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。     

骨移植在青少年特发性脊柱侧凸后路矫形术的应用研究

[目的]通过不同植骨在青少年特发性脊柱侧凸后路矫形植骨融合术中的应用比较,探讨其临床应用效果.[方法]回顾性分析2000年～2005年行后路钉-棒系统矫形手术的71例青少年特发性脊柱侧凸患者,其中自体骨移植21例(A组),同种异体骨移植23例(B组),自体骨混合同种异体骨移植27例(C组),比较随访第3、9、15、36个月的融合率、Cobb's角丢失率及假关节发生率.[结果]A组平均融合节段7个,B组平均融合节段7.6个,C组平均融合节段8个.随访的第3个月,融合率、Cobb's角丢失率及假关节发牛率A组、B组、C组无显著性差异(P＞0.05).第9个月,A组融合率高于B、C两组,A组与B、C组有显著性差异(P＜0.05),B、C组间无显著性差异(P＞0.05),Cobb's角丢失率及假关节发生率A、B、C组无显著性差异(P＞0.05).第15、36个月,融合率、Cobb's角丢失率及假关节发牛率A、B、C组无显著性差异(P＞0.05).[结论]同种异体骨移植、自体骨混合同种异体骨移植与自体骨移植在青少年特发性脊柱侧凸后路矫形手术中对维持矫形效果可取得相近的近远期临床效果.     

Long-term three-dimensional changes of the spine after posterior spinal instrumentation and fusion in adolescent idiopathic scoliosis

This is a prospective study comparing the short- and long-term three-dimensional (3D) changes in shape, length and balance of the spine after spinal instrumentation and fusion in a group of adolescents with idiopathic scoliosis. The objective of the study was to evaluate the stability over time of the postoperative changes of the spine after instrumentation with multi rod, hook and screw instrumentation systems. Thirty adolescents (average age: 14.5 ± 1.6 years) undergoing surgery by a posterior approach had computerized 3D reconstructions of the spine done at an average of 3 days preoperatively (stage I), and 2 months (stage II) and 2,5 years (stage III) after surgery, using a digital multi-planar radiographic technique. Stages I, II and III were compared using various geometrical parameters of spinal length, curve severity, and orientation. Significant improvement of curve magnitude between stages I and II was documented in the frontal plane for thoracic and lumbar curves, as well as in the orientation of the plane of maximum deformity, which was significantly shifted towards the sagittal plane in thoracic curves. However, there was a significant loss of this correction between stages II and III. Slight changes were noted in apical vertebral rotation, in thoracic kyphosis and in lumbar lordosis. Spinal length and height were significantly increased at stage II, but at long-term follow-up spinal length continued to increase while spinal height remained similar. These results indicate that although a significant 3D correction can be obtained after posterior instrumentation and fusion, a significant loss of correction and an increase in spinal length occur in the years following surgery, suggesting that a crankshaft phenomenon may be an important factor altering the long-term 3D correction after posterior instrumentation of the spine for idiopathic scoliosis. Received: 3 March 1998 Revised: 22 August 1998 Accepted: 15 September 1998     

Concurrent and overlapping surgery: perspectives from surgeons on spinal posterior instrumented fusion for adolescent idiopathic scoliosis

