青少年特发性脊柱侧凸患者下关节突软骨的组织形态学研究

目的：观察青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者上、下端椎及顶椎凸、凹侧下关节突软骨组织学分级和软骨细胞的增殖与凋亡，探讨其软骨内成骨性生长在侧凸进展中的作用。方法：16例AIS患者，平均年龄13．5岁。取上、下端椎和顶椎凸、凹侧下关节突进行组织学观察及免疫组织化学测定其软骨细胞的增殖指数（proliferation cell nuclear antigen，PCNA）和凋亡指数（Poly ADP-ribose pdymerase，PARP）。采用PCN/PARP比值及组织学分级作为软骨内成骨活跃程度的指标，并对其进行比较。结果：AIS患者上、下端椎和顶椎凸、凹侧下关节突软骨组织学分级、软骨细胞的增殖指数（PCNA）、凋亡指数（PARP）和PCNA／PARP比值的比较均没有统计学差异（P〉0．05）。结论：AIS患者上、下端椎和顶椎凸、凹侧下关节突软骨内成骨活跃程度没有差异，关节突软骨内成骨性生长发育可能对脊柱侧凸进展没有明显的作用。     

青少年特发性脊柱侧凸结构性腰弯患者腰椎关节突关节角的变化及其意义

目的:观察青少年特发性脊柱侧凸(AIS)结构性腰弯患者腰椎关节突关节角角度与正常腰椎关节突关节角角度的差异,探讨AIS患者后期出现腰背痛和腰椎退行性疾病高发的可能原因.方法:结构性腰弯的AIS患者21例(AIS组),非脊柱畸形的青少年20例(对照组).AIS组中男3例,女18例,年龄12～17岁,平均14.4岁,腰弯Cobb角38°～115°,平均54.2°.对照组男8例,女12例,年龄10～19岁,平均为15.2岁.均采用螺旋CT连续扫描T12～S1.通过PACS Client软件测量所有受试者腰椎关节突关节角和结构性腰弯AIS患者腰椎RAsag角.将对照组左、右侧腰椎关节突关节角角度进行配对t检验:对AIS组患者凹侧、凸侧的腰椎关节突关节角角度进行配对t检验.并对凹侧与凸侧腰椎关节突关节角角度差和Cobb角、相应节段腰椎的RAsag角进行相关性分析.结果:对照组双侧腰椎关节突关节角角度在所有节段未见显著性差异(P>0.05).AIS组所有节段凹侧的腰椎关节突关节角角度明显大于凸侧(P<0.05);凹侧和凸侧的腰椎关节突关节角角度差与Cobb角、相应节段腰椎的RAsag角没有显著相关性(p>0.05).结论:结构性腰弯的AIS患者凹侧的腰椎关节突关节角度明显大于凸侧,这可能是该类患者后期凹侧腰椎关节突关节更易发生退行性病变的因素之一.     

青少年特发性脊柱侧凸患者终板软骨的组织形态学研究

目的:观察青少年特发性脊柱侧凸(adolescent idiopathic scoliosis;AIS)患者终板软骨的组织学形态;探讨其与AIS发生、发展的关系.方法:20例AIS患者;前路手术时分别获取20份顶椎及18份下端椎终板软骨;每份均包含凸侧与凹侧.切片行HE染色;光镜下观察终板软骨组织形态;采用病理图像分析系统测量终板软骨肥大区的厚度、细胞巢面积、巢内细胞数及增殖区细胞数(个/视野).参照Enileking法设定曲度因子(factor of curve;FC);将顶椎标本分为FC≤6组(11例)和FC＞6组(9例).比较上述指标在不同部位、不同FC分组下的差异.结果:顶椎凸侧的上述指标均显著高于凹侧(P＜0.05);下端椎仅凸侧肥大区细胞巢平均面积显著大于凹侧(P＜0.05);顶椎与下端椎间同侧比较;仅下端椎凹侧肥大区的细胞数显著大于顶椎(P＜0.05).FC＞6组的顶椎凸侧和凹侧终板软骨肥大区的巢内细胞数显著小于FC≤6组(P＜0.05);FC＞6组的凸侧增殖区细胞数也显著小于FC≤6组(P＜0.05).结论:AIS患者终板软骨的组织学变化特征更倾向于与脊柱不同部位、不同状态下机械应力差异有关的继发性改变;但组织学变化与机械应力变化之间不完全平行;AIS的发生、发展可能伴有生物力学以外的因素.     

