支具治疗进展型早发性脊柱侧弯的临床研究

目的分析进展型早发性脊柱侧弯(early onset scoliosis,EOS)经支具保守治疗后畸形发展情况,并探讨支具矫形在此类患者中的疗效。方法以战略支援部队特色医学中心脊柱外科接受支具治疗至少2年且影像资料完整的19例EOS患者为研究对象,其中男12例,女7例。根据随访结果分为有效组和无效组,末次随访Cobb角与治疗前相比改善超过10°为治疗有效,未超过10°为治疗无效。支具治疗前、初次治疗后、末次随访时拍摄站立位全脊柱正(侧)位X线片,分别测量冠状位及矢状位畸形角度及平衡。结果19例支具治疗前平均Cobb角(40±10.4)°(20°~55°)、初次治疗后主弯Cobb角(28.15±14.78)°,末次随访主弯Cobb角(31.63±18.04)°,初次治疗后及末次随访均较治疗前明显好转(P<0.05)。两组末次随访时的胸廓宽度及胸椎高度均较支具治疗前明显增加,特发性EOS较先天性EOS治疗效果更好(P<0.05)。另外,顶椎位于胸腰段或腰段较顶椎位于胸段者效果更好(P<0.05)。初次治疗后两组间主弯矫正率差异无统计学意义(P>0.05),末次随访时差异具有统计学意义(P<0.05)。结论对于部分进展型早发性脊柱侧弯,支具治疗可作为保守治疗的选择之一,其中一些病例可得到满意矫形,即使部分病例不能避免手术,支具治疗也可在不影响胸廓发育的前提下适当延后手术时间。     

改良Cheneau支具治疗青少年特发性脊柱侧凸的疗效分析

目的　评价改良Cheneau支具治疗青少年特发性脊柱侧凸的临床效果。方法　观察自1996年 5月至 2 0 0 1年 6月使用改良Cheneau支具治疗并得到随访的 15 9例AIS患儿 ,其中男 6 8例 ,女 91例 ,年龄 7.2～ 16 .4岁 ,平均 10 .3岁 ,随访时间 2 4～ 4 8个月 ,平均 2 8个月。分别记录支具治疗前、治疗后 6个月、治疗后 1年、治疗后 2年的Cobb角、顶椎偏离中线距离、顶椎旋转程度和躯干位移等观察指标 ,评价支具治疗效果。结果　治疗前脊柱侧凸的Cobb角平均为 39.7° ,支具治疗 2年后Cobb角平均为 2 6 .8° ,矫正率为 35 .0 % ,二者差异有显著性意义 (P <0 .0 1)。支具治疗后顶椎偏离中线距离、顶椎旋转程度和躯干位移等观察指标亦有明显改善 (P <0 .0 1)。除 2例治疗失败外 ,其他患儿侧凸畸形均得到显著改善 ,无明显并发症。结论　改良Cheneau支具治疗青少年特发性脊柱侧凸可以取得满意疗效 ,正确的临床应用能有效避免手术治疗。     

生长棒近端锚定点数量对早发性脊柱侧凸疗效及并发症的影响

目的探究生长棒技术治疗早发性脊柱侧凸时近端不同锚定点数量对疗效及并发症的影响。方法以2016年1月至2020年3月首都医科大学附属北京儿童医院收治的33例采用传统双侧生长棒技术治疗的早发性脊柱侧凸患者为研究对象,所有患者随访时间≥2年,撑开次数≥2次,术前、术后及末次随访时影像学资料完整。按照近端锚定点数量不同将患者分为2组:A组近端远端各4个锚定点,共8个锚定点(15例);B组近端6个锚定点,远端4个锚定点,共10个锚定点(18例)。记录患者年龄、性别、随访时间、术前和末次随访时主侧弯Cobb角、T1-S1高度、冠状面偏移程度、影像学肩关节高度差、胸椎后凸Cobb角、矢状面偏移情况,以及随访期间椎弓根螺钉松动、移位、拔出、断棒、翻修情况。结果两组患者术前年龄、不同性别例数、随访时间、撑开次数的差异无统计学意义(P>0.05)。两组末次随访时主侧弯Cobb角均较术前减小,末次随访时T1-S1高度均较术前增大,差异有统计学意义(P<0.05)。A组术前与末次随访时相比,胸椎后凸Cobb角差异无统计学意义(P>0.05)。B组末次随访时胸椎后凸Cobb角较术前减小,差异有统计学意义(P<0.05)。末次随访与术前比较,主侧弯Cobb角的变化值及胸椎后凸Cobb角的变化值,B组均大于A组,差异有统计学意义(P<0.05)。结论传统双侧生长棒技术治疗EOS时,采用近端4个锚定点与6个锚定点均能取得冠状面侧弯的矫正,同时保持脊柱的生长;但采用近端6个锚定点可获得更大的冠状面主侧弯矫形力度和矢状面胸椎后凸的改善,同时锚定点相关并发症发生率更低。对于大的冠状面主侧弯(Cobb角>70°),尤其是合并较大胸椎后凸畸形(Cobb角>40°)的EOS,可以考虑增加锚定点。     

