马方和类马方综合征合并脊柱侧凸患者肺功能障碍的模式及影响因素

目的 探讨合并脊柱侧凸的马方和类马方综合征患者肺功能损害的模式及其影响因素.方法 回顾性分析1998年2月至2007年9月行脊柱侧凸矫形内固定手术且有术前肺功能资料的25例马方和类马方综合征患者(A组)的临床资料,其中男性11例,女性14例;年龄11～20岁,平均15岁.分析其肺功能指标(实测值与预计值的比值)与冠状面Cobb角、胸弯顶椎位置、受累节段数以及胸椎后凸角的关系.并与同期行脊柱侧凸矫形内固定术且弯型与此匹配的38例青少年特发性脊柱侧凸(MS)患者(B组)的肺功能指标进行比较分析.结果 A组患者肺活量(VC)、用力肺活量(FVC)、第1秒最大呼气容积(FEVI)等指标与冠状面Cobb角呈显著负相关(r=0.514、-0.503、-0.464,P<0.05);VC、FVC、FEV1以及最大呼气中期流量(MMEF)等指标明显小于B组(P<0.05);顶椎位置在T_(4～8)与在T_(9～12)的患者之间肺功能指标差异无统计学意义;受累节段≥8的患者,VC、FVC、FEV1和最大自主通气量(MVV)等指标小于受累节段<8者(P<0.05);胸椎后凸角与肺功能指标之间无明显相关性.结论 合并脊柱侧凸的马方和类马方综合征患者肺功能损害较MS患者严重,其肺功能主要受胸弯受累节段数和胸弯冠状面Cobb角共同影响.     

支具治疗对女性青少年特发性脊柱侧凸患者肺功能的影响

目的:观察支具治疗对女性青少年特发性脊柱侧凸(AIS)患者肺功能的影响。方法:2001年2月~2009年12月283例女性AIS患者在我院接受矫形手术治疗,术前检测患者用力肺活量(FVC)、第1秒用力呼气容积(FEV1),记录预计值、实测值及实测值占预计值百分比。根据术前是否曾接受支具治疗分为2组,支具治疗组80例(A组),未接受支具治疗组203例(B组)。分析2组患者术前肺功能参数的差异,同时对A组患者肺功能FVC及FEV1的实测值占预计值百分比(FVC%、FEV1%)与术时年龄、身高、主弯冠状面Cobb角、主侧凸累及节段数、主胸弯矢状面Cobb角、每日支具治疗时间、支具治疗总时长进行多元线性回归分析。结果:A、B组患者FVC预计值分别为3.23±0.40L和3.20±0.40L,FEV1预计值分别为2.76±0.40L和2.73±0.30L,A组与B组比较均无统计学差异(P>0.05);A、B组FVC实测值分别为2.58±0.60L和2.72±0.60L,FEV1实测值分别为2.34±0.50L和2.49±0.50L,A、B组FVC%分别为(80.3±16.5)%和(85.4±16.5)%、FEV1%分别为(85.6±18.4)%和(91.3±16.9)%,A组FEV1实测值、FVC%及FEV1%较B组均明显降低(P<0.05),其中主弯为胸弯患者(173例)明显(P<0.05),而主弯为胸腰弯/腰弯患者(110例)不明显(P>0.05)。A组患者中,胸段侧凸矢状面Cobb角与FVC%、FEV1%呈正相关(P<0.05),支具治疗总时长与FEV1%呈负相关(P<0.05);而术时年龄、身高、主弯冠状面Cobb角、主侧凸累及节段数、每日支具治疗时间(8~23h,平均18.7h)与FVC%及FEV1%均无显著相关性(P>0.05)。结论:支具治疗可使女性青少年特发性胸段脊柱侧凸患者肺功能FVC%及FEV1%下降,支具治疗总时长和胸段侧凸矢状面Cobb角可能是影响患者肺功能FVC%及FEV1%的相关因素。     

