智能手机Scoliometer软件在L_4~S_1融合术中获得最优化腰椎前凸角的价值

目的探讨智能手机Scoliometer软件在L4~S1融合术中获得最优化腰椎前凸角(lumbar lordosis,LL)的价值,并观察其准确性。方法将2014年11月-2015年2月收治并拟行L4~S1融合术的20例腰椎退行性疾病患者纳入研究。男8例,女12例;年龄41~65岁,平均52.3岁。病程6个月~6年,平均3.4年。术前摄标准腰骶椎侧位X线片,采用PACS影像系统测量骨盆入射角(pelvic incidence,PI)及L4~S1 Cobb角,参照公式[(PI+9°)×70%]计算理想L4~S1 Cobb角;术中矫形过程使用Scoliometer软件测量L4~S1 Cobb角,直至达理想L4~S1 Cobb角±5°范围;术后再次测量L4~S1 Cobb角。比较Scoliometer软件与PACs影像系统测量角度的一致性,以评估该软件测得角度的准确性及可靠性;比较理想L4~S1 Cobb角分别与手术前后L4~S1 Cobb角的差值,分析该方法的有效性。结果术前计算理想L4~S1 Cobb角为(36.17±1.53)°,PACS影像系统测得L4~S1 Cobb角为(22.57±5.50)°;术中矫正后Scoliometer软件测得L4~S1 Cobb角为(32.25±1.46)°;术后PACS影像系统测得L4~S1 Cobb角为(34.43±1.72)°。术中Scoliometer软件与术后PACS影像系统测量角度比较,组内相关系数为0.96、95%可信区间为(0.93,0.97),提示两者相关性很好;平均绝对误差为1.23°,提示Scoliometer软件与PACS影像系统测量角度有约1.23°的误差范围。理想L4~S1 Cobb角与手术前后PACS影像系统测得的L4~S1 Cobb角绝对差值分别为(13.60±1.85)、(2.31±0.23)°,比较差异有统计学意义(t=6.065,P=0.001)。结论智能手机Scoliometer软件可辅助医师在L4~S1融合术中获得最优化LL。     

经后路多点锚定技术治疗Ⅰ型神经纤维瘤病伴营养不良性脊柱侧凸的临床疗效

[目的]探讨经后路多点锚定技术治疗Ⅰ型神经纤维瘤病伴营养不良性脊柱侧凸的临床疗效。[方法]回顾性研究2005年1月~2013年12月本科收治的Ⅰ型神经纤维瘤病伴营养不良性脊柱侧凸23例;年龄10~22岁,平均13.6岁;其中胸弯13例,胸腰双主弯4例,胸腰弯3例,双胸弯2例,腰弯1例;术前冠状面Cobb角48.9°~91.4°,平均68.3°;凸侧Bending相Cobb角40°~79.2°,平均57.4°;柔韧性8.3%~28.1%,平均15.7%;顶椎旋转度2°~3°,平均2.3°;矢状面胸椎后凸Cobb角46.4°~79.6°,平均58.2°,胸腰段后凸Cobb角21.1°~35.7°,平均28.3°。均采用经后路多点锚定技术进行矫形融合固定。[结果]随访12~96个月,平均52个月。术后冠状面Cobb角16.3°~46.7°,平均28.4°;顶椎旋转度1°~2°,平均1.2°;矢状面胸椎后凸Cobb角16.1°~38.3°,平均25.3°,胸腰段后凸Cobb角-4.3°~18.7°,平均8.9°;术后各指标均获得良好的矫正,侧凸矫正率为46.3%~74.1%,平均56.9%。末次随访时侧凸矫正丢失率仅3.1%,无神经系统并发症,仅1例假关节形成。[结论]经后路多点锚定技术治疗Ⅰ型神经纤维瘤病伴营养不良性脊柱侧凸可获得较满意的矫形融合效果。     

胸腔镜辅助下治疗特发性脊柱侧凸

[目的]评价胸腔镜下前路松解,前路或后路矫形治疗特发性脊柱侧凸的治疗效果。[方法]回顾本院自2003年7月~2005年12月施行的11例胸腔镜辅助下前路松解,前路或后路矫形治疗特发性脊柱侧凸病例。年龄12~16岁,平均14.6岁。LenkeⅠ型9例,术前冠状面Cobb s角54°~68°,平均59.7°;LenkeⅢ型2例,术前冠状面Cobb s角分别为58°和71°,平均64.5°。Bending X线片侧凸矫正率为21.8%~32.4%,平均26.4%。对11例患者在胸腔镜辅助下,采用等离子冷消融切除椎间盘松解,前或后路矫正。对手术后及随访时,冠状面和矢状面的Cobb s角进行测量,并对手术时间,术中出血量,围手术期并发症及矫正丢失等进行分析。[结果]平均手术时间290 min,平均术中出血171 ml。松解节段5~7个,平均4.4个。9例LenkeⅠ型术后Cobb s角平均20.4°,Cobb s角矫正率平均65.8%;2例LenkeⅢ型术后Cobb s角分别为20°和25°,Cobb s角矫正率平均65.1%;1例术后包裹性胸腔积液,术后平均随访18.6个月;1例出现矫正度丢失14°,无神经系统及血管损伤并发症。[结论]与传统开胸前路胸椎侧凸矫形手术相比,胸腔镜辅助下胸椎松解前后路矫形治疗脊柱侧凸是安全有效的微创手术,可达到与开胸手术同样效果。     