Nuss手术治疗漏斗胸患儿合并特发性脊柱侧弯的临床研究

目的了解漏斗胸患儿合并特发性脊柱侧弯的发病情况及经Nuss手术治疗后脊柱侧弯的改变情况。方法以2011至2013年于首都医科大学附属北京儿童医院接受胸外科手术治疗并符合纳入标准的171例漏斗胸患儿为研究对象,患儿入院后行CT检查了解漏斗胸情况,并分别于Nuss手术前及取出钢板后行胸部及脊柱X线检查了解脊柱侧弯情况;对比脊柱侧弯与非侧弯患儿的胸骨旋转度、胸廓旋转度、Haller指数等指标,同期对比胸廓对称与非对称患儿的脊柱侧弯改变情况。结果171例漏斗胸患儿中合并脊柱侧弯的比例为21. 1%(36/171),平均Cobb角16. 9°;侧弯患儿与非侧弯患儿Haller指数无统计学差异(P 0. 05),但胸骨旋转度及胸廓旋转度均显著大于非侧弯患儿(P 0. 05);侧弯患儿根据弯度给予相应治疗(侧弯25°的患儿继续随诊观察,侧弯在25°～45°且骨骼发育未成熟的患儿要求佩戴支具,侧弯 45°的患儿予以手术治疗);中位随访时间为35. 73个月,随访过程中,13例原脊柱正常患儿出现脊柱侧弯,14例患儿原脊柱侧弯消失;胸廓不对称患儿脊柱侧弯出现变化的比例显著高于胸廓对称的患儿(P 0. 05)。结论漏斗胸患儿易合并特发性脊柱侧弯,Nuss手术治疗后其脊柱侧弯程度可能发生改变,需要小儿胸外科医生与小儿骨科医生共同协作治疗。     

儿童腰骶部半椎体早期后路切除治疗

目的 探讨儿童腰骶部半椎体的治疗方法及临床疗效.方法 回顾性分析2000年10月至2014年7月我院诊治的18例腰骶部半椎体的患儿的临床资料.通过对其手术前后影像学检查、查体及病历资料分析,评估其发病特点、手术方式、手术前后及末次随访时侧弯后凸Cobb角变化和躯干偏移改善情况.结果 本研究18例患儿手术时平均年龄5.1岁,8例患儿合并其他部位1～3个半椎体,14例合并脊髓拴系综合征等脊髓畸形.所有患儿均行一期经后路切除半椎体,4例无内固定,14例椎弓根螺钉内固定,术后平均随访63个月.术前半椎体节段Cobb角平均25.9°,术后平均11.3°,末次随访时平均10.4°,术后平均即刻矫正率为56.4％,末次随访时平均侧弯矫正率为59.8％.手术前近端代偿弯Cobb角平均20.8°,术后平均12.6°,末次随访平均12.0°,术后平均即刻矫正率为40.0％,末次随访时平均为43.3％.矢状面无后凸畸形,躯干偏移较前改善.术后1例因凸侧髂骨钉断钉导致侧弯矫正失败,2例术后出现短暂神经功能障碍,随访时1例较前好转,1例完全恢复,其余无椎弓根钉切割、断钉棒、感染、神经损伤等并发症.结论 儿童腰骶部半椎体容易合并脊髓畸形,早期行脊髓畸形手术同时可以后路切除半椎体不用内固定.早期后路腰骶部半椎体切除使用内固定能有效治疗脊柱畸形,避免局部严重畸形和防止继发代偿畸形,避免出现长节段的固定融合.     