PurposeThe purpose of this study was to determine perspectives of surgeons regarding simultaneous surgery in patients undergoing posterior spine instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS).MethodsA survey was administered to orthopaedic trainees and faculty regarding simultaneous surgery for primary PSIF for AIS. A five-point Likert scale (1: ‘Strongly Disagree’ to 5: ‘Strongly Agree’) was used to assess agreement with statements about simultaneous surgery. We divided simultaneous surgery into concurrent, when critical portions of operations occur at the same time, and overlapping, when noncritical portions occur at the same time.ResultsThe 72 respondents (78.3% of 92 surveyed) disagreed with concurrent surgery for ‘one of my patients’ (response mean 1.76 (sd 1.03)) but were more accepting of overlapping surgery (mean 3.94 (sd 0.99); p < 0.0001). The rating difference between concurrent and overlapping surgery was smaller for paediatric and spine surgeons (-1.25) than for residents or those who did not identify a subspecialty (-2.17; p = 0.0246) or other subspecialty surgeons (-2.57; p = 0.0026). Respondents were more likely to agree with explicit informed consent for concurrent surgery compared with overlapping (mean 4.32 (sd 0.91) versus 3.44 (sd 1.14); p < 0.001).ConclusionOrthopaedic surgeons disagreed with concurrent but were more accepting of overlapping surgery and anaesthesia for PSIF for AIS. Respondents were in greater agreement that patients should be explicitly informed of concurrence than of overlap. The surgical community’s evidence and position regarding simultaneous surgery, in particular overlapping, must be more effectively presented to the public in order to bridge the gap in perspectives.Level of EvidenceIV     

Clinical and economic implications of early discharge following posterior spinal fusion for adolescent idiopathic scoliosis

Objective

To evaluate the clinical and economic impact of a novel postoperative pathway following posterior spinal fusion (PSF) in patients with adolescent idiopathic scoliosis (AIS).

Methods

Patient charts were reviewed for demographic data and to determine length of surgery, implant density, use of osteotomies, estimated blood loss, American Society of Anesthesiologists (ASA) score, length of hospital stay, and any subsequent complications. Hospital charges were divided by charge code to evaluate potential savings.

Results

Two hundred and seventy-nine of 365 patients (76.4 %) treated with PSF carried a diagnosis of AIS and had completed 6 months of clinical and radiologic follow-up, a period of time deemed adequate to assess early complications. There was no difference between groups in age at surgery, sex, number of levels fused, or length of follow-up. Patients managed under the accelerated discharge (AD) pathway averaged 1.36 (31.7 %) fewer days of inpatient stay. Operative time was associated with a shorter length of stay. There was no difference in complications between groups. Hospital charges for room and board were significantly less in the AD group ($1.885 vs. $2,779, p < 0.001).

Conclusions

A pathway aimed to expedite discharge following PSF for AIS decreased hospital stay by nearly one-third without any increase in early complication rate. A small but significant decrease in hospital charges was seen following early discharge. Early discharge following PSF for AIS may be achieved without increased risk of complications, while providing a small cost savings.     

Radiographic evaluation of selective anterior thoracolumbar or lumbar fusion for adolescent idiopathic scoliosis

According to Lenke classification of adolescent idiopathic scoliosis (AIS), patients with type 5 curve in which the structural major curve is thoracolumbar or lumbar curve with nonstructural proximal thoracic and main thoracic curves, could be surgically treated with selective anterior thoracolumbar or lumbar (TL/L) fusion. This study retrospectively analyzed the radiographies of selective anterior TL/L fusion in 35 cases of AIS with Lenke type 5 curve. Segmental fixation with a single rigid rod through anterior thoracoabdominal approach was applied in all patients. Measurements of scoliosis curve in preoperative, immediate postoperative and follow-up radiographies were analyzed. The average follow up time was 36 months (24-42 months). The average preoperative Cobb angle of the TL/L curve was 45.6 degrees and improved into 9.7 degrees immediate postoperatively, with 79.7% curve correction. In addition, the minor thoracic curve decreased from 29.7 degrees preoperatively to 17.6 degrees postoperatively, with a spontaneous correction of 41.5%. During the follow-up, a loss of 4.6 degrees correction was found and the average Cobb angle of TL/L increased to 14.4 degrees . Also, the minor thoracic curve increased to average 20.1 degrees with a loss of 2.4 degrees correction. Trunk shift deteriorated slightly immediate postoperatively and improved at the follow-up. The lowest instrumented vertebra (LIV) tilt was improved significantly and maintained its results at the follow-up. During the follow-up, the coronal disc angle immediately above the upper instrumented vertebra (UIVDA) and below the LIV (LIVDA) aggravated, while the sagittal contours of T5-T12 and T10-L2 were well maintained. The lumbar lordosis of L1-S1 and the sagittal Cobb angle of the instrumented segments were reduced slightly postoperatively and at the follow-up. There were no major complications or pseudarthrosis. The outcomes of this study show that selective anterior thoracolumbar or lumbar fusion with solid rod instrumentation is effective for surgical correction of AIS with Lenke type 5 curve. The TL/L curve, minor thoracic curve, and LIV title can be improved significantly, with good maintenance of sagittal contour. However, the UIVDA and LIVDA aggravate postoperatively when the trunk rebalances itself during follow-up. The degeneration of LIV disc warrants longer-term follow-up.     

