青少年特发性脊柱侧凸支具治疗研究分析

[目的]探讨胸腰骶支具治疗青少年特发性脊柱侧凸的临床疗效,为开展青少年特发性脊柱侧凸的筛查和临床治疗提供参考依据。[方法]对2004年10月~2012年2月在云南部分地区筛查中确诊为青少年特发性脊柱侧凸的132例患者进行Lenke分型,并予胸腰骶支具治疗,比较治疗前后Cobb角。[结果]Lenke1型治疗前后Cobb角平均减小9°,差异具有统计学意义(P0.05),Lenke3型治疗前后胸弯Cobb角平均减小5.2°,胸腰弯Cobb角平均减小6.4°,差异均具有统计学意义(P0.05),Lenke5型治疗前后Cobb角平均减小12.7°,差异具有统计学意义(P0.05),Lenke6型治疗前后胸弯Cobb角平均减小2.0°,胸腰弯Cobb角平均减小6.8°,差异没有统计学意义(P0.05)。[结论]12~16岁是青少年特发性脊柱侧凸重点普查对象,胸腰骶支具对减缓或阻止Lenke1型、Lenke3型和Lenke5型畸形具有显著作用,而对Lenke6型没有明显效果,支具治疗对阻止或减缓病情发展不受年龄、性别和分型的影响。     

不同类型青少年脊柱侧弯支具治疗疗效观察

[目的]回顾性分析青少年脊柱侧弯支具治疗疗效,探讨不同类型青少年脊柱侧弯的支具选择及治疗措施.[方法]通过总结本科自2003年1月～2006年6月间接受支具治疗的青少年脊柱侧弯患者26例,男9例,女17例;年龄9～15岁(平均12.4岁),其中King-MoeⅠ型3例,Ⅱ型4例,Ⅲ型8例,Ⅳ型6例,Ⅴ型2例,半椎体畸形2例,胸段脊柱分节不良1例.分别采用胸腰骶支具外固定,支具固定前Cobb's角平均29.9°,支具治疗后Cobb's角平均20.8°.[结果]侧弯Cobb's角平均矫正9.1°,矫正率35%.KingⅠ型、Ⅱ型、Ⅲ型、Ⅳ型支具治疗后有改善,Ⅴ型支具治疗后无改善,其中3例先天性侧弯支具治疗后加重.26例观察0.5～2.5年,Cobb's角逐渐加大,失去支具治疗指征而采取手术者8例.[结论]支具治疗轻、中度Ⅰ、Ⅱ、Ⅲ、Ⅳ型特发性脊柱侧弯效果良好;参与侧弯椎体数越多支具治疗疗效越好;柔韧度好者支具治疗疗效良好;复杂脊柱侧弯及先天性脊柱侧弯支具固定可以预防术前快速加重.     

Correlation between quantity and quality of orthosis wear and treatment outcomes in adolescent idiopathic scoliosis

Orthotic treatment is the most commonly used non-surgical treatment method for adolescent idiopathic scoliosis (AIS). This study determined whether treatment outcome correlates with how often and how well children with AIS wear their orthoses. Eighteen (18) subjects (3M, 15F) who were diagnosed with idiopathic scoliosis and had worn their orthoses from 6 months up to 1 year participated in this study. All subjects were prescribed Boston braces to be worn full time (23 hrs/day). Twelve (12) subjects who completed their brace treatment were included in the data analysis. Three (3) treatment outcomes were classified as improvement, no change and deterioration. The quality of the brace wear was assessed by how often the brace was worn with zero force, below 80%, between 80 to 120%, and above 120% of the load level prescribed in the clinic. The quantity of brace wear was determined by how many hours per day they wore their brace. Subjects who wear their braces tighter and for more hours per day seem to have better outcomes.     

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.     

Advances in scoliosis brace treatment for adolescent idiopathic scoliosis

Orthotic treatment with a brace remains the treatment of choice for adolescent idiopathic scoliosis in the immature patient with documented progression or a curve magnitude of 25 degrees to 40 degrees . Studies of natural history and bracing consistently show high rates of curve progression and surgery with observation and significantly less so with brace treatment. Brace treatment is difficult in overweight patients and challenging in males. Many of the variations in brace study results may be attributable to differing rates of compliance with brace wear, a parameter that is becoming easier to measure.     