系统评价特发性胸椎侧弯胸腔镜下矫形的疗效和并发症

目的 通过系统文献回顾来评价当前胸腔镜技术在特发性胸椎侧弯矫形内固定中的应用价值.方法 计算机检索Medline、EMbase、中国生物医学文献数据库、中国期刊全文数据库和万方数据资源系统,纳入2011年6月以前发表的关于胸腔镜下特发性胸椎脊柱侧弯矫形的疗效、肺功能、患儿生活质量评分、并发症的临床研究,进行系统评价.结果 共纳入26个研究,其中13篇文献用于手术疗效及并发症分析,11篇用于术后肺功能分析,4篇用于术后SRS评分分析.共488例胸椎侧弯患儿(其中7例为非特发性胸椎侧弯)接受胸腔镜下矫形内固定手术,手术平均时间343 min、出血量434ml,平均固定节段6.7个,侧弯平均矫正率57.5％.胸椎后弯由术前16.4°矫正至术后26.4°.胸腔镜下矫形与传统后路钩棒或前路矫形效果无明显差异.125例(25.6％)患儿发生并发症,以内固定相关并发症最常见.患儿术后肺功能明显下降,但在术后1年时恢复至术前水平.远期随访显示患儿生活质量评分较高,对手术满意度好.结论 胸腔镜下特发性胸椎侧弯矫形内固定可获得与传统手术入路一样的矫形效果,术后肺功能恢复快,主观功能评分较好,但该手术技术的掌握具有明显学习曲线,手术时间长、出血量大、并发症发生率较高.对于适合该手术且对术后恢复及手术瘢痕要求较高的患儿,胸腔镜下矫形内固定仍然是较好的选择.     

后路半椎体切除短节段固定治疗儿童不平衡型多发半椎体的效果分析

目的 评价后路半椎体切除术短节段固定治疗儿童不平衡型多发半椎体的临床效果.方法 回顾性分析2003年6月至2013年6月行后路半椎体切除短节段固定术,治疗不平衡型多发半椎体(≥2个)22例的临床资料.其中,男12例,女10例;初次手术年龄3.0～7.5岁,平均4.2岁.手术前、后及末次随访时所有患儿均行站立位全脊柱正侧位X线检查.对比手术前、后冠状面Cobb角、顶椎偏距、冠状面平衡及矢状面局部后凸角、矢状面平衡变化;测量并比较胸椎(T1 ～T12)及脊柱高度(T1～S1)变化.结果 随访时间36～156个月,平均86.1个月.22例共51个半椎体,手术切除41个;平均每例有2.3个半椎体,平均切除1.9个;平均每例固定3个节段.术后侧凸Cobb角12.6°±7.2°明显小于术前45.8°±12.7°,侧凸矫形率为72.5％;术后局部后凸角11.2°±7.5°明显小于术前23.6°±18.0°,后凸矫形率为52.5％,差异均有统计学意义(P均＜0.05),末次随访时无明显丢失.冠状面平衡由术前(14.0±6.7)mm降至术后(8.5±4.0)mm,差异有统计学意义(P＜0.05).胸椎高度术前为(18.5±1.9)cm,末次随访时增至(24.4±3.0)cm;脊柱高度术前为(29.3±3.7)cm,末次随访时增至(38.7±4.4)cm,差异均有统计学意义(P均＜0.05).结论 对于3.0～7.5岁儿童双侧不平衡型多发半椎体畸形,后路选择性半椎体切除短节段固定矫形效果较好,同时可维持躯干整体平衡,保留脊柱生长潜能.     