Lenke 5型青少年特发性脊柱侧凸患者后路矫形术后颈椎矢状位曲度的改变

目的 :分析Lenke 5型青少年特发性脊柱侧凸(AIS)患者颈椎矢状位曲度(CSA)在后路矫形术后改变的特点。方法:回顾性分析2011年7月～2017年7月解放军总医院脊柱外科收治的43例Lenke 5型AIS患者的临床资料。在术前、术后及末次随访时的X线片上测量颈椎前凸角(CL)、胸椎后凸角(TK)、胸腰段后凸角(TLK)、腰椎前凸角(LL)、融合节段内腰椎前凸角(LIF)、C7矢状位垂直距离(SVA)。同时统计患者的基本资料,包括性别、年龄、Risser征、随访时间、融合节段椎体数目(NVF)及术前胸腰段/腰弯(TL/L Curve,TL/L C)。依据患者术前CSA分为颈椎前凸组(L组,术前CL0°)、颈椎后凸组(K组,术前CL≥0°);依据患者末次随访时CSA较术前的改变分为颈椎前凸增加组(I组)与颈椎前凸减少组(D组)。使用t检验分析L组与K组、I组与D组对应参数的差异性,使用LSD-t检验分析各组内术前、术后、末次随访时参数的差异。使用Pearson相关性检验分析CL与I组和D组各参数的相关性。检验水准为双侧α=0.05。结果:43例患者中男10例,女33例;年龄15.90±4.98岁,随访时间22.84±14.10个月。L组15例,K组17例;I组26例,D组17例。L组与K组、I组与D组的基本资料无显著性差异。所有患者末次随访时TK较术前增加(P=0.000);术后TLK与术前比较有显著性差异(P=0.000);CL在术前、术后及末次随访时无统计学差异。L组与K组术前CL(P=0.000)、LIF(P=0.029)、SVA(P=0.003)差异有统计学意义(P0.05)。K组末次随访时CL较术前改善(P=0.025),TK较术前增加(P=0.000);术后TLK较术前减小(P=0.002)并维持至末次随访(P=0.002)。I组与D组术前LL(P=0.043)、CL(P=0.009)有显著性差异(P0.05)。I组末次随访时CL较术前改善(P=0.008),TK较术前(P=0.000)及术后(P=0.001)增加;术后TLK较术前减小(P=0.005)并维持到末次随访时(P=0.006)。D组术后LL较术前增加(P=0.011)并维持到末次随访(P=0.001)。I组术前CL与TK、SVA有相关性;D组CL术前与LL、SVA,术后与TLK、SVA,末次随访时与TLK有相关性。结论:术前颈椎后凸的患者较颈椎前凸的患者在术后CSA的改善更为明显;随访中TK增加、术后TLK改善可能有助于CSA的改善;术后只有LL增加而无TK、TLK的改变则可能不会引起CSA改善。     

Lenke 5+型青少年特发性脊柱侧凸患者后路选择性融合术后胸弯的转归

目的:探讨Lenke 5+型脊柱侧凸患者不同融合策略疗效及选择性融合术后胸弯自发矫正情况.方法:回顾性分析2010年1月～2018年12月期间在我院接受手术治疗且随访2年以上Lenke 5+型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者资料,共80例,男13例,女6...     

Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis

The aim of this study is to quantify the changes in the sagittal alignment of the cervical spine in patients with adolescent idiopathic scoliosis following posterior spinal fusion. Patients eligible for study inclusion included those with a diagnosis of mainly thoracic adolescent idiopathic scoliosis treated by means of posterior multisegmented hook and screw instrumentation. Pre and post-operative anterior–posterior and lateral radiographs of the entire spine were reviewed to assess the changes of cervical sagittal alignment. Thirty-two patients (3 boys, 29 girls) met the inclusion criteria for the study. The average pre-operative cervical sagittal alignment (CSA) was 4.0° ± 12.3° (range −30° to 40°) of lordosis. Postoperatively, the average CSA was 1.7° ± 11.4° (range −24° to 30°). After surgery, it was less than 20° in 27 patients (84.4%) and between 20° and 40° in 5 patients (15.6%). The results of the present study suggest that even if rod precontouring is performed and postoperative thoracic sagittal alignment is restored, improved or remains unchanged after significant correction of the deformity on the frontal plane, the inherent rigidity of the cervical spine limits changes in the CSA as the cervical spine becomes rigid over time.     

Selective fusion for adolescent idiopathic scoliosis: a review of current operative strategy

Selective fusion of thoracic and thoracolumbar/lumbar curves in adolescent idiopathic scoliosis is a concept critically debated in the literature. While some surgeons strongly believe that a more rigid and straighter spine provides predictably excellent outcomes, some surgeons recommend a mobile and less straight spine. This topic is a crucial part of surgical treatment of idiopathic scoliosis, particularly in young patients who will deal with the stress of the fusion mass at the proximal and distal junctions over many years. This study will review the literature on various aspects of selective fusion.     

青少年特发性脊柱侧凸后路矫形后远端交界区变化

目的:探讨青少年特发性脊柱侧凸(AIS)患者后路矫形术后远端交界区(LIV+2)在冠状面、矢状面和轴位上的变化。方法:2005年6月～2007年6月手术治疗AIS患者32例,男6例,女26例,年龄10～19岁,平均14.4岁。按PUMC分型,Ⅰc1例,Ⅱa4例,Ⅱb19例,Ⅱb21例,Ⅱc11例,Ⅱc35例,Ⅱd15例,Ⅲa5例,Ⅲb1例。均采用后路全节段椎弓根螺钉系统矫形固定,其中远端融合椎(LIV)与稳定椎(SV)为同一椎体(A组)15例,LIV与SV非同一椎体(B组)17例。术前和末次随访时摄站立位全脊柱正侧位X线片,测量冠状面上躯干偏移(TS),LIV的倾斜度(LIVT),LIV尾侧椎间盘开角(LIVA),冠状面和矢状面上远端交界区的Cobb角和椎体的旋转度(LIV+1VR和LIV+2VR)。结果:随访24～36个月,平均29个月。两组末次随访时的TS与术前比较均无显著性差异(P0.05)。A组LIVT由术前20.2°±5.9°下降到末次随访时的4.7°±3.8°(P0.001),B组由17.2°±5.5°下降到4.4°±2.7°(P0.001);A组术前和末次随访时LIVA分别为7.5°±4.7°和3.9°±3.1°(P=0.056);B组分别为4.5°±3.4°和5.4°±3.2°(P=0.492);Pearson′s相关分析显示两组远端融合椎倾斜度变化和其尾侧椎间盘开角变化之间相关性不显著(A组r=-0.067,P=0.813;B组r=0.362,P=0.154)。A组远端交界区(LIV+2)冠状面上Cobb角由术前20.5°±9.6°矫正至末次随访时9.4°±7.3°(P0.001);B组由13.8°±6.7°矫正至8.1°±4.7°(P=0.013);A、B组末次随访时远端交界区矢状面上Cobb角与术前比较均无显著性差异(分别为P=0.464,P=0.598);Pearson′s相关分析显示A组末次随访时矢状面Cobb角和术前矢状面Cobb角之间相关性不显著(r=0.076,P=0.788),B组的相关性显著(r=0.803,P0.001)。两组末次随访时LIV+1VR和LIV+2VR与术前比较均无显著性差异(P0.05)。结论:AIS患者应用后路全节段椎弓根螺钉系统矫正后远端交界区在冠状面上矫形明显,矢状面和轴位上矫形不明显,且远端融合椎倾斜度减小。     

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.     

