Rasterstereographic back shape analysis in idiopathic scoliosis after anterior correction and fusion

OBJECTIVE: To determine the accuracy of rasterstereographic three-dimensional back surface analysis and reconstruction of the spine in cases of severe idiopathic scoliosis treated by anterior correction and fusion. DESIGN: Comparison of digitized radiographic curves and rasterstereographic curves by best fit superimposition and calculation of root mean square differences as parameters of similarity. BACKGROUND: Rasterstereography has been proven to be accurate in scoliosis up to 50 degrees Cobb angle. Since 1989 the device is in clinical routine use for non-operatively treated patients and reduces the need for otherwise indispensable radiographs significantly. METHODS: Fifty two patients with severe idiopathic scoliosis with Cobb angles up to 88 degrees were examined rasterstereographically and radiographically. Forty eight pre-operative anterior-posterior radiographs and 101 post-operative anterior-posterior radiographs were digitized. Radiographic and rasterstereographic curves were compared and the root mean square differences were calculated as parameters of precision of rasterstereographic reconstruction. RESULTS: Accuracy of rasterstereography in idiopathic scoliosis with Cobb angles between 50 degrees and 88 degrees is satisfactory. The root mean square difference of the radiographic and rasterstereographic curves was 6.4 mm for lateral deviation and 4.5 degrees for vertebral rotation. After anterior scoliosis surgery the precision of the device is good. The root mean square difference for lateral deviation was 3.4 mm and 3.2 degrees for rotation. Considering both groups an average root mean square of 4.7 mm and 3.7 degrees was calculated. CONCLUSIONS: Accuracy in severe scoliosis up to 88 degrees Cobb angle was satisfactory. The results of this first evaluation of surgically treated severe scoliosis showed a good accuracy after anterior surgery. The system can be used for post-operative follow up examinations and may reduce the number of X-rays considerably. In contrast to radiography, CT or MRI rasterstereography provides an objective quantification and documentation of the post-operative cosmetic improvement of the back shape in standing posture. RELEVANCE STATEMENT: Based on the findings of this study rasterstereography in future enables both objective quantification of cosmetic improvement and significant reduction of X-rays in idiopathic scoliosis with Cobb angles higher than 50 degrees before and after anterior surgical correction and fusion.     

What a school screening program could contribute in clinical research of idiopathic scoliosis aetiology

Purpose. Scoliosis school screening (SSS) programs have clinically benefited many children through early detection and treatment, as it is clearly stated in the Consensus Paper which has been published by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). It is also through these SSS programs that almost all of our current knowledge on the natural history and curve progression of IS has been made known. The present study summarizes the contribution of SSS in research of IS aetiology.

Method. We reviewed all the reports in relation to research of IS aetiology, which were published in peer-review journals and were originated from the Thriasio SSS program.

Results. Analysis comprises of reports for (i) IS prevalence, (ii) aetiological studies originated from school screening referrals which implicate numerous environmental and biological factors in IS pathogenesis, (iii) suggestions for a more efficient screening, (iv) IS natural history, and (v) the evolving aim of SSS based on the reported research.

Conclusions. SSS should be adopted by policy makers, because its scope goes beyond the identification of IS at an early stage, contributing significantly into the research for IS aetiology.     

What a school screening program could contribute in clinical research of idiopathic scoliosis aetiology

Purpose. Scoliosis school screening (SSS) programs have clinically benefited many children through early detection and treatment, as it is clearly stated in the Consensus Paper which has been published by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). It is also through these SSS programs that almost all of our current knowledge on the natural history and curve progression of IS has been made known. The present study summarizes the contribution of SSS in research of IS aetiology.

Method. We reviewed all the reports in relation to research of IS aetiology, which were published in peer-review journals and were originated from the Thriasio SSS program.

Results. Analysis comprises of reports for (i) IS prevalence, (ii) aetiological studies originated from school screening referrals which implicate numerous environmental and biological factors in IS pathogenesis, (iii) suggestions for a more efficient screening, (iv) IS natural history, and (v) the evolving aim of SSS based on the reported research.