儿童腰骶部半椎体一期后路切除短节段固定治疗效果分析

目的评价儿童先天性腰骶部畸形一期后路半椎体切除、短节段固定治疗的手术效果。方法回顾性分析2014年1月至2017年12月首都医科大学附属北京儿童医院诊治的21例腰骶部半椎体患儿的临床资料,均行腰骶部一期后路半椎体切除术以及短节段固定融合术,随访至少24个月。术前、术后及末次随访时患儿均行站立位全脊柱正侧位X线检查。对比术前、术后以及末次随访时结构性侧凸、近端代偿弯、胸椎后凸、腰椎前凸的Cobb角、躯干偏移、矢状面平衡以及骨盆入射角、骨盆倾斜角、骶骨倾斜角。结果 21例中男12例,女9例;手术年龄2.17～13.00岁,平均(6.50±3.22)岁;术后随访24～84个月,平均(48.10±17.72)个月;融合固定2～4个椎体,平均(2.67±0.91)个椎体;手术时间120～300 min,平均(168.57±46.18) min;术中出血量100～1 000 m L,平均(368.04±234.58)m L;侧凸Cobb角由术前的(28.9±6.3)°降至术后的(8.5±3.0)°,末次随访时为(7.0±3.4)°,矫正率为75.8%。冠状面近端代偿弯Cobb角由术前(25.8±11.7)°自发性矫正为末次随访时(13.7±8.3)°,矫正率为46.9%。术后躯干偏移较术前均有明显改善,末次随访冠状面及矢状面的矫正率分别为53.1%和56.3%,且随访过程中躯干趋于平衡和稳定。所有病例术前、术后脊柱-骨盆序列均保持平衡,术后无脊髓神经功能损伤、感染等并发症。结论儿童腰骶部半椎体畸形一期后路半椎体切除、短节段固定可获得较好的侧凸矫正并改善躯干偏移,同时可保留一定的活动节段,有效控制畸形的加重和近端代偿弯的进展,避免腰椎长节段的固定融合。     

后路交叉置钉技术在青少年脊柱侧凸治疗中的应用

目的探讨后路交叉置钉技术对于治疗青少年脊柱侧凸的临床疗效。方法 2010年1月至2014年1月,68例青少年脊柱侧凸病例,男10例,女58例,年龄11~16岁,平均13.5岁;其中4例为神经肌肉型脊柱侧凸,其余为特发性脊柱侧凸;术前冠状面主弯Cobb角平均56.2°,胸椎(T5~T12)后凸角度平均17.7°,手术方法为后路交叉置入椎弓根螺钉对脊柱侧凸进行矫正,对术后Cobb角、主弯Cobb角矫正率结果进行评价。结果术后随访12~40个月,平均22.5个月。术后主弯Cobb角矫正到18.5°,与术前比较有差异(t=3.705,P0.01),末次随访时平均20.2°,与术后比无差异(t=1.053,P0.05)。胸椎(T5~T12)后凸角术后平均22.8°,末次随访时平均23.2°,术前与术后、术后与末次随访相比较均无差异(P0.05)。术后主弯Cobb角矫正率为70.5%,而末次随访时虽然主弯矫正率(69.4%)有一定丢失,但和术后比较无差异(t=0.126,P0.05)。术后无患者出现脊髓或神经根损伤。末次随访时无内固定松动及断钉断棒,植骨融合牢固,均未出现明显的矫正丢失。结论对于青少年脊柱侧凸后路手术矫正,采用交叉置钉技术是一项值得推广的低费用、高安全的脊柱侧凸矫正技术。     

前后路Ⅰ期手术治疗重度僵硬性青少年特发性脊柱侧弯

目的 评价前后路Ⅰ期手术治疗重度僵硬性青少年特发性脊柱侧弯的临床疗效,探讨其手术适应证及手术操作要点.方法 回顾性分析2002年1月至2007年6月本院应用前后路Ⅰ期手术治疗21例重度僵硬性青少年特发性脊柱侧弯患儿的临床资料,年龄8～16岁,平均13.8岁.结果 7例行I期胸腔镜前路松解联合后路矫形手术,末次随访主侧弯冠状面Cobb角平均矫正率为70.3%;14例行Ⅰ期传统开放前路松解、截骨、骨骺阻滞联合后路矫形手术,末次随访主侧弯冠状面Cobb角平均矫正率为67.2%.末次随访未发现椎弓根螺钉松动、断裂、曲轴现象、平背畸形、假关节形成、肺功能下降等并发症.患儿外观畸形改善或矫正.结论 通过术前选择适宜的病例,术中严格操作,前后路Ⅰ期手术治疗重度僵硬性青少年特发性脊柱侧弯可取得良好的临床疗效,并可减少手术相关并发症,缩短住院时间及减少医疗费用.     