不同种类骨移植在青少年特发性脊柱侧凸后路矫形术中的中长期疗效评价

背景:脊柱侧凸矫正术中植骨融合技术是决定矫形治疗结果的关键因素之一。因自体骨应用受限,同种异体骨移植已广泛应用于临床。但同种异体皮质骨颗粒与同种异体松质骨颗粒在脊柱矫形患者中应用的实际效果是否一致?目的:比较不同种类骨移植在青少年特发性脊柱侧凸后路矫形植骨融合术中的应用效果。方法:2004年1月至2007年1月107例青少年特发性脊柱侧凸患者接受经后路脊柱侧凸矫形植骨融合手术。根据植骨材料不同分为A组(同种异体松质骨植骨,57例)和B组(同种异体皮质骨植骨,50例),比较两组患者随访第6、9、12、18、24、36个月的植骨融合情况、术后Cobb角变化情况及并发症等。结果:两组患者年龄、性别、主弯Cobb角、融合节段数及植骨量均无明显差异。平均随访时间为39.8个月。所有病例畸形明显矫正,术后1周总体矫正率为74.2%,最终随访总体矫正率72.1%。术后1周Cobb角及畸形矫形率,最终随访Cobb角、畸形矫形率及矫形度数丢失方面,两组相比均无明显统计学差异(P>0.05)。所有病例最终达到植骨骨性融合,A组平均融合时间15.0个月(6～36个月),B组平均融合时间15.9个月(6～36个月)。术后第6、9、12、18、24、36个月,两组骨性融合率均无明显统计学差异(P>0.05)。两组均未发生螺钉松动、断裂、断棒、假关节等并发症。术后A组4例(7.0%)、B组3例(6.0%)患者出现脑脊液漏,A组1例(1.8%)患者出现切口局部愈合障碍,均得到合理处理。结论:同种异体松质骨或皮质骨骨移植是脊柱侧凸后路矫形植骨融合术中较为理想的植骨方法之一,尤其是后者更是具有来源广泛、骨量大的优点。但在使用时,需根据同种异体骨骨愈合机制来制定术后治疗和康复计划,确保发挥复合骨移植在脊柱矫形术中的优势。     

后路椎弓根螺钉系统矫正青少年特发性脊柱侧凸术后主动脉位置变化分析

【摘要】 目的：评价接受后路椎弓根螺钉系统矫正手术的青少年特发性脊柱侧凸患者术前、术后1周和术后2年主动脉相对于脊柱的空间位置变化。方法：研究对象为接受后路椎弓根螺钉系统矫正手术的22例右胸主弯的青少年特发性脊柱侧凸患者。通过三维重建CT测量患者术前、术后1周、术后2年主动脉位置和顶椎旋转畸形情况,测量参数包括主动脉-椎体距离、主动脉-椎体角、主动脉-椎管距离、左侧椎弓根螺钉长度和顶椎旋转角。通过X线片测量胸主弯的Cobb角和胸椎后凸角。结果：术前主胸弯Cobb角为57.5°±9.8°,术后1周矫正至13.6°±6.5°,术后2年时为16.2°±6.8°;主胸弯Cobb角矫正率术后1周时为77.5%,术后2年时为73.3%。术前顶椎轴面旋转角为29.4°±9.3°,术后1周矫正至14.6°±6.9°,术后2年时为17.4°±6.8°;顶椎旋转畸形的矫正率术后1周时为49.5%,术后2年时为39.7%。主动脉-椎体距离在T6～T11节段术前显著大于术后1周（P<0.05）;在T7～T9节段术后2年显著大于术后1周（P<0.05）。主动脉-椎体角在T5～T11节段术前显著大于术后1周（P<0.05）;在T7～T10节段术后2年显著大于术后1周（P<0.05）。主动脉-椎管距离在T7～T11节段术前显著小于术后1周（P<0.05）;在T6～T10节段术后2年显著小于术后1周（P<0.05）。结论：右胸主弯的青少年特发性脊柱侧凸患者中,术后主动脉相对于脊柱的位置较术前向前内侧移位,术后2年较术后向后外侧移位。在使用椎弓根螺钉系统治疗特发性脊柱侧凸的手术中应该避免椎弓根螺钉穿出椎体前皮质或者椎弓根外侧皮质而导致主动脉损伤。     