后路单侧经椎弓根半椎体截骨治疗青少年先天性脊柱侧凸

目的评估后路经椎弓根截骨矫形部分半椎体保留治疗先天性半椎体所致脊柱侧凸畸形的临床疗效。方法共18例先天性半椎体合并脊柱侧凸患者纳入随访研究,平均年龄16.17岁（14～21岁）,术前测量半椎体所致脊柱畸形的节段性主弯Cobb角45.39°±6.81°,头侧代偿弯Cobb角27.5°±2.71°,尾侧代偿弯Cobb角为26.44°±6.85°,顶椎偏距为4.28±0.58cm,节段性后/前凸角度为14.11°±18.07°。所有病例均采用后路一期经半椎体椎弓根截骨,双侧固定矫正侧凸畸形。随访时间为14.17±6.56个月。综合评估影像学、临床疗效以及并发症的情况。结果手术时间为2.82±0.74h,术中失血量317.22±65.15ml。术后节段性主弯Cobb角为11.33°±4.68°,矫正34.06°±7.88°,末次随访14.61°±4.96°;头侧代偿弯Cobb角为8.72°±1.44°,矫正18.78°±3.17°,末次随访18.78°±3.17°;尾侧代偿弯Cobb角为7.98°±1.82°,矫正18.47°±5.83°,末次随访18.47°±5.83°;节段性后/前凸角为-1.94°±12.35°,矫正14.94°±10.18°,末次随访-1.5°±12.67°。顶椎偏距的矫正为2.31±0.52cm,末次随访2.1±0.24cm。术中没有血管、神经损伤、骨折等重大并发症发生,术后没有发生冠状面和矢状面的失代偿。结论后路半椎体经椎弓根截骨矫形能有效矫正轻、中度先天性半椎体所致脊柱侧凸畸形,缩短手术时间,创伤小,减少术中失血量,矫形效果满意,所选病例骨骼发育相对成熟者,避免矫形丢失。     

全脊柱核磁共振成像法评估青少年特发性脊柱侧凸的可行性研究

目的 探讨全脊柱MRI检查法测量Cobb角的可行性.方法 2名研究者分别对60例青少年特发性脊柱侧凸(AIS)的后前位及侧位X线片和全脊柱MRI片测量主弯及次弯Cobb角、T5～T12后凸、顶椎旋转,记录测量时间和测量的上下端椎,2名研究者在1周后进行重复测量.对比X线片和MRI测量结果使用Pearson相关法,而研究者之间和研究者内部进行可靠性评估.结果 研究发现在所有X线片和MRI测量结果之间具有显著相关性(P=0.01);主弯Cobb角(R =0.912),代偿弯角度(R=0.826),后凸(R =0.939).X线片和MRI测量结果的研究者组间主弯Cobb角的可靠性分别是R=0.958,0.889;代偿弯Cobb角的可靠性分别是R=0.948,0.858;椎体旋转R=0.954是有显著性的.X线片和MRI测量结果的研究者组内主弯Cobb角的可靠性分别是R=0.965,0.966;代偿弯Cobb角R=0.949,0.944,均有显著性.结论 研究结果示MRI能够获得的冠状面和矢状面测量结果与传统X线片测量结果有高度相关性.另外,MRI除具有可靠的椎体旋转测量外,MRI最大优势就是无辐射,并可替代用于MS诊断性评估.     