Radiological and cosmetic improvement 2 years after brace weaning--a case report

In the early international literature, up to now only very few cases are reported with adolescent idiopathic scoliosis (AIS) and a significant improvement of Cobb angle after conservative management. In the recent literature the possibility of an improvement of Cobb angle at skeletal maturity after brace treatment is mentioned no more. The application of physiotherapy and braces is widely rejected while the standards of conservative measures differ greatly worldwide. So it seems necessary more than ever to present the possibility of successful conservative measures nowadays. More detailed case reports with long-term follow-up using defined protocols are needed to provide appropriate standards for replication by others. The purpose of this presentation is to demonstrate the possibility of significant improvement of curvature angle and cosmesis after the application of long-term physiotherapy and brace treatment in a girl with a curve of more than 50 degrees where spontaneous resolving is not usual. A pre-menarchial girl (although being Risser 2) with a Cobb angle of 53 degrees was treated by exercises and curve-specific bracing for more than 3 years. Two years after the start of the weaning period, the Cobb angle was 36 degrees with a marked and stable cosmetic improvement at the age of 18 years. This case report shows that conservative treatment can improve both cosmesis and curvature in immature patients with AIS. The results of such treatment is appreciated by the patients because of the significant reduction of the truncal deformity as documented by surface topography.     

Sagittal counter forces (SCF) in the treatment of idiopathic scoliosis: a preliminary report

BACKGROUND: In patients with idiopathic scoliosis (IS), reduced thoracic kyphosis and reduced lumbar lordosis frequently occur in correlation with the lateral spinal curvature. Normalization of the sagittal profile and hyper-correction of the deviation in frontal and coronal plane are the main issues of the latest concept of bracing. The purpose of this study was to investigate the influence of of sagittal counter forces (SCF) on the scoliotic deformity. STUDY DESIGN: A case series of four patients with IS treated with two braces designed to improve the sagittal profile (Rigo-System-Chêneau-brace and with a sagittal counter force brace, SCF-brace). METHODS: The short-term effect (30 min) of both braces was evaluated using surface topography (Formetric surface topography system, Diers International, Wiesbaden). RESULTS: One patient (Cobb angle 92 degrees ) showed no short-term correction in the frontal and coronal planes; others (Cobb angles between 39 and 48 degrees ) exhibited valuable correction in frontal and coronal planes. There was no short-term correction in the sagittal plane for either brace. CONCLUSION: The application of sagittal counter forces (SCF) seems to have similar short-term effects as 3D correction and should be addressed more in future concepts of scoliosis bracing.     

Estimating the final outcome of brace treatment for idiopathic thoracic scoliosis at 6-month follow-up

OBJECTIVE: The study was conducted on the possibility of predicting the final outcome of bracing for idiopathic scoliosis at a follow-up period of 6 months. METHODS: In a retrospective study, 62 adolescent female patients with right thoracic scoliosis (20-40 degrees Cobb angle) treated with a brace were examined. A new compliance score was developed. The sample was divided into four groups based on compliance (compliance score) and initial correction (half-year after start bracing): group A, good compliance/high initial correction; group B, good compliance/low initial correction; group C, bad compliance/high initial correction; group D, bad compliance/low initial correction. The final outcome (1 year after weaning) was defined as successful if a curve correction of at least 5 degrees was achieved. The influence of factors on final outcome was analysed by ANOVA. Differences between continuous data were analysed by a two-sample Wilcoxon test. RESULTS: The overall final outcome was not successful (thoracic curve -3 degrees). However, the average outcome of the compliant group was successful (-5 degrees), while no success was achieved without good compliance (+5 degrees). High initial correction of more than 40% (p < 0.002) and good compliance (p< 0.004) were of significant impact for the outcome. Patients showing good compliance and high initial correction presented a successful outcome of 7 degrees Cobb angle. CONCLUSION: Compliant patients with a high initial correction can expect a final correction of around 7 degrees, while compliant patients with low initial correction may maintain the curve extent. Bad compliance is always associated with curve progression.     