青少年特发性脊柱侧凸患者脊柱前后柱骨骺软骨的组织形态学对比研究

目的：探讨青少年特发性脊柱侧凸（adolescentid iopathic scoliosis，AIS）患者脊柱前后柱软骨组织学和软骨细胞的增殖与凋亡有无差异及其对脊柱侧凸发生、进展的影响。方法：26例11～16岁AIS患者随机分为2组．A组12例行前路松解术或前路矫形内固定术；B组14例行后路矫形内固定术。A组取胸弯上端椎、顶椎和下端椎椎体生长板，B组取下关节突软骨．进行组织学观察及免疫组织化学测定其软骨细胞的细胞增殖核抗原（proliferation cell nuclear antigen，PCNA）指数和聚腺苷二磷酸-核糖聚合酶（poly ADP-ribose polymerase，PARP）指数。采用组织学分级作为生长潜能的指标，PCNA指数和PARP指数分别代表细胞增殖指数和凋亡指数作为软骨内成骨活跃度的指标。结果：A组AIS患者前柱椎体生长板组织学分级、增殖-肥大层软骨细胞的增殖指数（PCNA）和凋亡指数（PARP）均明显高于B组AIS患者后柱下关节突软骨．且有统计学差异（P〈0．05）。结论：相同年龄段AIS患者脊柱前、后柱生长潜能和软骨内成骨活跃程度存在差异．可能导致前柱生长过快、后柱生长缓慢，从而可能对脊柱侧凸的发生和进展发挥重要作用。     

青少年特发性脊柱侧凸患者脊椎中央软骨发育相关的CT研究

目的通过影像学测量结果分析脊椎中央软骨（NCC）在青少年特发性脊柱侧凸（AIS）发病中的可能作用。方法AIS患者组（A组）和相应年龄正常对照组（B组）的胸椎CT片各30例,每组均包括青春期前15例和发育成熟者15例。分别测量两组T7-T10椎体CT横断面上的椎弓根长度、椎弓根与脊椎中线的夹角以及NCC与脊椎中线的夹角。对各个相应参数进行比较分析。结果同一组内青春期前和发育成熟的患者的椎弓根长度无明显差异。同年龄层两亚组的椎弓根的长度亦无明显差异。四个亚组组内左、右侧（凹、凸侧）椎弓根与脊椎中线夹角以及NCC与脊椎中线的夹角无明显差异。结论在青春期NCC对椎弓根的生长无明显影响,对AIS的发生发展没有明显的作用,可能与NCC在此期生长活性较低有关。     

青少年特发性脊柱侧凸治疗研究进展

青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)是指脊柱的一个或数个节段在冠状面上偏离身体中线向侧方弯曲形成一个弧度(国际脊柱侧凸研究学会,Scoliosis Research Society,SRS,认为Cobb角＞10°),通常还伴有脊柱的旋转和矢状面上后凸或前凸的增加或减少的一种脊柱结构性三维畸形.     