下颈椎前路减压融合术后颈椎矢状位平衡的变化

目的 :探讨下颈椎前路减压融合术后颈椎矢状位平衡的变化。方法 :回顾性分析2012年1月~2016年12月在上海市东方医院脊柱外科因颈椎病接受颈前路椎间盘切除减压椎间融合手术(ACDF)患者的资料,共纳入326例,其中男175例,女151例;年龄34~81岁(56.0±9.4岁)。随访12~30个月(18.5±6.4个月),根据融合节段数分为四组:单节段融合组69例,双节段融合组85例,三节段融合组90例,四节段融合组82例。在术前及术后12个月随访时的颈椎侧位X线片上测量颈椎矢状位参数:C0-2 Cobb角、C2-7 Cobb角、C2-7矢状垂直距离(C2-7 SVA)和T1倾斜角(T1S),并记录手术前后JOA评分及颈肩臂疼痛VAS评分,计算术后12个月时各组参数改变量。单因素方差分析比较参数及评分指标改变量组间差异,Pearson相关性探讨术前及术后12个月颈椎矢状位参数变化关系。结果 :四组患者一般资料无统计学差异(P0.05)。术前和ACDF术后12个月,单节段融合组C0-2 Cobb角为21.07°±8.21°和20.92°±5.99°,C2-7 Cobb角为15.29°±8.64°和17.69°±11.25°,C2-7 SVA为20.94±10.77mm和20.61±10.23mm,T1S为23.02°±8.64°和24.05°±9.35°,术前与术后比较均无统计学差异(P0.05);双节段融合组C0-2 Cobb角为20.38°±7.49°和24.20°±7.96°,C2-7 Cobb角为13.04°±8.07°和15.85°±10.53°,C2-7 SVA为18.57±11.88mm和23.73±9.87mm,T1S为24.28°±6.71°和28.65°±7.64°,术前与术后比较均有统计学差异(P0.05);三节段融合组C0-2 Cobb角为16.76°±6.24°和20.54°±6.58°,C2-7 Cobb角为11.46°±7.83°和15.12°±10.42°,C2-7 SVA为19.36±8.40mm和25.25±12.20mm,T1S为26.56°±9.47°和30.39°±7.31°,术前与术后比较均有统计学差异(P0.05);四节段融合组C0-2 Cobb角为15.44°±6.50°和18.39±6.26°,C2-7 Cobb角为11.54°±8.30°和19.61°±5.53°,C2-7 SVA为22.39±12.60mm和27.68±11.17mm,T1S为24.70°±6.30°和31.22°±6.45°,术前与术后比较均有统计学差异(P0.05)。术前和术后12个月,四组组内T1S与C2-7 Cobb角、C2-7 SVA均呈正相关,C2-7 Cobb角与C2-7 SVA均呈负相关;术后12个月,四组间C0-2 Cobb角、C2-7 Cobb角、C2-7 SVA及T1S改变量比较差异均有统计学意义(P=0.010、0.001、0.003、0.002)。结论 :下颈椎前路减压单节段融合后颈椎矢状位平衡无明显变化;双节段及长节段融合后颈椎矢状位平衡显著改变,但下颈椎矢状位序列维持动态稳定。     

不同胸腰椎前路内固定系统对术后脊柱侧方成角的影响分析

目的 通过分析胸腰椎前路内固定系统与术后脊柱侧方成角的关系,探讨内固定系统对脊柱前路手术后脊柱侧方成角的影响。方法 回顾性分析2004年5月至2008年1月经前路治疗且获得随访的胸腰椎骨折患者172例,男124例,女48例;年龄15～ 70岁,平均39.0岁。根据应用的内固定系统不同分为4组：Z-plate组（63例）、Antares组(45例)、Profile组(50例)及单钉棒组(14例)。测量并比较各组术前、术后、未次随访时冠状面Cobb角大小、各组间冠状面Cobb角大小,及各组间不同程度侧方成角的比例。结果 所有患者术后获8～49个月（平均39个月）随访。本组患者术前Cobb角-14.3°～14.6°,平均0.8°±3.9°;术后Cobb角-8.2°～14.0°,平均3.2°±4.1 °;末次随访时Cobb角-1.1°～ 17.3°,平均3.5°±4.2°。术后及未次随访时与术前比较Cobb角差异均有统计学意义(P＜0.05),术后与末次随访时比较差异无统计学意义(P＞0.05)。4组患者各时间点冠状面Cobb角比较差异均无统计学意义(P＞0.05)。4组患者术后出现不同程度侧方成角的比例比较差异均无统计学意义(P＞0.759)。结论 胸腰椎骨折前路手术后脊柱侧方成角与使用内固定系统的种类无关。     

后路选择性胸腰弯或腰弯融合治疗Lenke 5C型青少年特发性脊柱侧凸

目的:评价后路选择性胸腰弯或腰弯融合治疗青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)的临床效果。方法:回顾性分析45例行后路选择性胸腰弯(20例)或腰弯(25例)融合的Lenke 5C型AIS病例,男4例,女41例,平均年龄14.9±2.1岁(12~20岁)。所有病例均行后路椎弓根螺钉内固定矫形融合,平均随访36±20个月(24~105个月)。术前、术后及末次随访时均摄站立位全脊柱正侧位X线片,对躯干偏移、融合节段邻近椎间盘开角、远端融合椎的倾斜、冠状面和矢状面Cobb角进行测量分析。测量数据使用SPSS 17.0统计学软件进行分析。结果:术前胸腰弯或腰弯Cobb角平均47.3°±7.2°,术后矫正至6.4°±4.6°,矫正率(84.8±11.6)%,末次随访时为9.1°±5.4°,矫形丢失2.7°±4.6°。胸弯术前25.7°±7.4°,凸侧Bending像Cobb角7.6°±5.8°,柔韧性(72.7±23.0)%,术后矫正至13.2°±6.7°,自动矫正率(48.5±29.4)%,末次随访14.2°±7.6°,矫形丢失1°±6°。躯干偏移:术前21.3±11.5mm,术后19.5±13.3mm,末次随访10.9±8.9mm。术后近端与远端融合椎邻近椎间盘开角较术后明显减小,且在随访过程中无明显加重。远端融合椎倾斜术后及末次随访时均显著改善。末次随访时,交界性后凸1例,躯干失衡3例,胸弯失代偿并行融合延长手术1例。所有病例末次随访时均未见假关节形成。结论:后路选择性胸腰弯或腰弯融合对Lenke 5C型特发性脊柱侧凸可获得满意矫形效果,胸弯可获得良好的自动矫正,有效缩短了融合节段。     