手工测量特发性脊柱侧弯Cobb角的可靠性评价

目的 应用无标记的X线片评价手工测量特发性脊柱侧弯Cobb角的可信度和可重复性.方法 4名骨科医师独立对53例患儿的术前站立位全脊柱正位及侧位X线片进行2次冠状面及矢状面Cobb角测量,2次测量间隔2周.冠状面主弯和Cobb角大于10°的代偿弯以及与Lenke和/或PUMC分型相关的矢状面T2～5,T5～12、T10～L2、T12～L1角度纳入分析.应用组内相关系数判定可靠性和可重复性.结果 36例上胸弯、53例胸弯、41例胸腰弯/腰弯及矢状面T2～5、T5～12、T10～L2及T12～L1后弯Cobb角各53例纳入分析,主弯Cobb角22°～167°,平均54.4°.结果 显示冠状面各角度测量中,上胸弯Cobb角的可信度(γ=0.592～0.714)和可重复性(γ=0.538～0.735)最差,有中等到好的一致性.胸弯Cobb角测量达到好到极佳的可信度(γ=0.881～0.942)和极佳的可重复性(γ=0.919～0.964).胸腰弯/腰弯角度测量有中等到极佳的可信度(γ=0.649～0.915)和好到极佳可重复性(γ=0.875～0.930).矢状面测量中,T2～5后弯Cobb角测量的可靠性最差,仅有低到中等的可信度(γ=0.373～0.662)和可重复性(γ=0.433～0.527).T5～12、T10～L2、T12～L1后弯cobb角测量均有好到极佳的可信度(分别为γ=0.787～0.909;0.857～0.964;0.889～0.983).T5～12Cobb 角测量有好到极佳的可重复性(γ=0.873～0.943),T10～L2、T12～L1 Cobb角测量均有极佳的可重复性(分别为γ=0.915～0.968;0.937～0.981).结论 大多数的角度测量指标有好到极佳的可信度和可重复性,可以应用于临床工作和科研中.总体上冠状面角度测量一致性较矢状面好.由于受到周围组织阴影干扰,冠状面上胸弯和矢状面T2～5 Cobb角测量的一致性较差.     

Single-staged anterior and posterior spinal fusion: A safe and effective alternative for severe and rigid adolescent idiopathic scoliosis in China

Aim:   Delayed treatment of adolescent idiopathic scoliosis (AIS) is common in Mainland China because of the lack of public education about health care resulting in the reluctance to undergo surgery. This leads to a high incidence of complex cases where surgeons may not be trained in advanced procedures. We report the efficacy of single-staged anterior and posterior spinal fusion for correction of severe AIS in China.
Methods:   A retrospective review was performed of 31 consecutive cases in which patients were treated at the Orthopaedic Department of Changhai Hospital in Shanghai between 2001 and 2004 with a combined anterior and posterior spinal fusion with screws, hooks, sublaminar wires or cables.
Results:   Thirty-one patients with AIS with Lenke type 1, 2, 3 and 4 curves were included for analysis. At least one of the curves was ≥90° in each patient. The mean coronal and sagittal Cobb angles of the main thoracic curve were 98° and 22° before surgery, 50.5° and 21° after surgery, and 53.7° and 24° at follow-up, respectively. No neurological deficits or deaths occurred. Solid arthrodesis with coronal and sagittal balance was achieved in all patients.
Conclusions:   A single-stage anterior release and fusion and posterior fusion for treatment of severe AIS is good alternative to pedicle screws/vertebrectomy on the basis of risk–benefit balance, and can be performed by surgeons not experienced in more complex procedures. The risk of pulmonary complications may be preferable to the risk of severe neurological complications when thoracic pedicle screws are applied, especially when surgeons are not adequately trained in their use.     