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。     

Reliability of cervical lordosis and global sagittal spinal balance measurements in adolescent idiopathic scoliosis

Study design

Radiological reproducibility study.

Purpose

To assess intra and interobserver reliability of radiographic measurements for global sagittal balance parameters and sagittal spine curves, including cervical spine.

Summary of background data

Sagittal spine balance in adolescent idiopathic scoliosis (AIS) is a main issue and many studies have been reported, showing that coronal and sagittal deformities often involve sagittal cervical unbalance. Global sagittal balance aims to obtain a horizontal gaze and gravity line at top of hips when subject is in a static position, involving adjustment of each spine curvature in the sagittal plane. To our knowledge, no study did use a methodologically validated imaging analysis tool able to appreciate sagittal spine contours and distances in AIS and especially in the cervical region.

Methods

Lateral full-spine low-dose EOS radiographs were performed in 75 patients divided in three groups (control subjects, AIS, operated AIS). Three observers digitally analyzed twice each radiograph and 11 sagittal measures were collected for each image. Reliability was assessed calculating intraobserver Pearson’s r correlation coefficient, interobserver intra-class correlation coefficient (ICC) completed with a two-by-two Bland–Altman plot analysis.

Results

This measurement method has shown excellent intra and interobserver reliability in all parameters, sagittal curvatures, pelvic parameters and global sagittal balance.

Conclusions

This study validated a simple and efficient tool in AIS sagittal contour analysis. It defined new relevant landmarks allowing to characterize cervical segmental curvatures and cervical involvement in global balance.     

Unusual presentation of osteoblastoma in a patient with idiopathic scoliosis after posterior spinal fusion

BACKGROUND CONTEXT: Few studies have described the diagnosis of osteoblastoma of the spine as a cause of scoliosis. These reports have described the tumor in conjunction with initial presentation of painful scoliosis. This case report presents a case of osteoblastoma 9 years removed from diagnosis and fusion of idiopathic scoliosis in the thoracic spine. PURPOSE: To report the late presentation of an osteoblastoma of the thoracic spine 9 years after posterior spinal fusion for scoliosis. STUDY DESIGN: Case report. METHODS: A 25-year-old man presented with thoracolumbar back pain and progressive neurological deficit 9 years after posterior spinal fusion for idiopathic scoliosis. Magnetic resonance imaging of the thoracic spine indicated the presence of a mass in the spinal canal causing cord compression. The patient underwent decompression with resection of the mass which was found to be an aggressive osteoblastoma. RESULTS: The patient enjoyed a full neurological recovery and has subsequently developed a recurrence at 13 months. CONCLUSIONS: We present osteoblastoma as a possible cause of low back pain and neurological deficit postfusion that should be considered in a differential diagnosis.     

医用磷酸钙在特发性脊柱侧凸矫形融合术中的应用

[目的]比较医用磷酸钙和自体髂骨在特发性脊柱侧凸矫形融合术中的临床效果.[方法]回顾性分析2006年6月～2009年1月在本科行钉-棒内固定系统矫形手术的62例特发性脊柱侧凸患者,其中自体髂骨移植组28例,医用磷酸钙移植组34例.对两组患者的平均手术时间、出血量、并发症、融合率、矫形丢失进行对比分析.[结果]62例患者均获得随访,每组至少随访24个月.两组患者出血量、手术时间相比,差异有统计学意义(P＜0.05).在自体髂骨组中,有2例(7.1％)出现感染,1例(3.6％)出现躯干不平衡,3例(10.7％)患者在最后一次随访中供区疼痛仍未消失.在磷酸钙组中,有2例(5.8％)出现术后切口渗出,1例(2.9％)出现感染.在移植术后第9个月,自体髂骨组融合率高于磷酸钙组(P＜0.05),其他时间相比两组融合率无统计学意义(P＞0.05).在术后最终随访中,主弯Cobb角度矫形丢失两组差异无统计学意义(P＞0.05).[结论]医用磷酸钙应用于特发性脊柱侧凸患者的后路融合术中可以达到满意的临床效果,避免了取髂骨移植带来的相应并发症.     

