The errors and complications in corrective operations for scoliosis

The analysis of mistakes and complications after 4377 correcting operations, performed in 2719 patients for severe scoliosis, was done. The working classification and on her background computer programme of disease diagnosis, prophylaxis and treatment were proposed. Mistakes of preoperative period were mainly tactical, while during the operation--technical, in early postoperative period--clinical and in the late postoperative period--orthopedic. The presence of mistakes lowered significantly the treatment efficacy, they had become the cause of mortality.     

Digital radiography can reduce scoliosis x-ray exposure

Digital radiology is a new computerized system of acquiring x-rays in a digital (electronic) format. It possesses a greatly expanded dose response curve that allows a very broad range of x-ray dose to produce a diagnostic image. Potential advantages include significantly reduced radiation exposure without loss of image quality, acquisition of images of constant density irrespective of under or over exposure, and reduced repeat rates for unsatisfactory films. The authors prospectively studied 30 adolescents with scoliosis who had both conventional (full dose) and digital (full, one-half, or one-third dose) x-rays. They found digital made AP and lateral image with all anatomic areas clearly depicted at full and one-half dose. Digital laterals were better at full dose and equal to conventional at one-half dose. Cobb angles were easily measured on all one-third dose AP and on 8 of 10 one-third dose digital laterals. Digital clearly depicted the Risser sign at one-half and one-third dose and the repeat rate was nil in this study, indicating digital compensates well for exposure errors. The study indicates that digital does allow radiation dose to be reduced by at least one-half in scoliosis patients and that it does have improved image quality with good contrast over a wide range of x-ray exposure.     

脊柱侧凸的数字化三维重建及临床应用

目的评价三维重建在脊柱侧凸诊断和治疗中的价值。方法确诊为不同类型的脊柱侧凸患者36例,36例患者分为2组：三维重建组16例,对照组20例。三维重建组术前进行单椎体椎弓根平面扫描重建,评价椎弓根的旋转角度、适宜进钉点、进钉长度、矢状位倾斜角度。术中均采用徒手椎弓根穿刺技术记录术中一次性椎弓根穿刺成功率。术后根据CT检查评估椎弓根螺钉植入位置,穿孔螺钉测量与理想进钉角度差。X线评价术后Cobb角和矫正率。结果 Cobb角：三维重建组为（36.70±16.6）°,对照组为（37.30±13.2）°,矫正率分别为71.3%和65.1%。椎弓根一次穿刺成功率：三维重建组为96.3%,对照组为79.5%,穿孔率：三维重建组为3.3%,对照组为11.5%。结论三维重建能够更好地显示脊柱侧凸的情况,有助于判断脊柱侧凸的类型和累及节段,为临床制定个性化的手术方案提供依据。     

Internet use by parents of children attending a dedicated scoliosis outpatient clinic

Purpose

No information exists on the level of internet use among parents of pediatric patients with scoliosis. The internet may represent a medium through which to provide information to augment the outpatient consultation. The aim of this research was to establish the prevalence of internet use amongst a cohort of parents attending a pediatric scoliosis outpatient clinic.

Methods

A previously used questionnaire (Baker et al., Eur Spine J, 19:1776–1779, 2010) was distributed to parents attending a dedicated scoliosis outpatient clinic with their children. Demographic data and details about use of the internet were collected.

Results

Fifty-eight percent of respondents had used the internet to search for information on scoliosis, and 94 % were interested in a local internet provided information provision. A positive history of corrective surgery and possession of health insurance were independent positive predictors of internet use.

Conclusions

As surgeons we need to be aware of our patients’ use of the internet, and there is the opportunity to use this medium to provide additional education.     

Digital fecal occult blood testing in the ambulatory urology clinic

BACKGROUND: This study was designed to evaluate the use and yield of fecal occult blood testing (FOBT) in an ambulatory urology clinic. STUDY DESIGN: Patients seen in the ambulatory urology clinic were prospectively evaluated with FOBT. The test was performed only on patients when a rectal examination was indicated as part of their urologic evaluation. Patients who were found to have a positive FOBT were then referred for additional gastrointestinal evaluation. RESULTS: One hundred eight patients were evaluated, including 57 men and 51 women. Eight patients (7%), including six men and two women, were found to be positive for fecal occult blood. Two patients were found to have upper gastrointestinal sources of bleeding (one gastritis with Barrett's esophagitis and one with a duodenal ulcer). Two patients had benign lower gastrointestinal sources of bleeding, including one with hyperplastic polyps and one with a tubular adenoma. One patient was diagnosed with a moderately differentiated adenocarcinoma of the sigmoid colon. One had negative followup fecal occult blood test, and two were lost to followup. CONCLUSIONS: Addition of FOBT to routine digital rectal examination performed in the ambulatory urology clinic is an inexpensive and simple test that can detect otherwise asymptomatic underlying gastrointestinal pathology. Although the six-sample test is a preferred test for colorectal cancer screening, a digital FOBT during routine urologic evaluation can detect a clinically significant upper or lower gastrointestinal lesion, at the same time increase compliance with FOBT. Larger, prospective studies are needed to confirm the benefit of digital FOBT during a routine urologic visit.     