后路椎弓根钉系统治疗Ⅰ型神经纤维瘤病合并小儿脊柱畸形

目的 回顾性研究16例神经纤维瘤病性脊柱畸形患儿的外科治疗结果,分析侧后弯分类与手术效果的关系.方法 2004至2008年资料完整的NF-1型脊柱畸形患儿16例,男12例,女4例,平均年龄8.4岁,平均随访时间2.6年.16例均为营养不良型.按照顶椎位置分为3组:胸弯组、胸腰弯组、单纯腰弯组.根据畸形类型和位置选择后路椎弓根钉系统矫形同定脊柱融合或前后路脊柱融合.所有病例行完整的影像学检查,并进行侧弯角度与手术效果之间关系的评估.结果 观察指标为脊柱冠状面及矢状面Cobb角的变化.冠状面和矢状面的矫形率分别达到65.3%和51.2%,侧弯最大矫正率89.8%,最小20%,后弯最大矫正率89.6%,最小25.9%,随访中丢失角度为5.8°和2.7°.无断棒、断钉、融合不良及内固定失败,随访期间未发现假关节存在,1例应用MOSS-MIAMI器械患儿手术半年后返院,因需增加融合范围再次行后路植骨手术.结论 神经纤维瘤病性脊柱畸形治疗较为复杂,难度较大,应用椎弓根钉系统后路矫形固定治疗此类畸形尤其是营养不良型NF-1型侧弯及后弯可获得较好的治疗效果.     

Brace treatment during pubertal growth spurt in girls with idiopathic scoliosis (IS): a prospective trial comparing two different concepts

STUDY DESIGN: Prospective comparison of the survival rates of two different bracing concepts with respect to curve progression and duration of treatment during pubertal growth spurt in two cohorts of patients followed up prospectively. OBJECTIVES: To determine whether the results obtained by the use of a soft brace (SpineCor) is comparable to the results of the Chêneau derived TLSO during pubertal growth spurt. BACKGROUND DATA: In recent peer reviewed literature, the SpineCor is described as an effective method of treatment for patients with scoliosis. However, until now, no controlled study has been presented comparing the results obtained with this soft brace to a sample treated with other bracing concepts proven effective. METHODS: Twelve patients with Cobb angles between 16-32 degrees during pubertal growth spurt are presented as a case series treated with the SpineCor. The survival rate of this sample is described and compared to a matched group of patients treated with the Chêneau brace of the same age group. All girls treated in both studies were pre-menarchial with the first clinical signs of maturation (Tanner 1-3). RESULTS: During the pubertal growth spurt, most of the patients (11/12) with SpineCor progressed clinicly and radiologicly as well (at least 5 degrees ). Progression could be stopped changing SpineCor to the Chêneau brace in most of the samples described (7/10). The avarage Cobb angle at the start of treatment with the SpineCor was 21.3 degrees , after an avarage observation time of 21.5 months, 31 degrees. The control sample, primarily treated with the Chêneau brace (n=15), showed at average no progression. Cobb angle at the start of treatment was 33.7 degrees and after the observation time of 37 months, 33.9 degrees . Radiological improvements can be reported for some of the cases (3/15) as well as progressions (3/15). At 24 months of treatment time, 73% of the patients with a Chêneau brace and 33% of the patients with the SpineCor where still under treatment with their original bracing concept, at 42 month follow-up time 80% of the patients with Chêneau braces and 8% of the patients with the SpineCor survived with respect to curvature progression. The differences of the proportions statisticly where highly significant. CONCLUSIONS: The SpineCor does not change natural history of idiopathic scoliosis during the pubertal growth spurt. The use of the Chêneau brace seems to do so. Oncoming studies with the aim to test the efficiency of braces should be based on samples at immediate risk for progression (only girls with first signs of maturation but pre-menarchial).     

THORACIC KYPHOSIS AND LUMBAR LORDOSIS DURING THE GROWTH PERIOD IN CHILDREN

ABSTRACT. The thoracic kyphosis and the lumbar lordosis were studied in 1101 healthy children in consecutive age-groups between 8 and 16 years of age. The sagittal curves were estimated with a spinal pantograph–a noninvasive device–with the child standing in a relaxed position. The accuracy and the reproducibility of this technique are studied and shown to be acceptable. The thoracic kyphosis varied in both boys and girls. The least pronounced kyphosis was seen at the age of 10–12 years. At the age of 8 and 14–16 the mean range of the kyphosis increased statistically significantly. A positive correlation was also seen between the velocity of growth and the range of the kyphosis. In the lordosis, a similar trend could not be seen, but instead a slow continuous increase. A positive correlation was also observed between the ranges of the kyphosis and lordosis in most of the age-groups. An individual variation was, however, seen and wide ranges of kyphosis as well as lordosis must be accepted as normal variations.