scoliosis was not related to the plane of symmetry of the rotated apical vertebra, for in kyphotic regions of the spine the rotations of these two planes were in opposite directions. In all cases, the magnitudes of the rotations were quite different, i.e., by a factor of -0.22 for curves in thoracic region and by a factor of 0.24 for curves in the lumbar region. This implies that mechanical measures to correct this spinal deformity or to prevent progression should apply different rotations to the apex from those applied to the curve as a whole and, in opposite senses, in curves in kyphotic regions. There was no evidence of an abnormality of sagittal curvature of a magnitude to implicate it in the etiology or in the treatment.     

Validity and reliability of a computer method to estimate vertebral axial rotation from digital radiographs

Axial vertebral rotation, an important parameter in the assessment of scoliosis may be identified on X-ray images. In line with the advances in the field of digital radiography, hospitals have been increasingly using this technique. The objective of the present study was to evaluate the reliability of computer-processed rotation measurements obtained from digital radiographs. A software program was therefore developed, which is able to digitally reproduce the methods of Perdriolle and Raimondi and to calculate semi-automatically the rotation degree of vertebra on digital radiographs. Three independent observers estimated vertebral rotation employing both the digital and the traditional manual methods. Compared to the traditional method, the digital assessment showed a 43% smaller error and a stronger correlation. In conclusion, the digital method seems to be reliable and enhance the accuracy and precision of vertebral rotation measurements.     

Clinical anatomy of vertebrae in scoliosis: global analysis in four different diseases by multiplanar reconstructive computed tomography

Background contextFew accurate analyses of clinically useful vertebral anatomy have been conducted, and most have focused on thoracic idiopathic scoliosis.PurposeTo evaluate the different anatomic characteristics in scoliosis by disease type and level.Study designObservational cohort study.Patient sampleForty-eight patients with scoliosis were included in this study.Outcome measuresSubjects underwent computed tomography (CT) of the whole spine.MethodsForty-eight patients with scoliosis were included in this study: 15 adolescent idiopathic, 11 cerebral palsy (CP), 10 muscular dystrophy (MD), and 12 congenital (CG) scoliosis patients with similar demographics. Subjects underwent CT of the whole spine, preoperatively. Eight anatomic parameters were measured in multiplanar reconstructive CT images, and statistical analysis was performed to investigate differences.ResultsIn general, values in the anatomic parameters were similar for the four diseases. Each parameter showed the unique change pattern according to the spinal level regardless of curvature shape, direction, or magnitude. In particular, chord length (CL) in MD and CG scoliosis was lower than in adolescent idiopathic scoliosis (AIS) and CP, and pedicle rib unit length was lower in CG scoliosis than in the other diseases (p<.05). Comparisons of convex and concave anatomies in AIS showed that inner pedicle width (PWI) and outer pedicle width (PWO) were wider for convex side, CL, pedicle width, and transverse pedicle angle were greater for concave side (p<.05), and differences were more significant at apices. However, in CP, PWI and PWO were similar between convex and concaves sides (p>.05). Although PWI and PWO were wider for convex sides and CL and pedicle length were greater for concave sides in MD (p<.05), differences were less significant at apices. Particularly, CG scoliosis showed severely deformed anatomy, with differences of seven parameters at apical vertebrae (p<.05).ConclusionClinical anatomies of vertebrae in scoliosis were found to differ significantly at different levels and in terms of convexity and disease type.     

The relationship between surface and radiological deformity in adolescent idiopathic scoliosis: effect of change in body position

Three-dimensional (3D) surface deformity of the trunk in adolescent idiopathic scoliosis (AIS) is affected by changes in patient position. Initial quantification of the curve and its associated deformity, as well as subsequent monitoring, relies on both radiological and surface measurements. However, there is often a discrepancy between radiological and apparent surface deformity. The present investigation studied the dynamics of the 3D deformity associated with changes in patient position on 27 patients with AIS. The trunk deformity was quantified in three positions by measuring the angle of thoracic inclination at each vertebral level using a scoliometer. The patients all had full spine radiography in the antero-posterior erect position. Vertebral rotation and lateral spinal curvature were measured from the radiographs. Body position altered the magnitude of the surface deformity over the whole trunk, with the prone position offering the optimum relationship between 3D trunk shape and radiological deformity. This could be attributed to the ease and standardisation of positioning for prone measurements, together with increased patient comfort. It is suggested that adoption of standardised positioning and measurement of surface and radiological deformity will permit consistency of clinical judgement based on these parameters.     

Measurement of vertebral rotation in idiopathic scoliosis using the Perdriolle torsionmeter: a clinical study on intraobserver and interobserver error

Summary This study was designed to determine the reliability and accuracy of the Perdriolle torsionmeter. Fifty-four observers were divided into three groups according to their previous experience in the field of orthopaedics and the treatment of scoliosis. Each observer, on two separate occasions, measured the apical vertebral rotation on preoperative and postoperative roentgenograms of three idiopathic thoracic scoliotic curves using the torsionmeter. For all groups, there was no statistically significant difference (P>0.05) between the average of the first and the average of the second measurements of vertebral rotation of any of the curves. In the curve with the highest frontal Cobb angle and vertebral rotation of more than 30°, there was a statistically significant difference (P=0.03) between the average measurements of the three groups of observers. We concluded that, as both intraobserver and interobserver error risks were insignificant, the torsionmeter can be accurately used by everyone in the fields of orthopaedics provided the vertebral rotation is not greater than 30° and the curve is mild or moderate. The reliability and accuracy of the torsionmeter was found to be questionable at more than 30° of vertebral rotation because of increased risk of interobserver error.This study was presented as a free paper at the SICOT Regional and 14th National Turkish Congress of Orthopaedic Surgery and Traumatology, 29 September–4 October 1995, Izmir