脊柱截骨矫形技术治疗成人复杂脊柱侧后凸畸形的疗效及安全性的前瞻性观察

目的:探讨应用脊柱截骨矫形技术治疗成人复杂脊柱侧后凸矫形术的安全性,并评估其临床应用价值。方法:选择2011年9月~2012年9月期间应用截骨技术治疗的成人复杂脊柱侧后凸畸形患者进行前瞻性研究。所有入选患者均于手术前后及末次随访时测量侧凸Cobb角、最大后凸Cobb角、冠状面平衡(distance between C7 plumbline and center sacral vertical line C7PL-CSVL)和矢状面平衡(sagittal vertical axis,SVA)等影像学相关参数。同时采用SF-36量表、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、SRS-22量表等评估其临床疗效,并使用AISA评分法评价患者手术前后及末次随访时神经功能情况。结果:共17例患者最终纳入本次研究,其中男7例,女10例;年龄18~55岁(34.6±10.9)岁,术前侧凸Cobb角51°~97°(78.5°±13.1°),后凸Cobb角50°~112°(71.8°±19.8°),C7PL-CSVL为58.4±21.3mm,SVA为56.4±51.2mm。手术时间200~540min(406.1±82.2min);术中出血量1000~12000ml(4088.9±2546.9ml)。术后侧凸Cobb角为37.7°±17.7°,后凸Cobb角为25.0°±16.4°,矫正率分别为51.9%±18.7%和67.2%±20.3%;C7PL-CSVL为18.0±9.4mm,SVA为27.6±16.9mm,均较术前明显改善。随访24.3±1.8个月,末次随访时侧、后凸Cobb角分别为39.5°±16.6°和26.2°±17.6°,C7PL-CSVL为22.1±15.4mm,SVA为30.4±17.1mm,随访期间无明显矫正丢失。术中监测均无诱发电位异常改变,无死亡、瘫痪等严重并发症,术后5例患者出现肢体远端一过性感觉功能减退,1例患者椎体前壁骨折,1例患者螺钉置钉不良,2例患者随访期间发生内固定并发症,总体并发症发生率为52.9%。术后和末次随访时的SF-36、VAS、ODI、SRS-22与术前比较均有明显改善,术后和末次随访时无显著性差异,ASIA运动和感觉评分与术前比较无显著性差异。结论:经后路脊柱截骨术治疗成人复杂脊柱侧后凸畸形矫正角度大,术后三维矫形效果满意,可显著改善患者临床症状和生活质量,但存在手术时间长、出血量大、并发症多等风险。     

单纯前路与前后联合入路矫形手术治疗重度颈椎后凸畸形

目的:探讨单纯前路与前后联合入路矫形手术治疗重度颈椎后凸畸形的适应证及疗效。方法 :我院2005年7月～2008年12月收治重度颈椎后凸畸形(Cobb角>40°)患者12例,男8例,女4例,年龄13～69岁,平均28.75岁。引起颈椎后凸的病因为:先天性发育畸形4例,神经纤维瘤病3例,退变性后凸2例,创伤性畸形2例,因颈脊膜瘤行后路C2～C5椎板切除术后颈椎后凸1例。术前JOA评分7～16分,平均11.6分;后凸Cobb角41°～113°,平均69.7°。均行颈椎矫形手术,其中8例(Cobb角41°～86°,平均58.9°,后凸节段无明显后方骨性融合,JOA评分平均11.9分)行前路手术;4例(3例Cobb角>90°,1例前后方均有明显的骨性融合,Cobb角48°～113°,平均91.3°,JOA评分平均11.0分)行前后路联合手术,一期完成1例,二期完成3例。记录患者手术时间、术中出血量,观察术后Cobb角及随访时的JOA评分、Cobb角变化。结果:8例单纯前路手术患者的平均手术时间为196min,平均术中失血量为520ml;术后2例患者出现肢体肌力下降,其中1例因术后5d内固定松动行手术重置内固定,再手术后肌力恢复到术前,另1例患者经甲强龙冲击治疗后肌力恢复到术前;术后Cobb角平均24.1°,畸形矫正率为59.1%;随访8～60个月,平均27.3个月,末次随访时Cobb角平均为36.9°,矫形丢失率为36.8%;末次随访时JOA评分为11～17分,平均15.1分,改善率为62.7%。4例前后联合入路患者的平均手术时间为420min,平均术中失血量为1088ml;1例患者术后出现肢体肌力下降,经甲强龙冲击治疗后肱二头肌、三角肌肌力仍较术前减弱,其余肌力恢复至术前;术后Cobb角平均32°,畸形矫正率为65.0%;随访6～45个月,平均24.8个月,末次随访时Cobb角平均为45.5°,矫形丢失率为22.8%;末次随访时JOA评分为9～16分,平均13.5分,改善率为41.7%。结论:重度颈椎后凸畸形患者Cobb角40°～90°且无明显后方骨性融合时采用单纯前路矫形手术治疗,Cobb角>90°或前后方结构均有明显的骨性融合时行前后路联合矫形手术治疗,近期疗效均较好。     

