TSRH系统后路矫正青少年特发性脊柱侧凸(附36例初步报告)

目的 :研究TSRH系统治疗青少年特发性脊柱侧凸 (AdolescentIdiopathicScoliosis,AIS)的矫形效果。方法 ,1 998～ 2 0 0 0年共 36例行TSRH系统矫形内固定术的AIS患者。平均随访时间为 2 1个月 (6～ 39个月 )。结果 :术前平均Cobb角为 57°,术后为 1 8°(平均矫正率为 68% ) ,最后随访时平均Cobb角 2 1°。躯干失平衡及矢状面生理曲度改善。 1例患者术后 3个月横突钩脱出 ,无神经系统并发症。结论 :侧凸TSRH系统后路矫形可获得满意效果     

TSRH内固定治疗脊柱侧凸

目的　回顾性研究TSRH(TexasScottishRiteHospital)脊柱内固定系统在治疗脊柱侧凸的临床疗效。 方法　对 1998年 1月至 2 0 0 0年 12月手术治疗的 12 9例脊柱侧凸患者 ,总结其侧弯矫形、脊柱平衡、并发症及 3年以上的随访结果。根据手术方法不同 ,共分为 4组。A组 :单纯脊柱后路融合固定术 ;B组 :单纯脊柱前路融合固定术 ;C组 :分期前、后路融合固定术 ;D组 :Ⅰ期前、后路融合固定术。四组患者均应用TSRH内固定系统。手术时平均年龄 14 .2岁 (6～ 5 5岁 ) ,平均随访 34个月。结果　A组 :78例病人行单纯脊柱后路融合TSRH内固定 ,术后平均矫形率为6 3.4 %。随访 38个月 (2 4～ 5 0个月 ) ,平均矫形丢失 7°,矫形丢失率平均 9.5 %。本组并发症发生率为 12 .8% ,包括 3例脱钩 ,3例螺钉断裂 (共 6枚螺钉 ) ,1例术后侧弯失代偿 ,1例术后发生曲轴现象。B组 :2 2例患者行单纯脊柱前路融合、短节段TSRH内固定 ,平均矫形率为 74 .8%。平均随访 36个月 ,平均矫形率丢失 5 %。 2例发生一过性交感神经损伤。术后 6个月内均自然恢复。C组 :17例有 90°以上的侧弯 ,且Bending像上侧弯仍大于 7°的患者行前路松解 ,2～ 3周后再行后路融合TSRH内固定。本组平均手术时间 8.3h ,出血 935ml,输血 6 83ml,平均矫形 33.6°,矫     

TSRH后路内固定系统治疗青少年特发性脊柱侧凸

目的　探讨应用 TSRH器械后路手术治疗青少年特发性脊柱侧凸的疗效。方法　对在 1997年 9月至 2 0 0 1年 9月行 TSRH后路手术治疗的 4 2例青少年特发性脊柱侧凸患者侧凸的矫正度、脊柱的平衡以及并发症等进行分析。结果　 King / 型患者胸弯的矫正率为 6 6 % ,King 型双弯患者胸弯矫正率为 5 0 % ,随访时矫正率丢失 8%～ 14 %。King 型患者腰弯的矫正率为 4 1% ,King 型患者腰弯的矫正率为 5 1% ,随访矫正率丢失接近 2 0 %。King / 型患者手术后躯体平衡迅速得到改善 (6 0 % ) ,而 King 型及 型躯体平衡改善不明显。在术前有明显的胸椎后凸减少 (小于 2 0°)患者中 ,术后可见胸椎后凸有部分改善。其余无明显改善。无神经并发症的发生 ,1例发生远端脱钩 ,1例患者在术后 15个月有延迟性的深部感染发生 ,深部培养为厌氧杆菌。结论　使用 TSRH器械可达到较满意的矢状位和冠状位的胸弯矫正 ,但需进一步努力去改善腰椎的钩子模式及外科技巧 ,从而达到和维持更好的腰弯矫正。     

TSRH系统治疗青少年特发性脊柱侧凸的术中护理

总结17例青少年特发性脊柱侧凸手术病人的护理配合.①不同年龄段的病人选择不同的卧位摆放方法,年龄15～18岁,身体发育接近成人的病人使用脊柱拱形架摆俯卧位;年龄＜15岁,身体矮小的病人,选择胸枕、腿枕摆俯卧位手术.②30 min交替更换头位,使眼部腾空,实施眼部、颈部的保护性护理措施.③术中监测脊髓功能.④术中严格无菌操作.结果17例手术病人术后矫形效果好,未发生钩、钉、棒断裂、移位现象.     