Conclusions. SSS should be adopted by policy makers, because its scope goes beyond the identification of IS at an early stage, contributing significantly into the research for IS aetiology.     

Boston矫形器治疗青少年特发性脊柱侧凸的疗效分析

目的研究Boston矫形器对青少年特发性脊柱侧凸(AIS)的临床治疗效果。方法选择1997年3月至2002年12月使用Boston矫形器治疗并得到随访的AIS患者108例,观察并比较患者治疗前、后的Cobb角、顶椎偏离中线距离(AVT)、顶椎旋转度(AVR)、躯干位移(TS)以及肺活量(VC)、第1秒用力呼气容积占用力肺活量的百分比(FEV1／FVC)、每分钟最大通气量(MVV)、残气量(RV)等指标,分析并评价Boston矫形器的疗效。结果矫形器治疗前,脊柱侧凸的Cobb角为(38．2±10．8)°,矫形器治疗2年后Cobb角平均为(24．4±8．9)°,治疗前、后比较差异有统计学意义(P<0．01),矫正率为36．1％。矫形器治疗后, AVT、AVR和TS与治疗前比较,有显著改善(P<0．01);而肺功能各项指标(包括VC、FEV1／FVC、MVV和RV)的正常率并无明显改变(P>0．05)。Risser。征Ⅰ度(包括0度)患者矫正率分别与Risser征Ⅱ度、Ⅲ度患者比较,差异均有统计学意义(P<0．05)。除3例患者因出现侧凸进展改行手术矫形外,其他患者侧凸畸形均得到显著改善,肺功能无明显损害。结论Boston矫形器对AIS的临床治疗有效,Risser征可以作为预测AIS矫形器矫形效果的指标之一。     

Lateral steps reveal adaptive biomechanical strategies in adolescent idiopathic scoliosis

Introduction

Adolescent idiopathic scoliosis (characterized by a morphological deformation of the trunk) prompts the development of new postural control strategies. This adaptation has an influence on the dynamics of motor behaviour. The present study analysed ground reaction forces during lateral stepping in order to highlight the dynamic consequences of idiopathic scoliosis.

Material and methods

Ten adolescents suffering from idiopathic scoliosis with right thoracic curvature (Cobb angle ≥15°) and 15 healthy adolescents participated in the study. We used two force platforms to record ground reaction forces for the right and left legs during large and small lateral steps (LSs).

Results

Our results revealed intergroup and interlimb differences for both types of step. For small LSs, right-side (i.e. convexity side) initiation induced a significant increase in the ground reaction force impulse during the postural phase for the scoliotic group, when compared with the control group. For large LSs, left-side (i.e. concavity side) initiation induced a significant increase in ground reaction force impulse during the landing phase only. Patients always displayed slower dynamic behaviour than healthy controls. For both stepping sides, the asymmetry index (AI) was higher in the scoliotic group than in the control group (0.2 ≤ AI ≥ 85 in the scoliotic group versus 0.1 < AI > 24.4 in the control group). Furthermore, the scoliotic group showed a significant increase in the variability of the dynamic parameters (> 8%).

Conclusion

In scoliotic subjects, lateral stepping prompts specific dynamic behaviour affecting both limbs, in order to maintain balance during movement despite spinal deformation. This stepping task could be used in future studies to identify specific motor strategies.     

Bracing adolescent idiopathic scoliosis: A systematic review of the literature of effective conservative treatment looking for end results 5 years after weaning

Purpose. The purpose of this study is to investigate long-term radiological and clinical outcomes of brace treatment, comparing to those of the natural history or surgical treatment.

Method. Review of literature.