Use of the iPhone for Cobb angle measurement in scoliosis

Purpose

The Cobb technique is the universally accepted method for measuring the severity of spinal deformities. Traditionally, Cobb angles have been measured using protractor and pencil on hardcopy radiographic films. The new generation of mobile ‘smartphones’ make accurate angle measurement possible using an integrated accelerometer, providing a potentially useful clinical tool for assessing Cobb angles. The purpose of this study was to compare Cobb angle measurements performed using a smartphone and traditional protractor in a series of 20 adolescent idiopathic scoliosis patients.

Methods

Seven observers measured major Cobb angles on 20 pre-operative postero-anterior radiographs of Adolescent Idiopathic Scoliosis patients with both a standard protractor and using an Apple iPhone. Five of the observers repeated the measurements at least a week after the original measurements.

Results

The mean absolute difference between pairs of smartphone/protractor measurements was 2.1°, with a small (1°) bias toward lower Cobb angles with the iPhone. 95% confidence intervals for intra-observer variability were ±3.3° for the protractor and ±3.9° for the iPhone. 95% confidence intervals for inter-observer variability were ±8.3° for the iPhone and ±7.1° for the protractor. Both of these confidence intervals were within the range of previously published Cobb measurement studies.

Conclusions

We conclude that the iPhone is an equivalent Cobb measurement tool to the manual protractor, and measurement times are about 15% less. The widespread availability of inclinometer-equipped mobile phones and the ability to store measurements in later versions of the angle measurement software may make these new technologies attractive for clinical measurement applications.     

Comparison between Oxford Cobbmeter and digital Cobbmeter for measurement of Cobb angle in adolescent idiopathic scoliosis

Purpose

The purpose of this study was to compare Cobb angle measurements performed using an Oxford Cobbmeter and digital Cobbmeter in a series of 20 adolescent idiopathic scoliosis (AIS) patients.

Methods

Four observers measured major Cobb angles on 20 standing postero-anterior radiographs of AIS patients with both Oxford Cobbmeter and digital Cobbmeter (iPhone Cobbmeter Application). The measurements were repeated a week after the original measurements.

Results

The mean Cobb angle in this study was 43.6° ± 23.62°. The mean measurement time for an observer to measure the 20 Cobb angles was 24.9 min for the smart phone compared with 25.6 min for the Oxford Cobbmeter. The 95 % confidence interval for differences between smart phone and Oxford Cobbmeter measurements on the same radiograph was ±3.68°. The intra-observer variability of the smart phone is equivalent to the Oxford Cobbmeter. The 95 % confidence intervals for inter-observer error were ±5° and ±5.8° for the smart phone and Oxford Cobbmeter, respectively.

Conclusions

We conclude that the smart phone with integrated Tiltmeter and Cobbmeter application is an equivalent Cobb measurement tool to the Oxford Cobbmeter. The advantages of smart phone are the accuracy of determining the most inclined vertebrae and accordingly more precise Cobb angle measurement. The new smart phones with these integrated applications may be really helpful to the spine surgeons, especially in hospitals where PACS or Oxford Cobbmeter is not available.

     

经椎弓根椎体内植骨与后外侧植骨治疗胸腰椎爆裂骨折的影像学研究

目的 探讨经椎弓根椎体内植骨与后外侧植骨在胸腰椎爆裂骨折治疗中的作用.方法 对1999年1月至2009年12月手术治疗的46例椎体内植骨患者与18例后外侧植骨患者进行长期随访,于术前、术后、内固定取出前及末次随访时,测量矢状位X线片后凸角、伤椎楔变角、伤椎前后缘高度比、伤椎上间隙角、下间隙角的变化,进行对比分析,并通过CT、MRI观察植骨融合和椎间盘塌陷及其对后凸矫正丢失的影响.结果 椎体内植骨组伤椎楔变角由术前的27.2°±6.5°矫正至术后的7.0°±3.0°,伤椎前后缘高度比由术前的(53.3±11.8)%矫正至术后的(92.3±2.4)%;后外侧植骨组伤椎楔变角由术前的23.9°±4.4°矫正至术后的8.8°±2.1°;伤椎前后缘高度比由术前的(60.7±10.0)%矫正至术后的(88.5±3.3)%;椎体内植骨组优于后外侧植骨组,差异均有统计学意义(P＜0.05).终末随访时两组后凸角、伤椎楔变角、伤椎前后缘高度比矫正丢失差异均有统计学意义(P＜0.05),而伤椎上、下间隙角的丢失差异无统计学意义(P＞0.05).结论 椎体内植骨的"撑起"复位作用,早期可以比后外侧植骨更好地恢复伤椎形态和脊柱序列,但并不能阻止内固定取出后的晚期椎间隙塌陷和矫正度丢失.