轻中度青少年特发性脊柱侧凸肺功能的影响因素分析

目的探讨轻中度青少年特发性脊柱侧凸(Adolescent Idiopathic Scoliosis,AIS)肺功能的影响因素。方法选取2016-01-2018-02,我院收治的60例青少年特发性脊柱侧凸患者,作为观察组;选择正常健康青少年20例,作为对照组。测定所有患者的肺功能指标,包括用力肺活量(FVC)、FVC预计值(FVC pred)、FVC占预计值的百分比(FVC pred%)、第1秒用力呼气量(FEV1)、FEV1预计值(FEV1 pred)、FEV1占预计值百分数(FEV1 pred%)、FEV1占FVC百分数(FEV1/FVC%)。结果两组FVC、FVC pred%、FVC pred、FEV1、FEV1 pred指标比较,差异无统计学意义(P0.05),而FEV1 pred%和FEV1/FVC%差异有统计学意义(P0.05)。根据患者脊柱不同侧凸类型比较,FVC、FEV1差异有统计学意义(P0.05)。AIS患者不同性别比较,各项肺功能指标FVC、FEV1/FVC%、FVC pred、FEV1 pred、FVC pred%、FEV1/FVC%、FEV1差异均无统计学意义(P0.05)。AIS患者的年龄相关系数比较中,FVC、FEV1、FVC pred、FEV1 pred比较差异有统计学意义(P0.05);最大Cobb角与FVC、FVC pred、FVC pred%、FEV1、FEV1 pred、FEV1 pred%、FEV1/FVC%均无相关性(P0.05)。结论轻、中度青少年特发性脊柱侧凸会导致肺功能障碍,并且与年龄成正比,而不同侧凸类型和Cobb角的大小与肺功能无关。     

青少年特发性脊柱侧凸患者脊柱柔韧性的影响因素

目的:探讨青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者脊柱柔韧性的可能影响因素.方法:选取2006年12月～2008年4月在我院脊柱外科手术治疗的204例AIS患者,男性36例,女性168例,平均年龄15.0岁;平均Cobb角50.1°;平均Risser征3.4度;主弯跨度平均6.8个椎体;主弯顶椎旋转度平均2.0度.摄站立位全脊柱正侧位及仰卧左右侧屈位X线片,计算主弯柔韧性.采用相关分析研究各临床指标与主弯柔韧性的相关性.结果:女性AIS患者的脊柱柔韧性明显高于男性(P<0.05);胸腰弯组和腰弯组AIS患者的脊柱柔韧性显著大于胸弯组(P<0.05),胸腰弯和腰弯组之间无显著性差异(P>0.05).女性AIS患者中的年龄及主弯Cobb角(站立位与侧屈位)均与脊柱柔韧性显著负相关(P<0.05),且胸弯女性AIS患者的月经初潮至手术时间及顶椎旋转度也与脊柱柔韧性显著负相关(P<0.05).男性胸弯AIS患者中侧屈位主弯Cobb角、胸腰弯/腰弯组中主弯Cobb角(站立位与侧屈位)均与脊柱柔韧性显著负相关(P<0.05).主弯跨度及Risser征与脊柱柔韧性均无明显相关性(P>0.05).结论:女性AIS患者脊住柔韧性受年龄、月经初潮至手术时间、主弯Cobb角(站立位与侧屈位)、弯型及顶椎旋转度等因素影响;男性AIS患者的脊柱侧凸柔韧性主要受主弯Cobb角及弯型影响.     