吻合血管腓骨移植的数字化设计与初步临床应用

目的 探讨吻合血管腓骨移植数字化设计修复长段骨和(或)软组织缺损的临床应用价值.方法 选择四肢长段骨缺损患者9例,术前血管造影后行螺旋CT供区小腿扫描.将扫描数据输入计算机,应用Amira 3.1软件对腓骨及其营养血管行三维重建.术前根据患者骨缺损长度、形态及软组织缺损面积.利用三维重建图像进行精确测量和个性化没计,并模拟手术关键操作.术中仔细核对腓动脉与重建血管走行,并依术前设计切取腓骨(皮)瓣.移植于骨缺损受区进行固定.参照Enneking系统对患肢功能进行评价,以达到正常肢体功能的百分数表示,参照国际挽救肢体专题讨论会制定的"同种及带血管移植的放射学评价方法"对移植腓骨的转归进行影像学评价.结果 三维重建图像直观地体现了腓骨、营养血管及腓动脉穿支皮瓣的三维结构及空间毗邻关系.通过数字化设计和模拟手术操作,町避免术中因小腿血管损伤或血管变异致切取失败和供区意外损伤.9例移植的腓骨(皮)瓣全部成活.术后随访6～30个月,平均15.8个月.骨缺损均修复,骨性愈合时间平均为4.5个月,肢体功能恢复率90.4%.结论 数字化设计可为修复长段骨缺损手术方案的选择提供科学依据,方便术前模拟及术中指导,降低手术风险.     

指骨骨龄对特发性脊柱侧凸患者脊柱生长潜能评估的组织学研究

目的 探讨特发性脊柱侧凸(IS)患者指骨骨龄(DSA)对生长潜能评估的可靠性.方法 于28例IS患者前路手术时采集其椎体上、下生长板标本,行HE染色,光镜下行组织学观察并进行组织学分级(HG).患者左手中指正位x线片确定DSA分期.对患者HG、DSA分期、月经状态和社会学年龄进行相关性分析.结果 28例IS患者DSA分期与椎体生长板HG之间存在显著负相关(r=-0.541,P=0.003).在DSA Ⅱ期和DSA Ⅲ期患者之间,生长潜能差异具有统计学意义(P:0.014).7例DSAⅢ期患者椎体生长板组织学有Ⅱ度生长活性.DSAⅢ期患者椎体生长板HG与月经状态(初潮至手术的时间)存在显著负相关(r=0.591,P=0.006).结论 DSA分期可能为临床评估IS患者脊柱生长潜能的方便易行指标,但必须结合患者的月经状态和社会学龄才能正确评估IS患者的脊柱生长潜能.     

Chemonucleolysis as a method of treatment in lumbar and thoracolumbar scoliosis: errors, complications and indications for use

The authors summarize their experience in the treatment of 106 patients with dysplastic lumbar and thoracolumbar scoliosis. Already 24 hours after closed chemonucleolysis there was considerable correction of the curvature and an increase in the stability index. The method may be recommended for the treatment of lumbar and thoracolumbar scoliosis at stages II and III if the curvature angle does not exceed 50 degrees. In severe curvatures the efficiency of chemonucleolysis is low. Observation of the patients showed that the method causes little traumatism, is easily endured by the patients and allows for reliable discontinuation of the progress of deformation. The complications after closed chemonucleolysis may be avoided by employing the technique of discography, the application of the plaster-of-Paris jacket and by making use of adequate anaesthetic and dehydration therapy during the immediate post-manipulation period. The complications after chemonucleolysis did not deteriorate the results of the treatment.     

Anterior and thoracoscopic scoliosis surgery for idiopathic scoliosis

Surgical management of idiopathic scoliosis is based on the natural history of this spinal disorder and on the likelihood of developing a worsening deformity. Anterior surgical treatments continue to evolve and provide advantages over posterior procedures in specific instances. Open and thoracoscopic anterior approaches allow direct access to the anterior stabilizing structures of the spine, enable mobilization of a rigid deformity, and provide a large surface area for arthrodesis. Thoracoscopic procedures provide a more cosmetically appealing alternative to a large midline posterior or anterolateral thoracotomy scar. Although the indications and contraindications for anterior versus posterior surgical intervention (for thoracic and thoracolumbar curve patterns) have been defined to some degree, there remains appropriate flexibility in the decision-making process, allowing the surgeon to make an optimal recommendation for each patient based on surgeon experience and patient needs.     