Abstract：

Objectives To retrospectively investigate the outcome of transpedicular intracorporeal grafting and posterolateral grafting in treatment of thoracolumbar burst fractures. Methods Forty-six patients treated with transpedicular intracorporeal grafting from January 1999 to December 2009 and followed up for 19-119 months ( average 67 ± 13 months) were reviewed retrospectively, and were compared with 18 patients who had underwent posterolateral fusion during the same period through radiographic analysis. Radiographic measurements included Cobb angle, vertebral wedge angle ( VWA), ratio between anterior and posterior vertebral height (APHR), upper inter-vertebral angle, lower inter-vertebral angle on X-ray, CT and MRI. Results In transpedicular intracorporeal grafting group, the VWA was corrected from 27.2°±6. 5° to 7. 0°± 3.0° and the APHR from (53. 3 ± 11.8 ) % to (92. 3 ± 2. 4 ) % . In posterolateral fusion group, the VWA was corrected from 23.9°± 4. 4° to 8. 8°± 2. 1 ° and the APHR from ( 60. 7 ± 10. 0 ) % to ( 88. 5±3. 3 )%. Transpedicular intracorporeal grafting group showed better postoperative correction results than posterolateral fusion group (P ＜0. 05), and had less loss of correction of Cobb angle, VWA and APHR at final follow-up (P ＜ 0. 05 ). Conclusions The transpedicular intracorporeal grafting can improve injured vertebral body morphology recovery better than posterolateral bone grafting, but can not prevent the late loss of correction after implant removal.     

Radiographic angles in hallux valgus: Comparison between protractor and iPhone measurements

Radiographic angles are used to assess the severity of hallux valgus deformity, make preoperative plans, evaluate outcomes after surgery, and compare results between different methods. Traditionally, hallux valgus angle (HVA) has been measured by using a protractor and a marker pen with hardcopy radiographs. The main objective of this study is to compare HVA measurements performed using a smartphone and a traditional protractor. The secondary objective was to compare the time taken between those two methods. Six observers measured major HVA on 20 radiographs of hallux valgus deformity with both a standard protractor and an Apple iPhone. Four of the observers repeated the measurements at least a week after the original measurements. The mean absolute difference between pairs of protractor and smartphone measurements was 3.2°. The 95% confidence intervals for intra‐observer variability were ±3.1° for the smartphone measurement and ±3.2° for the protractor method. The 95% confidence intervals for inter‐observer variability were ±9.1° for the smartphone measurement and ±9.6° for the protractor measurement. We conclude that the smartphone is equivalent to the protractor for the accuracy of HVA measurement. But, the time taken in smartphone measurement was also reduced. © 2015 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. J Orthop Res 33:1250–1254, 2015.     

Reliability analysis for manual measurement of coronal plane deformity in adolescent scoliosis. Are 30?×?90?cm plain films better than digitized small films?

For several years, digitized small radiographs are used to measure Cobb angle in idiopathic scoliosis. The interobserver and intraobserver Cobb angle measurement variability associated with small radiographs were compared with measurement variability associated with the long-cassette radiographs. Twenty adolescent patients with a double major idiopathic scoliosis had erect full-spine p-A radiographs and Cobb angle measurements performed by eight different observers on a 30 x 90 cm plain-film radiograph and a digitized 14 x 42 cm image. Inter-observer and intra-observer reliability using each techniques were assessed using a paired t-test, Spearman rank correlation study and intraclass correlation coefficients. The angle variability between small film and plain-film measurements was assessed using the same methods. Intra-observer and inter-observer study showed good reliability using both techniques. The comparison between small films and plain-films measurements showed very good agreement with an intraclass correlation coefficient of 95% and confidence interval between 0.962 and 0.972. In our study, Cobb angle determination was not found to vary significantly with film size. The small film image used for full-spine radiographs in our institution allows manual Cobb angle measurements to be performed. A study is currently conducted in our institution to determine if a computer-assisted measurement method significantly improves Cobb angle measurements reliability in routine practice compared with manual measurements of Cobb angles on small films.     