Results. Most of the ling-term follow-up study of brace treatment showed initial improvement with use of the brace, slight improvement compared with the original curve at the time of the brace discontinuation, and an additional loss of correction at the time of the follow-up. The rate of loss of correction was comparable to the progression rate observed in the natural history after skeletal maturity, and the effect of the brace treatment remained even with some loss of correction after the treatment. Clinical outcomes investigated were pain, function, and activity of the patients, including marital status, child bearing, and job performance. Most of the studies concluded that quality of life of the patients treated by brace was comparable to that of the control, with some exception reported regarding back pain and some kind of activities.

Conclusion. Brace treatment is effective even in the long-term for the treatment of adolescent idiopathic scoliosis. Curve progression after the treatment was equivalent to that in the natural history. Quality of life of the patients treated by brace was comparable to that of the normal control.     

Bracing adolescent idiopathic scoliosis: a systematic review of the literature of effective conservative treatment looking for end results 5 years after weaning

Purpose. The purpose of this study is to investigate long-term radiological and clinical outcomes of brace treatment, comparing to those of the natural history or surgical treatment.

Method. Review of literature.

Results. Most of the ling-term follow-up study of brace treatment showed initial improvement with use of the brace, slight improvement compared with the original curve at the time of the brace discontinuation, and an additional loss of correction at the time of the follow-up. The rate of loss of correction was comparable to the progression rate observed in the natural history after skeletal maturity, and the effect of the brace treatment remained even with some loss of correction after the treatment. Clinical outcomes investigated were pain, function, and activity of the patients, including marital status, child bearing, and job performance. Most of the studies concluded that quality of life of the patients treated by brace was comparable to that of the control, with some exception reported regarding back pain and some kind of activities.

Conclusion. Brace treatment is effective even in the long-term for the treatment of adolescent idiopathic scoliosis. Curve progression after the treatment was equivalent to that in the natural history. Quality of life of the patients treated by brace was comparable to that of the normal control.     

先天性脊柱侧弯后路融合术后康复的远期疗效 .

Accordingtoreports，theincidencerateofcongenitalspinaldeformityis５．１９％inourcountry，andinthepatients，２３．８％requiredsurgerytreatment．Congenitalscoliosisismostfrequentonekindsofcongenitalspinaldeformity．Becausetherearenumerouspopulationinourcountry，theabsolutequantityofthepatientswithcongenitalscoliosisisverylarge．Itisveryimportantforimprove－mentoflivingqualitywhenpatientsarematuretoperformearlydi－agnosisandearlytreatment，preventtheoccurrenceofseverecom－plicationsinlateperiodan…     

重度特发性胸腰段脊柱侧凸患者应用前后路手术联合内固定的疗效及预后

目的探讨重度特发性胸腰段脊柱侧凸患者应用前后路手术联合内固定的疗效及预后。方法选择60例重度特发性胸腰段脊柱侧凸患者,随机分为2组。前后路组患者给予前后路联合内固定术,后路组患者给予后路联合内固定术。观察2组患者治疗情况、术前术后指标变化及随访情况。结果 2组患者手术时间、出血量、住院时间比较有显著差异(P0.05);2组患者融合节段无显著差异(P0.05)。2组术后主弯Cobb角、后凸角及躯干偏移均有显著改善(P0.05)。2组末次随访主弯Cobb角丢失度数、后凸丢失度数、主弯Cobb角矫正率、后凸矫正率无显著差异(P0.05)。结论前后路联合内固定术与后路联合内固定术对重度特发性胸腰段脊柱侧凸患者治疗效果相当,后路联合内固定术手术时间与住院时间更短,但出血量更大,风险更高。     

特发性脊柱侧弯住院患者主要照顾者负荷及影响因素分析

目的：了解特发性脊柱侧弯患者在住院期间主要照顾者照顾负荷的现状,探讨照顾负荷的影响因素。方法采用一般情况问卷、照顾负荷问卷和焦虑自评量表对60例特发性脊柱侧弯患者及其主要照顾者进行调查。结果60名主要照顾者负荷总分为24~65分,平均(35.46±11.54)分,且60名照顾者中有53.3%处于焦虑状态;多元线性逐步回归分析显示,照顾者月收入、每天照顾时间、是否有他人协助以及照顾者焦虑情况是照顾者照顾负荷的主要影响因素。结论特发性脊柱侧弯患者在住院期间其主要照顾者均存在着一定的负荷,医护人员在护理患者的同时应该给予照顾者一定的爱护与帮助,以减轻其照顾负荷。     