Ⅰ型神经纤维瘤病合并脊柱侧凸患者肺功能损害模式的研究

目的 分析I型神经纤维瘤病(NF1)合并脊柱侧凸患者肺功能损害的模式,以及影响其肺功能的影像学因素.方法 选取2003年1月至2009年6月间收治的NF1合并脊柱侧凸患者36例(NF1组),特发性脊柱侧凸(IS)患者64例(IS组),术前检测患者的肺活量(VC)、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、最大呼气中期流量(MMEF)、最大自主通气量(MVV).比较两组肺功能参数的差异.按照弯型部位及有无萎缩性改变将NF1组患者分类并分类比较肺功能损害的差异,分析影响肺功能的影像学指标.结果 两组肺功能参数VC、FVC、FEV1、MMEF、MVV差异均无统计学意义(P>0.05).NF1组胸弯患者肺功能显著低于非胸弯患者;营养不良型患者与非营养不良型患者肺功能损害差异无统计学意义(P>0.05);顶椎位置以及Cobb角与肺功能参数显著相关(P<0.05).结论 NF1合并脊柱侧凸患者的肺功能损害模式与IS患者类似,胸弯患者比非胸弯患者肺功能损害严重,侧凸位置以及Cobb角大小是影响患者肺功能的主要因素.     

小角度青少年特发性脊柱侧凸患者弯型的性别差异

目的:探讨小角度青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者弯型是否存在性别差异.方法:274例AIS患者,女性213例,年龄13～18岁(15.3±1.4岁),Risser征3～5(3.7±0.6),Cobb角10°～40°(26.7°±6.1°);男性患者61例,年龄14～18岁(15.7±1.0岁),Risser征3～5(3.5±0.5),Cobb角10°～40°(25.9°±5.9°).对所有患者拍摄前后位全脊柱X线片,然后对X线片检查结果进行分析.并测量冠状面侧凸Cobb角和躯干偏移距离.对不同性别间测量结果进行统计学分析.结果:小角度AIS患者不典型弯型脊柱侧凸的发生率为8.8%,其中男性小典型弯型脊柱侧凸的发病率为16.4%,明显高于女性的6.6%(P<0.05).两组均以单胸弯最为常见,各种典型弯犁在两组中的分布没有显著性差异(P>0.05).在胸弯中,胸椎左侧凸的发生率为3.4%,其中男性患者胸左侧凸的发病率为10.7%,明显高于女性的1.7%(P<0.05).在冠状面上,男性患者的躯干失平衡率为28.3%,明显高于女性的20.1%(P<0.01).结论:小角度AIS各种典型弯型脊柱侧凸的分布没有性别差异.但男性患者小典型弯型脊柱侧凸和冠状面躯干失平衡的发生率明显高于女性患者.     

女性青少年特发性脊柱侧凸患者自我形象评估的相关影响因素分析

目的:探讨女性青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者自我形象评估的影响因素。方法:回顾性分析2010年9月～2011年3月在我院就诊的252例女性AIS患者,年龄12～18岁,平均14.5±1.8岁。均摄取患者站立位全脊柱正侧位X线片,并独立填写一份简体中文版SRS-22问卷。在站立位全脊柱正侧位X线片上测量Cobb角、顶椎旋转度、胸椎后凸角、腰椎前凸角、脊柱冠状面力线偏移及脊柱矢状面力线偏移等参数。采用相关分析研究各临床指标与自我形象评分的相关性。结果:患者平均Cobb角35.5°±12.8°;平均顶椎旋转度2.0°±0.7°;平均胸椎后凸角16.2°±9.0°;平均腰椎前凸角51.3°±9.8°;平均脊柱冠状面力线偏移1.2±0.7cm;平均脊柱矢状面力线偏移2.4±1.5cm;平均体重指数18.3±2.2;平均自我形象评分16.7±2.8分。胸弯和胸腰弯/腰弯的自我形象评分均与主弯Cobb角有相关性(r分别为-0.171,-0.225,P均<0.05);其中大角度胸弯组呈显著相关(r=-0.484,P=0.005)。而其他参数与患者自我形象评估均无明显相关性(P均>0.05)。结论:女性AIS患者的自我形象主要受主弯Cobb角的影响,其中大角度胸弯患者的自我形象受主弯Cobb角的影响最大。     