不同侧凸方向的Lenke 5型脊柱侧凸前路矫形疗效的比较

【摘要】 目的：比较不同侧凸方向的Lenke 5型脊柱侧凸前路矫形内固定的手术疗效。方法：对2005年1月~2009年12月期间在我院手术治疗的Lenke 5型青少年特发性脊柱侧凸（AIS）患者进行回顾分析。按照侧凸方向分为左侧凸组（L组,n=38）和右侧凸组（R组,n=14）,在术前、术后及末次随访时的X线片上测量两组患者的如下参数：冠状面参数包括胸弯、胸腰弯/腰弯Cobb角及冠状面平衡等;矢状面参数有胸椎后凸角、胸腰段交界角、腰椎前凸角和整体矢状面平衡等。对两组病例的上述参数进行独立样本t检验,分析比较两组的矫形疗效。结果：两组术前主弯Cobb角、主弯累及节段及代偿胸弯Cobb角均无显著性差异（P＞0.05）。L组、R组平均随访时间分别为3.1±0.9年（2~4年）、2.7±0.8年（2~3年）。与L组相比,R组手术时间（208.8±41.4min vs. 225.6±39.6min）及出血量（236.5±159.6ml vs. 284.4±164.7ml）较多,但均无统计学差异（P=0.132和P=0.345）。L、R组腰弯平均矫正率分别为66.7%和64.4%（P=0.808）,末次随访平均矫正丢失率分别为4.6%和5.1%（P=0.992）;L、R组胸弯平均矫正率分别为49.8%和47.7%（P=0.886）,末次随访时平均矫正丢失率分别为13.4%和14.3%（P=0.759）。两组均无血管损伤及神经并发症,无1例发生内固定失败。L组术后2例患者发生远端Adding-on,1例患者发生近端交界性后凸;R组1例出现近端Adding-on。结论：前路胸腰弯/腰弯矫形融合术是治疗Lenke 5型脊柱侧凸的有效方法,且不同侧凸方向对矫形疗效无明显影响。     

特发性脊柱侧凸手术方式的选择

目的探讨和评价不同部位和程度的特发性脊柱侧凸手术方式的选择。方法175例特发性脊柱侧凸患者接受了矫正融合手术。按照畸形的程度和部位分为4组,分别采取不同的手术方法。各组患者的失血量、手术时间、矫正率、随访矫正丢失率及并发症均进行了分析比较。结果所有患者均安全完成手术,没有神经系统并发症的发生。侧凸矫正率分别为：第1组：81％;第2组：86％;第3组：68％;第4组：72％。所有患者随访时间2年以上,平均为38个月(24～52个月)。结论根据脊柱侧凸畸形的程度和部位,正确选择适当的矫正方式,特发性脊柱侧凸可以获得满意的治疗效果。     

King Ⅱ型特发性脊柱侧凸的手术治疗

目的:探讨KingⅡ型特发性脊柱侧凸的手术治疗效果。方法:将37例KingⅡ型脊柱侧凸分为两组,A组12例为KingⅡA型,行选择性胸椎融合;B组25例为KingⅡB型,行胸腰弯融合。手术均采用中华长城系统经后路矫形固定。结果:随访24～50个月,A组胸弯平均矫正率79.1%,腰弯矫正率71.4%,有2例发生躯干失平衡;B组胸弯平均矫正率70.8%,腰弯矫正率73.5%,1例发生躯干失平衡。结论:KingⅡA型行选择性胸弯融合,KingⅡB型融合胸腰弯,可获得良好的临床效果。     

青少年脊柱侧凸畸形患者超声心动图异常分析:特发性脊柱侧凸与先天性脊柱侧凸的比较

背景:脊柱畸形患者可合并有超声心动图(ultrasonic cardiography,UCG)结果异常,但文献中缺乏特发性脊柱侧凸(idiopathic scoliosis,IS)与先天性脊柱侧凸(congenital scoliosis,CS)患者UCG异常的比较.目的:比较青少年IS患者与CS患者UCG结果异常的发...     