Results of treatment of idiopathic scoliosis with the Charleston bending orthosis

The authors present a preliminary retrospective review of the treatment of 32 patients with idiopathic scoliosis with the Charleston bending thoracolumbosacral orthosis (TLSO), a new, low-profile spinal orthosis. At the onset of treatment, the patients' mean age was 12.5 years and the mean Risser stage was 0.4. Females achieved menarche at an mean of 1.8 months after starting orthotic treatment. Single structural curves were treated in all patients. At this time, 2 patients have failed treatment, their curves progressing 12 degrees and 8 degrees, respectively. An additional 11 patients have successfully completed treatment, having reached skeletal maturity with no more than 5 degrees of curve progression. Their mean curve change was a 2.2 degrees decrease. The other 19 patients remain under treatment. The Charleston bending TLSO is worn only during nighttime sleeping hours. It is well tolerated, with excellent patient compliance and low psychological stress, and it may be as successful at curve control as other orthoses. Experience with more patients and longer follow-up is needed.     

计算机辅助测量青少年特发性脊柱侧凸脊柱长度的方法及可行性分析

目的 :提出一种新的计算机辅助测量青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)脊柱长度的方法,评价其准确性和可重复性。方法:在前后站立位脊柱全长正位X线片上选取每个椎体的四个顶点,基于Matlab 6.5软件,设定程序确定L4下终板至T1上终板的中线,将中线上点的距离和作为脊柱长度。由1名医师采用计算机辅助测量方法和2名医师采用手工测量方法,随机选取5例AIS患者并对每例患者进行5次重复测量,计算两种方法测量结果的均值和标准差,评价计算机辅助测量脊柱长度方法的准确性和可重复性。选取45例AIS患者,其中女38例,男7例,年龄10～16岁(13.5±1.5岁);Cobb角10°～45°(32.5°±8.7°)。由同一骨科医师在前后站立位脊柱全长正位X线片上分别采用手工测量方法和计算机辅助测量方法获得T1～L4脊柱长度,计算均值和标准差,比较两种测量方法的结果是否存在差异。应用计算机辅助测量方法测量计算出45例AIS患者L4～T1的脊柱长度,对同一医师应用该测量方法间隔4周的两次测量结果做比较,分析同一观察者在不同时间的可重复性;对3名不同医师分别应用该测量方法的测量结果做比较,分析该方法不同观察者间的可重复性。结果:应用计算机辅助测量方法测量5例AIS患者的脊柱长度(±s)分别为325.8±0.46mm、391.3±0.43mm、476.7±0.04mm、441.3±0.79mm和432.8±0.50mm,2名医师应用手工测量方法测量5例AIS患者的脊柱长度分别为325.7±8.3mm、390.9±7.6mm、476.7±6.0mm、441.5±8.2mm、433.1±6.0mm和326.2±5.9mm、391.4±7.5mm、476.1±5.8mm、441.6±8.2mm、432.9±5.8mm,应用计算机辅助测量方法多次测量脊柱长度测得结果的标准差较手工测量结果低得多。采用计算机辅助测量方法与手工测量方法测量45例AIS患者的脊柱长度(±s)分别为404.7±43.2mm和405.1±45.5mm,两组均数比较差异无显著性(P0.05),采用计算机辅助测量方法测量AIS脊柱长度的同一观察者间隔4周的组内相关系数为0.995(P0.05),不同观察者间的组内相关系数为0.942(P0.05)。结论:计算机辅助测量AIS患者脊柱长度的方法较传统的手工测量方法操作简单,并且其准确性和可重复性均较好。     

青少年特发性脊柱侧凸的治疗进展

青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)是指年龄在10¹8岁,冠状面上Cobb角>10°伴有椎体的旋转而无其他器质性病变的一种常见病。该疾病能够导致身体外观畸形、疼痛,甚至心肺功能受损,严重影响了患者的身心健康及生活质量。在治疗上,对于轻中度的AIS患者常用定期观察、支具等保守治疗方法,能够有效的延缓侧凸的进展;对于保守治疗无效,达到手术阈值的AIS患者,则建议手术治疗,目前较为常用的手术方法是以椎弓根螺钉内固定系统为代表的后路椎体融合术,往往能够达到较好的临床疗效。近年来,由于物理治疗性脊柱侧凸特异性运动(PSSE)疗法安全有效,越来越受欢迎。目前对于AIS患者治疗的具体适应证正逐渐完善,治疗理念与技术在不断更新,临床疗效也不断得到改善。本文将从保守治疗和手术治疗两方面展开,主要阐述常用的治疗方法在临床上的进展和应用以及所面临的问题,为临床治疗的选择提供参考。     

青少年特发性脊柱侧凸治疗研究新进展

青少年特发性脊柱侧凸（AIS）是最常见的脊柱畸形之一,严重危害青少年健康。过去数十年来对AIS分型或治疗的认识取得了长足的进步,治疗方法更趋合理,但在治疗策略上依然存有争议和分歧,尤其是对某些特殊类型的AIS。该文就AIS治疗的新近进展作一简要综述。     

Efficacy of exercise therapy for the treatment of adolescent idiopathic scoliosis: a review of the literature

Purpose  

Current evidence regarding the use of exercise therapy in the treatment of adolescent idiopathic scoliosis (AIS) was assessed with a review of published literature.     