退变性腰椎侧凸长节段融合术后远端交界性问题分析

目的 :探讨退变性腰椎侧凸(degenerative lumbar scoliosis,DLS)长节段固定融合术后远端交界性问题(distal junctional problem,DJP)的发生率、危险因素及对患者生活质量的影响。方法 :2009年4月～2017年10月在我院确诊为DLS、年龄≥40岁、行长节段(≥4个节段)固定融合手术、随访时间≥1年的患者132例,将随访时出现DJP的13例患者纳入DJP组,未出现任何机械性并发症的41例患者纳入对照组。对个体因素[手术时的年龄、性别、体重指数(body mass index,BMI)、骨密度(bone mineral density,BMD)和T值、合并糖尿病和高血压情况、美国麻醉医师学会(ASA)分级等因素]、手术因素[固定融合节段数、远端固定椎(lowest instumented vertebra,LIV)位置、截骨操作和椎间融合情况]以及术前和术后影像学参数[侧凸Cobb角、顶椎的旋转程度(Nash-Moe)、顶椎偏移距离(apical vertebral translation,AVT)、冠状位平衡(coronal vertical axis,CVA)、胸椎后凸角(thoracic kyphosis,TK)、胸腰段后凸角(thoracolumbar kyphosis,TLK)、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(sacral slope,SS)、矢状位平衡(sagittal vertical axis,SVA)、T1骨盆角(T1 pelvic angle,TPA)、躯干整体倾斜角(global tilt,GT)等]进行单变量和多变量分析。比较两组术前和随访时的腰痛视觉模拟(visual analog scale,VAS)评分、下肢痛VAS评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、日本骨科学会(Japanese Orthopaedic Association,JOA)-29评分、脊柱研究学会(Scoliosis Research Society-22,SRS-22)评分和健康状况调查简表(short form 36 health survey questionnaire,SF-36)评分。结果 :本组患者DJP的发生率为9.8%(13/132),其中6例(46.2%)患者进行了翻修手术。DJP组患者骨密度T值显著低于对照组,DJP患者骨量减少及骨质疏松的比例显著高于对照组(P0.05),其他个体因素无显著性差异。两组手术因素均无显著性差异。与对照组相比,DJP组患者术前TLK较大、PT较小、SVA70mm的比例较高(53.85%vs 19.51%,P=0.040);术后即刻TLK、SVA显著大于对照组,矢状位失衡患者比例显著高于对照组(46.15%vs 14.63%,P=0.046),其他影像学参数无显著性差异。Logistic回归分析提示骨质疏松(OR=8.90,95%CI=1.95～40.51,P=0.005)、术后即刻矢状位失衡(OR=5.82,95%CI=1.15～29.42,P=0.033)发生DJP的风险分别增加了7.9倍、4.8倍。两组患者术前各项健康相关生活质量评分均无统计学差异;对照组患者术后各项健康相关生活质量评分较术前均有显著性提高(P0.05),而DJP组患者ODI、JOA评分、SF-36精神健康较术前无明显提高(P0.05);与对照组比较,DJP组随访时腰痛VAS评分、ODI、JOA评分、SRS疼痛、SRS功能状况、SRS亚总分、SRS治疗满意度、SF-36生理健康评分、SF-36精神健康评分更差。结论:DLS长节段固定融合术后9.8%的患者发生了远端交界性问题,严重影响患者术后生活质量改善;骨质疏松和术后即刻矢状位失衡是发生DJP的独立危险因素。