特发性脊柱侧凸三维矫正技术研究进展

目的对特发性脊柱侧凸(idiopathic scoliosis,IS)三维矫正技术研究现状及矫形效果进行综述。方法广泛查阅近年来IS三维矫正技术相关文献,进行综述。结果 IS三维矫形越来越受到重视,各种手术方式及新的矫正技术被应用于IS矫形手术中,已取得了令人满意的三维矫形效果。结论随着对IS患者脊柱畸形认识的不断加深以及矫形理念的不断更新,更为安全、有效的矫正技术将成为IS患者脊柱三维矫形研究的热点。     

有关特发性脊柱侧凸的外科动态

1未经治疗的特发性脊柱侧凸的转归2003年第5期《美国医学杂志(JAMA)》刊登了由美国爱荷华大学主持的对特发性脊柱侧凸患者的长期随访研究结果。该研究对444名在1932至1948年间诊断为特发性脊柱侧凸的患者进行了长达50年的随访观察,将117名未治疗的患者与年龄相当、性别相配的志愿者进行了对照研究。这些患者的平均年龄为66岁(54~80岁),平均随访时间51年。结果发现,二者之间的死亡率并无显著性差异。呼吸困难的发生率研究组为22%,对照组为15%。但如果侧凸大于80°或顶椎在胸椎,则呼吸功能障碍的发病率较高。下腰痛的发生率研究组为61%,对照…     

三维矫形手术治疗青少年特发性脊柱侧凸

目的：回顾分析三维矫形内固定手术治疗青少年特发性脊柱侧凸（AIS）的临床效果。探讨手术相关融合区的选择问题。方法：2001年-2006年在我院行三维矫形内固定手术的AIS患者78例。男27例，女51例，年龄10～18岁，平均15．6岁，其中LenkeI型38例，Lenke Ⅱ型6例，LenkeⅢ型11例．LenkeⅣ型1例，LenkeV型14例，LenkeVI型8例。术前冠状面Cobb角平均560，顶椎偏距平均5．9cm。躯干偏移距离平均2．8cm。根据患者畸形类型和柔韧性选择融合范围。术后及随访时在X线片上测量主弯冠状面的Cobb角、顶椎偏距、躯干偏移距离。结果：术后随访1～5年，平均28个月，冠状面Cobb角平均残留230，矫正率为59％；终末随访平均丢失4．5^o，丢失率为8％；顶椎偏距平均残留2．7cm，矫正率为55％，终末随访时平均丢失0．5cm。丢失率为8．5％；终末随访时躯干偏移距离平均1．4cm。结论：三维矫形内固定手术能有效改善AIS畸形。根据畸形特点选择正确的融合区进行适度的矫正是手术成功的关键。     

色努支具治疗青少年特发性脊柱侧凸的疗效及影响因素分析

目的 ：观察色努支具治疗青少年特发性脊柱侧凸的疗效,探究影响疗效的相关因素。方法 ：2016年1月～2018年6月采用色努支具治疗的青少年特发性脊柱侧凸患者49例,其中女性46例,男性3例,治疗初始年龄12.6±1.3岁（10～15岁）,初始主弯Cobb角32.5°±6.9°（20°～45°）,初始Risser征2.2±1.6。收集患者的临床资料：年龄、每日佩戴时间等信息;影像学资料：初始、佩戴支具即刻和随访的系列脊柱全长X线片。通过佩戴支具即刻X线片计算初始支具矫正率。评估治疗后结果：Cobb角减少≥6°定义为“改善”,Cobb角变化5°以内定义为“稳定”,Cobb角增大≥6°定义为“进展”,前两者为治疗成功。观察初始支具矫正率在各组结果中的差异;分析畸形进展的患者相关因素：畸形严重程度（20°～29°,30°～39°及40°～45°三组）、Risser征（0～4）和侧凸类型（胸弯、胸腰弯/腰弯、双主弯三种类型）;并分析影响初始支具矫正率的可能因素。结果：49例患者平均治疗2.0±1.0年,所有患儿每天支具佩戴时间在18～20h以上,依从性良好。随访2.0±1.0年（1～5年）,末次...     

Height of girls with adolescent idiopathic scoliosis

In a Finnish population, the standing height of 1500 consecutive female patients aged 9-24 years (mean 13.9 years) with untreated idiopathic scoliosis of at least 10 degrees in their lateral curves was compared with the standing height of average girls. The mean magnitude of the major curves was 29.4 degrees (range 10 degrees-80 degrees), and that of the minor curves 20.3 degrees (range 0 degrees-66 degrees). A formula for the height loss caused by the lateral curves, and that caused by thoracic kyphosis, was derived. The corrected height of the girls with idiopathic scoliosis was highly significantly (P<0.001) greater than the height of average girls at the age of 11-15, and this high level of significance was present at the age of 11-13, even without correcting for the height loss caused by scoliosis. After maturation, the girls with idiopathic scoliosis were not significantly taller than average girls. On average, the magnitude of thoracic kyphosis did not affect the height of patients with scoliosis as compared with the height of normal girls of the same age.     