特发性与先天性脊柱侧凸患者肺功能障碍的差异性比较

目的：比较特发性脊柱侧凸（idiopathic scoliosis，IS）与先天性脊柱侧凸（congenital scoliosis．CS）患者肺功能参数的差异性。方法：术前检测214例脊柱侧凸患者的肺活量（vital capacity，VC）、用力肺活量（forced vital capacity，FVC）、第1秒用力呼气容积（forced expiratory volume in one second，FEV1）、最大呼气中期流量（maximal mid-expiratory flow，MMEF）、最大自主通气量（maximal voluntary ventilation，MVV），计算实测值占预计值百分比（实／预％），其中IS 141洌（IS组），CS73例（CS组），将肺功能指标与Cobb角进行相关分析。依据主弯顶椎所在位置分为胸段及非胸段侧凸两组，胸段侧凸依据Cobb角大小分为：Cobb角〈600（A组）、60&#176;≤Cobb角〈90&#176;（B组）、Cobb角≥90&#176;（C组）3组。分析胸段及非胸段IS、CS患者术前肺功能参数的差异．同时比较年龄≤10岁的IS、CS患者各参数的差异。结果：脊柱侧凸患者VC、FVC、FEV1、MMEF及MVV的实／预％与Cobb角呈显著性负相关（r=-0．40--0.55）。在胸段侧凸患者中，CS组的FEV1实／预％为64．2％，明显低于IS组患者的80．0％（P〈0．05）；不同Cobb角CS组患者的VC、FVC、FEV1、MVV实／预％值都较相应Cobb角的IS组患者低（P〈0．05）。非胸段侧凸患者中，CS组的VC、FVC、MVV的实／预％较IS组患者低（P〈0．05）。年龄≤10岁的CS与IS患者肺功能指标比较也具有显著性差异（P〈0．05）。结论：IS和CS患者均存在肺功能损害，但损害模式不同，IS以限制性通气功能障碍为特征，CS表现为混合性通气功能障碍；年龄和Cobb角相匹配时．无论在胸段还是非胸段，CS患者的肺功能损害均较IS患者严重；且两者肺功能损害的差异性在青春期前就存在。     

不同弯型青少年特发性脊柱侧凸患者脊柱-骨盆矢状面参数研究

目的:探讨不同弯型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者脊柱-骨盆矢状面平衡情况。方法:回顾性分析2013年9月~2014年12月我科收治的161例AIS患者,其中男34例,女127例,年龄12~17岁(14.6±2.1岁)。在术前站立位全脊柱正侧位X线片上测量主弯Cobb角、颈椎角(cervical sagittal alignment,CSA)、胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacrum slope,SS)以及C7铅垂线与S1后上缘的水平距离(sagittal vertical axis,SVA)。根据不同弯型将AIS患者分为单胸弯组、双胸弯组和腰弯组,比较3组间脊柱-骨盆矢状位参数的差异,采用Pearson相关性分析对各参数间的相关性进行分析。结果:单胸弯组61例,其中男13例,女48例,主弯Cobb角为51.2°±8.7°;双胸弯组40例,其中男7例,女33例,主弯Cobb角为53.7°±5.2°;腰弯组60例,男14例,女46例,主弯Cobb角为48.9°±4.8°。3组患者年龄及性别分布均无统计学差异(P0.05)。3组间Cobb角大小的差异无统计学意义(P0.05)。单胸弯组的CSA、TK均显著小于双胸弯和腰弯组(P0.05),但后两组间的差异无统计学意义(P0.05),余各项矢状面参数3组间无统计学差异(P0.05)。在3组患者中,CSA与TK均呈显著性正相关(单胸弯组r=0.73,P0.05;双胸弯组r=0.29,P0.05;腰弯组r=0.60,P0.05),但与LL及骨盆参数(PI、SS、PT)无显著相关性(P0.05)。双胸弯组TK与LL呈正相关性(r=0.40,P0.05),而在另外两组则无相关性(P0.05)。结论 :单胸弯型AIS患者较双胸弯型和腰弯型患者具有更小的颈椎前凸,3种弯型AIS患者的颈椎前凸均与TK呈正相关。单胸弯型患者的TK较另外两种弯型患者更小。双胸弯型患者的TK与LL密切相关,而单胸弯型与腰弯型患者的TK与LL无关。     