特发性和先天性脊柱侧凸患者椎间盘终板软骨的钙结合蛋白和相关蛋白表达差异及其临床意义

目的 探究特发性和先天性脊柱侧凸椎间盘终板软骨的钙结合蛋白S100和相关蛋白表达价值.方法 回顾性分析2019年1～12月湘南学院附属医院收治的22例脊柱侧凸患者的病例资料,其中12例为特发性脊柱侧凸作为IS组,10例为先天性脊柱侧凸作为CS组,对椎间盘终板软骨中S100A8及热休克蛋白90(HSP90)以及钙调蛋白(...     

非甾体类抗炎镇痛药在腰椎后路内固定术后镇痛效果的比较

目的：比较氟比洛芬酯与帕瑞昔布钠在腰椎后路内固定术后手术区域镇痛治疗中的疗效及安全性。方法：接受单节段腰椎后路内固定手术治疗的90例患者随机分为3组,每组30例,A组为术后氟比洛芬酯100 mg镇痛,B组为术后帕瑞昔布钠40 mg镇痛,C组为术后生理盐水对照组。记录术后2、6、12、24、48、72 h的疼痛VAS评分、术后追加盐酸曲马多用量和发生不良反应的例数,并进行统计学分析。结果：A、B组术后各时间点镇痛效果显著优于C组（P＜0．05）;C组术后追加阿片类镇痛药物用量显著多于A、B组（P＜0．05）;术后2 h,A组VAS评分显著低于B组;术后6、12、24 h,A组与B组VAS评分比较差异无统计学意义（P＞0．05）,术后48、72 h A组VAS评分显著高于B组（P＜0．05）。C组不良反应例数显著少于A、B组（P＞0．05）, A、B组发生不良反应例数比较差异无统计学意义（P＞0．05）。结论：氟比洛芬酯与帕瑞昔布钠均能减轻术后疼痛且不良反应发生率低,以氟比洛芬酯起效更快,而帕瑞昔布钠长期镇痛效果更优。     

咀嚼口香糖不能加速Lenke 5型青少年特发性脊柱侧凸患者后路融合术后胃肠道功能恢复：一项前瞻性单盲随机对照研究

目的：探讨咀嚼口香糖对Lenke 5型青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）患者后路融合术后胃肠道功能恢复的影响。方法：2016年1月至2018年1月海军军医大学附属长征医院收治的行后路融合手术的Lenke 5型AIS患者随机分为口香糖组和对照组（注册号：ChiCTR-IOR-17013449）。口香糖组患者术后第1~3天每天8:00、12:00、18:00咀嚼口香糖20～30 min;对照组不给予咀嚼口香糖处理。主要终点指标：术后初次通气时间、初次肠蠕动时间、术后住院时间及进食时间。次要终点指标：术后镇痛药用量、腹部疼痛及恶心评分、术后并发症。结果：最终纳入99例患者,其中口香糖组49例,对照组50例。两组患者术后首次通气时间（P=0.162）、肠蠕动时间（P=0.387）、首次进食时间、术后住院时间（P=0.730）差异均无统计学意义。两组患者术后并发症发生率、镇痛药用量、腹痛及恶心评分差异无统计学意义。结论：Lenke 5型AIS患者后路融合术后咀嚼口香糖不能加速胃肠道功能恢复。     

两种手术方式治疗退行性腰椎侧弯合并腰椎管狭窄症疗效比较

目的 探讨微创经椎间孔入路腰椎椎体间融合术(MIS-TILF)与后路减压固定融合矫形术(PLIF)治疗退行性腰椎侧弯合并腰椎管狭窄症的疗效.方法 选取自2018年5月至2020年5月收治的104例退行性腰椎侧弯合并腰椎管狭窄症患者为研究对象.根据手术方案将患者分为A组和B组,每组各52例.A组患者行MIS-TILF,B...     