后路截骨联合椎弓根内固定矫形治疗僵硬性脊柱侧后凸畸形

目的探讨经后路截骨联合椎弓根内固定矫形治疗僵硬性脊柱侧后凸畸形疗效。方法对26例僵硬性脊柱侧后凸畸形患者进行后路截骨、椎弓根内固定矫形。8例行后路Ponte截骨,13例行椎弓根截骨术(PSO)联合Ponte截骨,5例行全椎体切除术(VCR)。比较患者术前、术后和末次随访时Cobb角的变化及C7中垂线与骶骨中垂线距离的变化。结果患者均获得随访,时间12~60个月。侧凸Cobb角:术前30°~135°(90.7°±30.6°),术后12°~30°(18°±5.6°),矫正率为82.5%,末次随访13°~32°(20°±5.8°),丢失4.3%;后凸Cobb角:术前20°~60°(40.6°±18.5°),术后10°~26°(16.8°±6.2°),矫正率为85%,末次随访13°~30°(20.5°±7.0°),丢失3.7%;C7中垂线与骶骨中垂线距离:术前3.8~6.5(5.1±1.3)cm,术后0.3~1.3(0.7±0.3)cm,末次随访0.4~1.7(0.8±0.3)cm。所有患者未发生神经损伤等并发症,仅1例患者术后3个月出现内固定松动,经延长固定节段后骨性融合。结论术前充分的评估,选择合适的后路截骨方式,联合椎弓根内固定矫形治疗僵硬性脊柱侧弯,能有效矫正畸形和恢复脊柱冠、矢状面平衡。     

一期前路病灶清除钛网植骨融合内固定治疗下颈椎结核

目的总结一期前路病灶清除钛网植骨融合内固定治疗颈椎结核的临床疗效。方法 2008年7月至2011年12月,采用一期前路病灶清除钛网植骨融合内固定治疗下颈椎结核15例,男9例,女6例;年龄32~71岁,平均55岁。病灶累及两个椎体者11例,其中C3~41例,C4~52例,C5~64例,C6~74例;累及3个椎体者4例,均为C5~7。颈椎后凸Cobb角为22°~46°,平均35°。神经功能按Frankel分级,B级2例,C级3例,D级8例,E级2例。术前抗结核药物治疗2周以上,术后继续抗结核治疗12~18个月。随访观察患者临床症状改善和植骨融合情况。结果手术均顺利完成,术中无大血管、脊髓、食道、气管损伤。切口均一期愈合,未发生感染及窦道形成。随访20~60个月,平均30.6个月。患者临床症状及神经功能有不同程度恢复,神经功能1例B级恢复至D级,其余均达E级。术后末次随访后凸Cobb角0°~5°,平均2.6°,较术前明显减少,差异有统计学意义(P0.01)。患者植骨均完全融合,融合时间3~5个月,平均3.5个月,无内固定松动、脱落、折断、结核复发等并发症。结论在规范抗结核治疗的基础上,一期前路病灶清除钛网植骨融合内固定是治疗下颈椎结核的有效方法 。     

记忆合金加压钉抑制脊柱矢状面生长的实验研究

目的 探讨记忆合金加压钉植入后非融合性抑制胸段脊柱矢状面生长的作用.方法 将18只幼年雌性山羊随机分为长钉组、短钉组、对照组各6只.长钉组和短钉组通过前路手术在前凸的T6～11胸椎节段植入记忆加压长钉(齿长7 mm)、短钉(齿长4 mm),对照组不予手术.分别于术前、术后3个月行X线片检查,测量Cobb角,对手术前后组间数据及组内自身对照数据进行统计学分析,并计算后凸增加率.大体观察被固定节段脊柱是否融合.结果 全部样本无脱失,均进入结果分析.T6～11 Cobb角,短钉组术前为7.0°±2.3°,术后3个月为12.7°±4.7°,后凸增加率为81.4%;长钉组术前为6.2°±4.0°,术后3个月为14.0°±4.9°,后凸增加率为125.8%;术前及术后长钉短钉两组组间比较,差异均无统计学意义(术前P=0.655;术后P=0.596).将长钉组和短钉组分别与对照组比较,术前差异均无统计学意义(分别为P=0.929和P=0.720);术后差异均有统计学意义(分别为P=0.007和P=0.021).大体观察证实,植入记忆合金加压钉节段脊柱未融合.结论 在山羊胸椎正前方植入记忆合金加压钉可以非融合性控制山羊胸椎的矢状面生长,增加后凸角度.