青少年特发性脊柱侧凸的治疗进展

青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)是指年龄在10¹8岁,冠状面上Cobb角>10°伴有椎体的旋转而无其他器质性病变的一种常见病。该疾病能够导致身体外观畸形、疼痛,甚至心肺功能受损,严重影响了患者的身心健康及生活质量。在治疗上,对于轻中度的AIS患者常用定期观察、支具等保守治疗方法,能够有效的延缓侧凸的进展;对于保守治疗无效,达到手术阈值的AIS患者,则建议手术治疗,目前较为常用的手术方法是以椎弓根螺钉内固定系统为代表的后路椎体融合术,往往能够达到较好的临床疗效。近年来,由于物理治疗性脊柱侧凸特异性运动(PSSE)疗法安全有效,越来越受欢迎。目前对于AIS患者治疗的具体适应证正逐渐完善,治疗理念与技术在不断更新,临床疗效也不断得到改善。本文将从保守治疗和手术治疗两方面展开,主要阐述常用的治疗方法在临床上的进展和应用以及所面临的问题,为临床治疗的选择提供参考。     

M-CSF在青少年特发性脊柱侧凸患者成骨细胞中的表达及意义

目的从成骨细胞（osteoblast,OB）水平探讨巨噬细胞集落因子（macrophage colony stimulating factor,MCSF）与青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）患者骨量降低的关系。方法AIS患者27例,其中男25例,女2例;年龄12～18岁,平均14.9岁;Cobb角40°～94°,平均57.3°。将所有AIS患者分为两组：A组14例,为骨量正常患者;B组13例,为骨量减低患者。正常对照组8例（定为C组）,年龄12～18岁,平均15.3岁。3组均采用双能X线吸收测量仪（dual-energy X-ray absorptiometry,DEXA）测量骨密度（bone mineral density,BMD）,测量部位包括非优势侧股骨近端及腰椎。所有受试者术中取适量髂前上嵴的松质骨,运用植块法培养成骨细胞。培养至P3代后行表型鉴定,用RT-PCR检测AIS组和正常对照组中M-CSF mRNA的表达水平。结果B组中M-CSFmRNA的表达量均较A组（P〈0.05）和C组高（P〈0.05）,A组与C组M-CSFmRNA的表达量无显著统计学差异（P〉0.05）。结论M-CSF在OB水平mRNA表达强度的异常可能与AIS骨量降低的分子机制相关。     

青少年特发性脊柱侧凸术后女性妊娠相关问题

青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)是脊柱在三维结构上的畸形,好发于青少年女性.目前脊柱三维矫形手术仍是中重度AIS有效的治疗手段.AIS术后患者的生存质量评价越来越受到患者与脊柱外科医生的关注和重视,然而AIS好发于年轻女性且大多都处在生育年龄之前,目前对于A...     

PFTS在青少年特发性脊柱侧凸术前检查中的临床意义

目的：探讨青少年特发性脊柱侧凸后路矫正融合术患者术前肺功能检查异常发生率,以及其与术后肺部并发症相关性,方法：回顾性复习了１３１例符合条件青少年特发性脊柱侧凸患者的病历记录和影像检查如术前、术后出现的心肺系统的症状和体征。结果：绝大多数患者术前ＰＦＴｓ正常（７３．２８％）,术前出现的呼吸系统症状和ＰＦＴｓ结果异常显著相关（Ｐ〈０．００１）。１３１例患者中仅４例发生了术后肺部并发症（发生率３．０１％     

Bracing in adolescent idiopathic scoliosis

The article reviews the present knowledge about brace treatment for adolescent idiopathic scoliosis (AIS). Indications, technique, problems, and results, are presented based on the literature. It is stressed by the authors that more scientific evidence is needed to reach a final conclusion whether brace treatment in AIS is effective or not.     

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.     

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.     

Detection of adolescent idiopathic scoliosis

The aim of our study was to evaluate the current methods of detection of adolescent idiopathic scoliosis. Data were collected from 100 consecutive patients with adolescent idiopathic scoliosis referred to the Scoliosis clinic in 2000. The age of the patient, the Cobb angle at presentation and the person who first noticed the deformity were recorded. Sixty three percent of the cases were detected by family or friends. The number of cases being detected at school had dropped considerably to 8%. Fifty six percent of all cases presented with a Cobb angle of more than 40 degrees. Our study shows that the most common method of detection was by family and friends. Seventy percent of these cases were detected when the deformity was advanced with Cobb angles of more than 40 degrees. There was a drop in the number of cases detected at school when most of the curves are at an earlier stage. We believe that greater awareness is needed in the community, for earlier recognition of idiopathic scoliosis.     