青少年特发性脊柱侧凸植入物内固定后冠状面失平衡及模型构建

背景：青少年特发性脊柱侧凸是目前临床上影响青少年身体外观的常见病,但通过Logistic回归方程来分析固定后冠状面失平衡目前尚缺乏报道。目的：探讨Lenke Ⅱ型青少年特发性脊柱侧凸患者固定后冠状面失平衡的原因。方法：对新疆医科大学第一附属医院脊柱外科2001年1月至2012年11月收治的141例Lenke Ⅱ型青少年特发性脊柱侧凸患者进行多个变量的单因素比较和多因素Logistic回归分析,筛选导致青少年特发性脊柱侧凸患者固定后发生冠状面失平衡的危险因素,并构建预测模型。结果与结论：141例患者中有30例出现固定后冠状面失平衡,占全部受试患者的21．28％。对于LenkeII型特发性脊柱侧弯畸形患者,固定前顶椎3—4级Nash-More椎体旋转、4—5级Risser征、主弯矫正率,柔韧性〉1、下胸弯Cobb角〉70。等易引起固定后冠状面失平衡。多因素Logistic回归分析提示椎体旋转、Risser征、主弯矫正率,柔韧性、下胸弯Cobb角等是LenkeII型青少年特发性脊柱侧凸患者固定后发生冠状面失平衡的独立危险因素。预测模型为Y=1／[1＋exp（-1．182X1＋1．228X2＋1．671X3-0．71X4＋0．407）]。     

脊柱侧凸病人融合术前和手术两年后背部肌肉的肌电分析

目的 脊柱融合是治疗脊柱侧凸的基本方法。脊柱的生物力学性质在融合后会发生改变,这种变化可能导致背部肌肉功能异常。本文研究脊柱侧凸患者脊柱融合手术前和手术两年后背部肌肉功能的改变。方法 采集和分析18例脊柱侧凸患者脊柱融合手术两年后背部四对肌肉的肌电信号,得到信号和平均方根值、中频值和肌电包络等参数,并和手术前进行比较。结果 手术两年后,病人肌电的幅度增加、中频值下降,同时部两侧肌电包络的对称性降低。结论 手术两年后患者背部肌肉的各项肌电参数发生的变化和废用性肌肉萎缩的特征一致,表明融合术两年后,脊柱侧凸患者的背部肌肉已经出现萎缩现象。     

脊柱侧凸治疗进展中的有限元分析

背景：脊柱侧凸是一种包括椎体水平面旋转的复杂病理特点的三维脊柱畸形。有限元分析法可取代传统的生物力学实验法进行重复实验分析以及数字化仿真模拟,在脊柱侧凸的生物力学研究中的运用日益深入。 目的：旨在强调运用有限元分析法对脊柱侧凸的支具和手术治疗方面进行简要的阐述。 方法：以＂脊柱侧凸;有限元＂为检索词,检索PubMed数据库以及万方数据库1986年1月至2013年5月文献。选择文章主要内容与脊柱侧凸治疗的有限元分析直接相关的、代表性好、相关领域权威杂志的文章共38篇进行讨论。 结果与结论：如何设计出更加符合脊柱侧凸生物力学特征的个体化支具已成为研究热点。利用多重影像学技术将肋骨、胸骨以及骨盆等引入有限元模型中,分析研究脊柱侧凸施加三维矫形力的最佳方式。研究发现施加载荷最佳的方式是在脊柱侧凸的凸侧区域。有限元分析法可预测和评估患者的矫形过程及效果,进而制定出合理的矫形治疗方案。有限元分析法模拟分析内固定器械与脊柱之间的应力分布情况,更有效的预防治疗后并发症的发生。