马方综合征脊柱侧凸患者术前SRS-22、SF-36问卷心理健康评分分析:与青少年特发性脊柱侧凸患者的比较

背景:脊柱畸形不仅影响青少年的外观,还会影响患者的心理健康。但关于马方综合征脊柱侧凸(MSS)畸形对青少年心理健康影响的文献报道并不多。目的:分析接受矫形手术的MSS患者术前SRS-22问卷和SF-36问卷中的心理健康评分情况,并与青少年特发性脊柱侧凸(AIS)患者进行比较。方法:回顾分析2010年9月至2014年8月在我院接受手术治疗的28例MSS患者的SRS-22问卷及SF-36问卷结果,其中男7例,女21例;术时年龄11~19岁,平均14.8岁。选取同期收治的56例AIS患者的资料进行配比,男7例,女49例;年龄11~17岁,平均14.3岁。比较两组患者的临床及影像学参数、SRS-22问卷和SF-36问卷中的心理健康评分的差异。结果:MSS组与AIS组患者SRS-22问卷心理健康平均得分分别为3.6±0.5和3.8±0.6,总得分分别为17.8±2.7和19.2±3.0。MSS组与AIS组患者SF-36心理健康最终得分分别为66.3±11.4和71.9±10.3。上述SRS-22问卷及SF-36问卷心理健康得分组间比较差异均有统计学意义(P<0.05)。得分差异主要来自于SRS-22问卷的Q20和SF-36问卷的Q9.8,其他问题得分差异无统计学意义。MSS组患者的上述心理健康评分与患者年龄、身高、体重指数、术前剃刀背高度、主弯冠状面Cobb角、顶椎偏距、术前冠状面躯干平衡情况、术前双肩及骨盆失平衡情况和矢状面胸后凸均无显著相关性(P>0.05)。结论:手术治疗的MSS患者的心理健康状况评分低于AIS患者,这种差异主要来源于问卷中有关愉快感受方面。MSS患者的心理健康状况评分与患者侧凸的临床及影像学参数无明显相关性。     

Postural control in siblings to scoliosis patients and scoliosis patients

The etiologic importance of postural dysfunction, as shown by many authors in adolescent idiopathic scoliosis (AIS), has been under great debate. The authors' hypothesis was that a factor that is involved in the development of the scoliotic curvature, would be present also in nonscoliotic siblings to scoliosis patients, as AIS is a hereditary transmitted disease. Postural function in 100 siblings to scoliotic children was investigated by means of stabilometry, and compared with a matched control group of healthy children, as well as a group of scoliotic children. The siblings showed a postural control function that was significantly different from both of the other groups. The siblings had a postural sway that was less than the sway measured in both controls and scoliosis patients. The sway was also more asymmetrical than in the two other groups. In the authors' opinion, the presence of this postural aberration in siblings indicates that it is a factor in the etiology of AIS.     

Follow-up problems in scoliosis patients

With reference to 4 different methods - theoretical derivation, computed model, recent radiological analysis based on 120 scoliosis patients and measurement of the posterior median line in 40 scoliosis patients - the unreliability of follow-up in scoliosis patients is illustrated. The results are compared with previous publications by other authors and discussed. A method of determining spinal geometry three-dimensionally by means of topometric methods (5) is described. The validity of this measuring method is demonstrated in the patient by geometrical measurement of the posterior median line without treatment, under halo gravity extension and in movement.     

Intraspinal anomalies in scoliosis: An MRI analysis of 177 consecutive scoliosis patients

Background:

The association of intraspinal neural anomalies with scoliosis is known for more than six decades. However, there are no studies documenting the incidence of association of intraspinal anomalies in scoliotic patients in the Indian population. The guide lines to obtain an magnetic resonance imaging (MRI) scan to rule out neuro-axial abnormalities in presumed adolescent idiopathic scoliosis are also not clear. We conducted a prospective study (a) to document and analyze the incidence and types of intraspinal anomalies in different types of scoliosis in Indian patients. (b) to identify clinico-radiological ‘indicators’ that best predict the findings of neuro-axial abnormalities in patients with presumed adolescent idiopathic scoliosis, which will alert the physician to the possible presence of intraspinal anomalies and optimize the use of MRI in this sub group of patients.