成人特发性脊柱侧凸手术疗效的分析

[目的]回顾性分析成人特发性脊柱侧凸的手术疗效.[方法]对62例随访2年以上资料完整的成人特发性脊柱侧凸患者进行回顾性分析,分析术前及术后疼痛分布及疼痛缓解率,对侧凸术前及术后Cobb's角、后凸角、前倾角、矫正率进行影像学评估,分析成人特发性脊柱侧凸术后疗效.[结果]需要持续治疗的严重或中度疼痛的患者从术前的16%下降到4%,在年龄较大(大于40岁)组患者中,疼痛的改善是明显的;胸椎、腰椎Cobb's角平均矫正率为56%,胸椎侧凸、胸腰段或腰段侧凸度数随着年龄增加而增加,而矫正率随着年龄的增加而降低;矢状面平衡的改善是明显的,胸椎后凸角及腰椎前凸角均恢复到正常生理角度范围之内,但各年龄组之间比较无显著性差异(P>0.05).[结论]在40岁以上成人特发性脊柱侧凸患者中,疼痛是患者要求手术的重要原因,术后疼痛的改善是明显的;另一方面,成人特发性脊柱侧凸患者中冠状面Cobb's角矫正率随着年龄的增加而降低,而矢状面后凸角、前倾角矫正率与年龄无关.     

青少年特发性脊柱侧凸的手术治疗

特发性脊柱侧凸是青少年常见的畸形之一,严重危害其身心健康.几十年来,特发性脊柱侧凸的手术技术已经从单一平面和单一节段的矫正发展到多平面和多节段的矫正,矫正效果也有明显提高.本文从手术人路及手术方法人手,综述了青少年特发性脊柱侧凸手术治疗的发展历程及目前应用较广泛的手术方式.     

选择性置钉钉棒内固定矫治青少年特发性脊柱侧弯

目的 探讨选择性置钉钉棒内固定手术矫正青少年特发性脊柱侧弯的疗效.方法 本组共32例,男13例,女19例,年龄14-23岁.采用选择性经椎弓根置钉、钉棒系统内固定矫治其脊柱侧弯畸形,并术后随访6-24个月.结果 32例脊柱侧弯和后凸畸形基本矫正,胸腰背部疼痛症状消失,躯干外观明显改善,恢复正常学习与工作.结论 选择性置...     

Evolution of the curve patterns during brace treatment for adolescent idiopathic scoliosis

Summary of background data

The curve pattern of idiopathic scoliosis is important for making decisions concerning bracing. However, whether the curve pattern changes during brace treatment have not been fully documented. The aim of this study was to investigate the changes of curve pattern during brace treatment in skeletally immature patients with adolescent idiopathic scoliosis (AIS).

Methods

From January 2002 to January 2011, AIS patients treated with a Boston or Milwaukee brace were recruited after meeting the following inclusion criteria: older than 10 years of age at initiation of bracing; having a Cobb angle of 25°–40°; with a Risser sign 0–2; being regularly followed until the weaning of brace or the necessity of surgical treatment; and without history of previous treatment. A total of 130 female and 11 male AIS patients were included. The mean age was 12.9 years at initiation of bracing, and the female patients were, on average, 2.7 months past menarche. The mean follow-up period was 2.6 years (range 1.0–5.5 years). The definitions of changes in curve patterns were divided into four categories as follows: (1) shift of the apex of the main curve; (2) change in the curve span of more than two vertebrae; (3) change in the main curve type with regard to the apex location; and (4) change of curve direction. The patients were divided into two groups. Group A was comprised of patients who had experienced one or more categories of curve pattern changes, and Group B was comprised of those who had not.

Results

Of these 39 patients, 14 had apex shifting, 2 underwent curve span changes, 22 experienced changes in the main curve type, and one female had both changes in the apex and curve span. At the initiation of bracing, patients in Group A demonstrated significantly lower menarchal status (P = 0.018) and lower Risser grade (P = 0.025) than those in Group B. The difference in the percentage of patients who underwent Boston bracing between the two groups was statistically significant (41.5 % for Group A vs. 24.0 % for Group B, P = 0.023).