Physical examination in adolescent idiopathic scoliosis

The following distinguish the physical examination in scoliosis: it is extensive, it is revealing, and it influences treatment. Throughout this discussion, reference frequently is made to evaluation for underlying neural disease. Idiopathic scoliosis is a diagnosis of exclusion, and a neural etiology of spinal deformity must be ruled out in every case.     

Body composition in adolescent idiopathic scoliosis

Study design

A controlled prospective cross-sectional case study.

Objective

To investigate body mass index (BMI) and corporal composition in girls with adolescent idiopathic scoliosis (AIS) and compare them with a normal population matched by sex and age.

Summary and background data

There is controversy as to whether there are real anthropometric alterations in patients with AIS. Relative to the weight or the BMI, some studies find differences and other studies do not detect them. AIS and anorexia nervosa (AN) make their debut during adolescence and both may be associated with an alteration of their subjective physical perception. Some authors propose a link between AIS and AN supported both by an alteration of physical perception and lower BMI. No studies on body composition in AIS have been published.

Methods

Adolescent idiopathic scoliosis patient surgery candidates during 2008 were studied. Body composition was evaluated using the bioelectrical impedance analysis (Bodystat, Isle of Man, UK). A study population of more than 5,000 patients that was published by Kyle et al. (Nutrition 17:534–541, 2001) was chosen as a control (group 1). Another control group (group 2) of healthy volunteers matched by sex and age was selected among a school age and university population in Barcelona, Spain. A variance analysis was used to analyze differences between the mean values of the control group 1, the European control group, and the AIS patient surgery candidates (Epiinfo 6.2001). Comparisons between the AIS patients and control group 2 were performed with the T Student test of unpaired samples using the SPSS 15.0 (Statistical Package Social Science) software.

Results

Twenty-seven women with a mean age of 17.4 years. BMI was 18.9 kg/m² (SD 1.7; 95 % CI 18.31–19.73). In the variance analysis, a significant difference between AIS and group 1 in BMI was observed (21.0 vs. 18.9, p = 0.000004); fat-free mass (FFM = 42.6 vs. 38.9, p = 0.0000009) and fat mass (FM = 15.6 vs. 13.7, p = 0.03). Significant differences in BMI (22.13 vs. 18.9, p = 0.001; 95 % CI difference 1.85–4.60), fat mass index (FMi = 7.17 vs. 4.97, p = 0.000; 95 % CI difference 1.36–3.05) and fat-free mass index (FFMi = 14.95 vs. 13.09, p = 0.001; 95 % CI difference 0.26–1.86) between AIS and group 2 were also seen.

Conclusion

The conclusion is that there is a real alteration of body composition in AIS. The BMI, FFMi and FMi are lower than in the general population in the series under study.     

Joint laxity in idiopathic adolescent scoliosis

Joint laxity was quantified by measuring the distance from the thumb tip to the forearm during passive apposition in 500 normal Southern Chinese women. Joint laxity was found to have a normal distribution throughout the population and to decrease with age. When 109 Chinese girls with idiopathic adolescent scoliosis were similarly tested they were found to have significantly more laxity, suggesting that the two conditions are associated.     

Sexual dimorphism in adolescent idiopathic scoliosis

Adolescent idiopathic scoliosis (AIS) is one of the orthopedic disorders in which clinical evidence of sexual dimorphism is most marked. Sexual dimorphism in spine growth, morphology, stiffness, curve pattern, and hormones may be the environment in which genetic factors combine to produce the phenotype of a scoliosis patient. These factors also may play a role in the curve progression despite treatment and may help explain why some patients' curves never change and others are recalcitrant to nonoperative treatments. There are important differences in male and female AIS that impact diagnosis, treatment, and outcomes.