Materials and Methods:

The data from 177 consecutive scoliotic patients aged less than 21 years were analyzed. Patients were categorized into three groups; Group A - congenital scoliosis (n=60), group B -presumed idiopathic scoliosis (n=94) and group C - scoliosis secondary to neurofibromatosis, neuromuscular and connective tissue disorders (n=23). The presence and type of anomaly in the MRI was correlated to patient symptoms, clinical signs and curve characteristics.

Results:

The incidence of intraspinal anomalies in congenital scoliosis was 35% (21/60), with tethered cord due to filum terminale being the commonest anomaly (10/21). Patients with multiple vertebral anomalies had the highest incidence (48%) of neural anomalies and isolated hemi vertebrae had none. In presumed ‘idiopathic’ scoliosis patients the incidence was higher (16%) than previously reported. Arnold Chiari-I malformation (AC-I) with syringomyelia was the most common neural anomaly (9/15) and the incidence was higher in the presence of neurological findings (100%), apical kyphosis (66.6%) and early onset scoliosis. Isolated lumbar curves had no anomalies. In group-C, incidence was 22% and most of the anomalies were in curves with connective tissue disorders.

Conclusion:

The high incidence of intraspinal anomalies in presumed idiopathic scoliosis in our study group emphasizes the need for detailed examination for subtle neurological signs that accompany neuro-axial anomalies. Preoperative MRI screening is recommended in patients with presumed ‘idiopathic’ scoliosis who present at young age, with neurological findings and in curves with apical thoracic kyphosis.     

Immunological suppression after surgery in scoliosis patients

This is a prospective study to analyze the postoperative immunological changes in scoliosis surgery. Twenty-eight patients who underwent Harrington instrumentation were analyzed. Seven patients who underwent arthroscopic surgery were analyzed as a control group. The objective of this study is to determine whether surgery and surgical stress (minor versus major surgery) changed the immune capability of patients as indicated by the ratio of lymphocyte cell types and interferon induction. Pre- and postoperative blood from scoliosis and knee arthroscopy patients was analyzed at various times using antisera and two-color flow cytometry with monoclonal antibodies. Both scoliosis and knee arthroscopy patients had a post-operative decrease in the population of B-lymphocytes (Leu 12+) and a transient increase in the natural killer cells (Leu 4-/Leu 19+) and the cytotoxic T-lymphocytes (Leu 2a++/Leu 15-). These changes were significantly greater in the scoliosis patients, who also experienced a prolonged decrease in the inducer T-lymphocytes (Leu 8+/Leu 3a+) for 3 weeks following surgery. Production of interferon-a and interferon- by lymphocytes was suppressed postoperatively and returned to preoperative levels within 3 weeks. Immunological depressive changes occurred postoperatively and lasted at least 1 week. These effects are more pronounced with longer surgeries, suggesting greater postoperative vigilance for infections in these cases.     