Abstract：

Objective To present that Nickel-Titanium (NT) memory alloy staples in fusionlessly controlling the growth of the vertebrates in the sagittal plane. Methods Eighteen infant female goats were selected and equally divided into 3 random groups:long staple group, short staple group and blank control group. Five long staple (the legs' length = 7 mm) and five short staple (the legs' length =4 mm) were implanted into each goat in long and short staple groups repecetively by anterior approach, right on the front of the thoracic vertebrae from T6 to T11. The control group was not given any treatment. X-ray examination was performed pre-operatively and post-operatively. Cobb angle of lateral radiograph was measured and the data of Cobb angle were statistically analyzed. At the end of the experiment, whether the staples implanted spinal columns were fused or not were evaluated by gross observation. Results Finally, all of the goats were included in the final results. Before the operations, T6-11 sagittal Cobb angle was 7.0°±2.3°in short staple group, and 6.2°±4.0°in long staple group. And after the operation, the T6-11 Cobb angle was increased to 12.7°±4.7°in short staple group with the increased rate of 81.4%, and 14. 0°±4. 9° in long staple group with the increased rate of 125.8%, respectively. Before and after the surgery, there were no significant differences between long staple group and short staple group in terms of Cobb angle ( pre-operation P=0. 655, post-operation P = 0. 596). Before the surgery, there were no differences in terms of Cobb angle,between long staple groups and control group ( P =0.929), and short staple groups and control group( P=0.720). At the end of the experiment, there were significant differences between long staple group and control group in terms of Cobb angle ( P = 0. 007), and between short staple group and control group (P=0.021).The staples implanted spinal columns were not fused which was proved by gross observation. Conclusions The memory alloy staple implantation by anterior approach, right on the front of the thoracic vertebrae of goats, can control the growth of thoracic vertebrates leading to kyphosis.     

经伤椎内固定椎间椎体内打压植骨治疗胸腰椎骨折

目的探讨后路经伤椎短节段复位内固定联合椎间椎体打压植骨治疗胸腰椎骨折的疗效。方法采用经伤椎后路复位短节段内固定、椎间椎体内植骨治疗21例胸腰椎骨折患者。根据术前、术后1周及末次随访时正、侧位X线片评判术后伤椎椎体前缘高度、后凸Cobb角恢复及内固定失败和骨融合情况。结果患者均获随访,时间12~32个月。未见断钉断棒及内固定松动。伤椎及椎间植骨均获骨性愈合。伤椎椎体前缘高度:术后1周为95.1%±3.2%,末次随访时为93.9%±3.6%,均较术前39.6%±10.3%明显改善(P0.01)。损伤节段后凸Cobb角:术后1周为12.2°±2.9°,末次随访时为12.9°±3.5°,均较术前(33.7°±6.2°)明显恢复(P0.01)。末次随访时与术后1周比较,伤椎椎体前缘高度和Cobb角均无明显变化(P0.05)。结论后路经伤椎短节段内固定联合椎间及伤椎打压植骨治疗胸腰椎骨折,重建了椎间和椎体的稳定性,有助于减少术后内固定失败及矫正丢失。     

颈椎单开门椎管扩大成形术椎板开门角度对脊髓型颈椎病疗效的影响

目的:探讨椎板开门角度对颈椎单开门椎管扩大成形术(expansion of open-door laminoplasty)治疗脊髓型颈椎病疗效的影响。方法:选取我院2006年7月至2009年1月采用颈椎后路单开门椎管扩大成形术治疗并获得24个月以上随访的脊髓型颈椎病患者198例,男115例,女83例;年龄29～72岁,平均49±5岁。双节段39例(C3～C5 11例,C4～C6 28例);三个节段(C4～C7)97例,四个节段(C3～C7)62例。患者均有术前颈椎正侧位、双斜位和过度屈伸位X线平片和颈椎CT及MRI检查图片;术前JOA评分4～9分,平均6.3±2.9分。按照术后1周CT片上测量的椎板开门角度以30°为界限分为两组,统计两组手术时间、出血量、术后出现并发症病例、C2-C7 Cobb角度、颈椎前凸指数、颈椎活动度和脊髓后移数值,末次随访时评价患者神经功能情况,计算神经功能改善率。结果:开门角度>30°的患者共76例(A组);开门角度15°～30°的患者共122例(B组)。两组术前JOA评分、C2-C7 Cobb角度、颈椎前凸指数及颈椎活动度无显著性差异(P>0.05)。A组手术时间110±13min,出血量250±80ml;B组手术时间120±30min,出血量230±100ml,两组比较均无显著性差异(P>0.05)。术后A组51例(67.1%)出现轴性症状,8例(10.4%)发生C5神经根麻痹,1例(1.32%)颈椎轻度后凸畸形;B组37例(10.5%)出现轴性症状,3例(2.4%)发生C5神经根麻痹,4例(3.28%)发生关门,A组轴性症状和C5神经根麻痹的发生率高于B组,差异有显著性(P<0.05)。术后1个月脊髓后移值为0～7.95mm,平均2.41±0.46mm。末次随访时两组C2-C7 Cobb角度、颈椎前凸指数及颈椎活动度无显著性差异(P>0.05);JOA评分改善率A、B组分别为(72.1±11.7)%和(69.0±12.3)%,两组间比较无显著性差异(P>0.05)。结论:不同椎板开门角度术后神经功能改善率无显著性差异;将椎板开门角度控制在15°～30°轴性症状及C5神经根麻痹发生率较低,但应防止发生关门。