特发性与先天性脊柱侧凸患者肺功能障碍的差异性比较

目的：比较特发性脊柱侧凸（idiopathic scoliosis，IS）与先天性脊柱侧凸（congenital scoliosis．CS）患者肺功能参数的差异性。方法：术前检测214例脊柱侧凸患者的肺活量（vital capacity，VC）、用力肺活量（forced vital capacity，FVC）、第1秒用力呼气容积（forced expiratory volume in one second，FEV1）、最大呼气中期流量（maximal mid-expiratory flow，MMEF）、最大自主通气量（maximal voluntary ventilation，MVV），计算实测值占预计值百分比（实／预％），其中IS 141洌（IS组），CS73例（CS组），将肺功能指标与Cobb角进行相关分析。依据主弯顶椎所在位置分为胸段及非胸段侧凸两组，胸段侧凸依据Cobb角大小分为：Cobb角〈600（A组）、60°≤Cobb角〈90°（B组）、Cobb角≥90°（C组）3组。分析胸段及非胸段IS、CS患者术前肺功能参数的差异．同时比较年龄≤10岁的IS、CS患者各参数的差异。结果：脊柱侧凸患者VC、FVC、FEV1、MMEF及MVV的实／预％与Cobb角呈显著性负相关（r=-0．40--0.55）。在胸段侧凸患者中，CS组的FEV1实／预％为64．2％，明显低于IS组患者的80．0％（P〈0．05）；不同Cobb角CS组患者的VC、FVC、FEV1、MVV实／预％值都较相应Cobb角的IS组患者低（P〈0．05）。非胸段侧凸患者中，CS组的VC、FVC、MVV的实／预％较IS组患者低（P〈0．05）。年龄≤10岁的CS与IS患者肺功能指标比较也具有显著性差异（P〈0．05）。结论：IS和CS患者均存在肺功能损害，但损害模式不同，IS以限制性通气功能障碍为特征，CS表现为混合性通气功能障碍；年龄和Cobb角相匹配时．无论在胸段还是非胸段，CS患者的肺功能损害均较IS患者严重；且两者肺功能损害的差异性在青春期前就存在。     

Digital redesign of analog controllers based on minimizing integral of squared errors

Digital redesign is to replace an existing well‐designed analog feedback controller by a digital one along with a sampler and a hold. In this paper, we present a digital redesign technique which takes into account both closed‐loop and intersample behaviour. More precisely, we give a numerical procedure to optimally discretize an analog controller such that the integral of the squared error between the closed‐loop step responses of the analog and digital controlled systems is minimized. A parametric expression is derived for evaluating the integral performance index. With this expression, the optimal digital redesign problem becomes an optimal parameter selection problem which can be solved using existing optimal parameter search algorithms. Moreover, it allows one to obtain optimal reduced‐order digital controllers for sampled‐data control systems over a range of sampling periods. Copyright © 2003 John Wiley & Sons, Ltd.     

Digital measurement and correlation analysis of coronal and sagittal anatomic parameters in the radiographs of adolescent patients with idiopathic scoliosis

Objective

To use digital software to measure the morphologic and anatomic parameters of adolescent idiopathic scoliosis (AIS). Differences and correlations among different parameters were compared to provide an anatomic basis for the selection of treatment methods and preoperative evaluation of AIS.

Methods

Spinal radiographs were taken from 300 boys and girls (age, 10–18 years) suffering from idiopathic scoliosis in four grade-A hospitals in Inner Mongolia. After screening, 120 cases with complete imaging data were assessed. Imaging data were transferred to a work station (Dr Wise™). The anatomic indices of the Cobb Angle, CVA, AVT, TS, CA, CPT, CSI, FPT, CCA, TK, LL, SS, PT, and PI were measured.

Results

There were significant differences in AVT between different grades and types of scoliosis (F = 34.079, P = 0.000; χ² = 23.379, P = 0.000). AVT was a protective factor, and the smaller the AVT, the less severe was the scoliosis. Compared with adolescents with mild or moderate scoliosis, the Cobb angle of adolescents with severe scoliosis was negatively correlated with CCA, LL, and SS (r =  − 0.641, p < 0.05; r =  − 0.695, p < 0.01; r =  − 0.814, p < 0.01).

Conclusions

Some of the anatomic parameters in the coronal and sagittal planes of adolescents with idiopathic scoliosis were significantly different according to the severity and type of scoliosis. Significant correlations were found between more anatomic indices in adolescents with severe scoliosis than in adolescents suffering from mild or moderate scoliosis.

     

脊髓空洞与脊柱侧凸

脊髓空洞是指脊髓中央管室管膜内外有液体积聚且呈筒样串联，可以在颈髓或上胸段几个节段内发生，也可向上、下延展。脊髓空洞形成的最常见原因为枕大孔区畸形和小脑扁桃体下疝，即Chiari畸形，90％的脊髓空洞与Chiari畸形有关。临床上脊髓空洞也可呈“特发性”而单独存在。脊髓空洞可伴发脊柱侧凸。在各种类型的脊柱侧凸中，脊髓空洞的发生率为4％～8％，而在脊髓空洞患者中，脊柱侧凸的发生率高达25％～85％。