Gait analysis in patients with idiopathic scoliosis

Introduction The goal of this study was to observe scoliotic subjects during level walking to identify asymmetries—which may be related to a neurological dysfunction or the spinal deformity itself—and to correlate these to the severity of the scoliotic curve.Methods We assessed the gait pattern of ten females (median age 14.4) with idiopathic scoliosis characterised by a left-lumbar and a right-thoracic curve component. Gait analysis consisted of 3D kinematic (VICON) and kinetic (Kistler force plates) measurements. The 3D-segment positions of the head, trunk and pelvis, as well as the individual joint angles of the upper and lower extremities, were computed during walking and static standing. Calculation of pertinent kinetic and kinematic parameters allowed statistical comparison.Results All subjects walked at a normal velocity (median: 1.22 m/s; range:1.08–1.30 m/s; height-adjusted velocity: 0.75 m/s; range: 0.62–0.88 m/s). The timing of the individual gait phases was normal and symmetrical for the whole group. Sagittal plane hip, knee and ankle motion followed a physiological pattern. Significant asymmetry was observed in the trunks rotational behaviour in the transverse plane. During gait, the pelvis and the head rotated symmetrically to the line of progression, whereas trunk rotation was asymmetric, with increased relative forward rotation of the right upper body in relation to the pelvis. This produced a torsional offset to the line of progression. Minimal torsion (at right heel strike) measured: median 1.0° (range: 5.1°–8.3°), and maximal torsion (at left heel strike) measured 11.4° (range 6.9°–17.9°). The magnitude of the torsional offset during gait correlated to the severity of the thoracic deformity and to the standing posture, whereas the range of the rotational movement was not affected by the severity of the deformity. The ground reaction forces revealed a significant asymmetry of [Msz], the free rotational moment around the vertical axis going through the point of equivalent force application. On the right side, the initial endo-rotational moment was lower, followed by a higher exo-rotational moment than on the left. All the other force parameters (vertical, medio–lateral, anterior–posterior), did not show a significant side difference for the whole group. The use of a brace stiffened torsional motion. However the torsional offset and the asymmetry of the free rotational moment remained unchanged.Conclusion The most significant and marked asymmetry was seen in the transverse plane, denoted as a torsional offset of the upper trunk in relation to the symmetrically rotating pelvis. This motion pattern was reflected by a ground-reaction-force asymmetry of the free rotational moment. Further studies are needed to investigate whether this behaviour is solely an expression of the structural deformity or whether it could enhance the progression of the torsional deformity.No financial assistance was provided for this work     

Persistent pain in patients following scoliosis surgery

Chronic or persistent pain is increasingly recognised as a consequence of surgery in a number of different disciplines. The pain often exhibit qualities that differ from the acute post-operative pain and may represent changes in the central nervous system. There is lack of information regarding the incidence of persistent pain in patients following spinal surgery for scoliosis. This study aims to estimate the incidence of persistent pain following spinal surgery for scoliosis in a group of mainly adolescent patients. Questionnaires were distributed to consecutive patients attending the outpatient clinic of a hospital with specialist services in paediatric orthopaedics and spinal surgery. One hundred and five patients out of 122 eligible patients completed the survey. Fifty-two percent had ongoing pain upon hospital discharge either in the primary surgical site and/or in the iliac bone graft site. Approximately 10 and 7% of all patients had back and pelvic pain persisting beyond 12 months, respectively. A small proportion described elements of neuropathic pain. There was a trend suggesting that those who experienced more severe post-operative pain were more likely to develop persistent pain. These data are consistent with those reports that implicate surgery as the trigger for chronic pain.     

Zinc status in patients with idiopathic scoliosis

The zinc content in m. sacrospinalis, hair, leukocytes of peripheral blood, and in serum was examined in 50 patients with idiopathic scoliosis treated by Harrington instrumentation. A control group included 20 patients treated for spinal column injury. A significant decrease of zinc content in back muscles was observed in patients with scoliosis. The value of zinc in hair, leukocytes, and serum did not differ compared with the control group. Similarly, the potassium and magnesium content in muscle was the same in both groups. These results do not suggest that there is a primary zinc deficiency in patients with idiopathic scoliosis. The authors consider the decreased zinc content in back muscle of patients with idiopathic scoliosis to be a secondary disturbance associated with primary deformation of the spinal column.     

Trunk muscle activities in braced scoliosis patients

There are two theories as to why bracing may prevent the progression of idiopathic scoliosis curves, the passive and the active theories. The passive theory is that progression is prevented by the forces exerted by the brace. The active theory is that progression is prevented by muscle contractions that arise in response to wearing the brace. This study examined the active theory of brace correction. Trunk muscle myoelectric activities were measured in ten adolescent females with right thoracic idiopathic scoliosis being treated with Boston braces. Activities were both measured when wearing and when not wearing their braces. Differences in braced and unbraced myoelectric activities were seldom statistically significant and never biomechanically significant. Boston brace effectiveness seems not to result from active responses to brace wearing.