Evaluation of a new sagittal classification system in adolescent idiopathic scoliosis

European Spine Journal - The purpose of the present study was to validate a new spinal sagittal classification. We retrospectively included 105 consecutive AIS patients who underwent posterior...     

Harrington-Luque联合矫正青少年特发性脊柱侧凸

目的　评价Harrington Luque联合矫正青少年特发性脊柱侧凸的疗效。 方法　应用Har rington Luque联合治疗青少年特发性脊柱侧凸 16例。 结果　术前Cobb角平均 81 5° ,术后平均2 8 5°,矫正率达 6 5 % ,平均身高增加 5 2cm。经 1～ 9年随访 ,融合良好 ,无一例复发。结论　该方法撑开力大、应力分散 ,能最大限度矫正脊柱侧凸畸形 ,内固定稳定 ,有利于植骨融合     

Brace treatment resulting in overcorrection of adolescent idiopathic scoliosis

Brace treatment for idiopathic scoliosis in skeletally immature children is the only effective nonoperative modality for the control of curve progression. The Charleston bending brace is a custom-molded spinal orthosis that holds the patient in a completely corrected or overcorrected position while worn at night. A 9-year-old girl presented with 10° right upper thoracic and 7° left lower thoracic curves and was Risser sign 0. Nighttime treatment with a Charleston bending brace was initiated when the left lower thoracic curve progressed to 19°. After 27 months of nighttime brace wear, the lower thoracic curve was 21° to the right. Further investigation, including magnetic resonance imaging of the spine, failed to diagnose an identifiable explanation for this atypical occurrence. Conservative treatment may improve radiographic and cosmetic appearance. Overcorrection of the curve, although not likely, is possible when part-time or nighttime bracing is implemented as a means of conservative management.     

青少年特发性脊柱侧凸发病机制及治疗进展

近年有较多学者对青少年特发性脊柱侧凸(AIS)病因及发病机制进行研究,取得了很大进展.在基因水平方面,确认一些可能与AIS发病有关的染色体遗传基因点,且发现一些核酸转录因子的异常表达.在组织学方面,发现AIS患者凹凸侧椎体骨质、椎旁肌肌纤维及椎间盘等均有异常改变.通过MRI及CT检查,对椎体、椎管及脊髓畸形有了更深入的认识,不仅对椎体旋转、椎管变形及椎弓根等畸形有了更明确的了解,还发现了脊髓裂、脊髓空洞、脊髓拴系症及Chiari畸形等异常病变.内固定器械的改良使脊柱侧凸术的纠正效果得到很大改善;临床观察发现AIS治疗中不同内固定器械矫正脊柱侧凸Cobb角的后期丢失存在差别.     

Bracing in adolescent idiopathic scoliosis

The article reviews the present knowledge about brace treatment for adolescent idiopathic scoliosis (AIS). Indications, technique, problems, and results, are presented based on the literature. It is stressed by the authors that more scientific evidence is needed to reach a final conclusion whether brace treatment in AIS is effective or not.     

Further evaluation of the Scolitron treatment of idiopathic adolescent scoliosis

One hundred forty-two patients were treated by the Scolitron method of lateral electric surface stimulation (LESS) for scoliosis. Using 10 degrees progression as a failure point, clinicians reported the following: 56.3% of patients were classified as failures, 26.8% as successes; and 16.9% were still under treatment. When broken down into individual groups, true protocol patients, at risk for progression, had the lowest success rate; whereas those that were nonprotocol, and least at risk, had the highest success rate. This method should still be considered experimental and cannot be considered an alternative to bracing at this time.     

青少年特发性脊柱侧凸外科治疗并发症回顾分析

自20世纪80年代Cotrel—Dubousset报道脊柱侧凸三维矫形以来,矫治效果比以往的Harrington、Luque时代有了显著提高。国内自1997年开展此类手术,病例数量不断积累,但关于青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）手术治疗的并发症报道相对较少。本文针对2个脊柱外科中心2000年2月～2005年12月间共收治的589例AIS患者的并发症发生情况进行回顾性研究,