Conclusion

Changes in curve pattern can occur during brace treatment. Patients with less skeletal maturity and those treated with a Boston brace are more susceptible to this phenomenon.     

Posterior scoliosis correction for adolescent idiopathic scoliosis using side-opening pedicle screw-rod system utilizing the axial translation technique

Background:

Though adequate literature is present depicting the results of pedicle screw-rod instrumentation using top loading systems for correction of adolescent idiopathic scoliosis (AIS), using the rod rotation technique, few published data is available regarding side loading systems used for a similar purpose. We report a retrospective study of a cohort of patients with strict inclusion criteria who underwent surgical correction of AIS with side-opening pedicle screw-rod posterior instrumentation using the axial translation technique of curve correction to assess the efficacy of side opening system for scoliosis correction with regards to patient satisfaction, Cobb''s angle correction and spinal balance.

Materials and Methods:

Clinical and radiological outcomes were measured in 14 consecutive patients (3 males, 11 females) with an average age of 14.0 years (range 9 to 23 years). They were followed up for an average period of 13.0 months (range – 2.2 to 28.5). All patients underwent posterior instrumentation only with pedicle screws used as anchor points. Hybrid constructs using hooks/wires or curves requiring anterior release were excluded from the study. All levels were not instrumented – more screws were put on the concavity and in the peri-apical region. Radiological evaluation was done by whole spine standing AP, lateral radiograms preoperatively and 1, 3, 6 and12 months after surgery. Cobb''s angles were measured and the spinal balance was noted. Clinical evaluation was done by SRS questionnaire. The complications were documented.

Results:

The mean preoperative Cobb''s angle was 58.35° (range – 44 to 72°), which came down postoperatively to 23.45° (range – 10 to 38°) signifying a mean correction of 59.57% (range – 26.92 to 76.17%). Clinical outcomes were evaluated using the SRS – 30 questionnaires. The values of mean pre- and postoperative scores are 3.68 and 4.18, showing an improvement of 0.5 points. Other than one patient of superficial wound infection, which healed with antibiotics, there was no major complication. No patient had neurological deterioration.

Conclusion:

Side-opening spinal instrumentation systems, using the axial translation technique, achieved good clinical and radiological outcome for patients of AIS.     

支具治疗后初始Cobb角进展速率对青少年特发性脊柱侧凸患者支具疗效的预测价值

目的 :比较行支具治疗的青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者的支具治疗后初始Cobb角进展速率(initial angle velocity,IAV)和初始矫正率与支具疗效的相关性,探讨IAV对AIS患者支具疗效的预测价值。方法:回顾性分析于我院门诊行正规支具治疗的女性AIS患者126例,其中胸主弯74例,胸腰弯52例。于患者每次随访拍摄的站立位全脊柱正位片上测量主弯的Cobb角和Risser征。另外记录患者每次随访时的实足年龄、月经状态及身高等资料。根据患者末次随访时Cobb角进展程度分为两组:进展组55例Cobb角进展≥6°;非进展组71例Cobb进展6°。IAV定义为患者支具治疗后第一次随访时的Cobb角进展速率,初始矫正率定义为支具治疗后第一次随访时的Cobb角矫正率。采用独立样本t检验比较两组之间的差异,逻辑回归分析不同支具疗效的预测因素。结果:本组所有患者平均初诊年龄12.4±1.6岁;月经年龄12.3±1.2岁;平均初诊身高154.4±9.7cm;初诊Risser征2.1±1.7;平均初诊Cobb角24.4°±6.1°。初诊至第一次随访平均时间间隔4.1±0.6个月;初诊至末次随访平均时间间隔35.9±13.7个月(24~60个月)。末次随访时平均Cobb角29.2°±8.4°。独立样本t检验示进展组和非进展组患者初诊年龄、月经年龄、初诊身高、初诊Risser征及初诊Cobb角均无显著差异(P0.05)。非进展组IAV显著小于进展组(-9.9°±13.8°/年VS 5.2°±12.5°/年,P0.001),而非进展组初始Cobb角矫正率显著大于进展组[(11.6±16.9)%VS(-5.3±16.4)%,P0.001]。逻辑回归分析示支具疗效与IAV(OR=8.451,P=0.004)呈显著相关,而与初始矫正率(OR=2.192,P=0.139)无显著相关。结论:支具治疗后初始Cobb角进展速率与AIS患者支具疗效呈显著相关,较高的支具治疗后初始Cobb角进展速率预示较差的支具治疗效果。