青少年特发性脊柱侧弯的生物力学研究进展

与青少年特发性脊柱侧弯解剖直接相关的生物力学分析主要围绕肌筋膜层、肌肉层、韧带层、关节层和椎间盘层5个层面,研究多围绕生物力学模型建立、影像学可视化指标。本文就青少年特发性脊柱侧弯生物力学解剖特性和临床应用的最新研究进展作一综述,旨在为后续研究提供理论依据。     

青少年特发性脊柱侧弯病因学研究现状

青少年特发性脊柱侧弯(Adolescent idiopathic scoliosis,AIS)是指根据初诊年龄划分的10岁以上未成年患者,脊柱有侧弯及旋转畸形,而无任何先天性脊柱异常或合并有神经肌肉或骨骼疾病,占特发性脊柱侧弯的80％左右,国内外发病率为2％～4％,女性多见,男∶女的比例大约为1∶4[1].目前已有的病因学研究显示其发病机制十分复杂.本文从基因遗传因素、神经系统功能异常、生物化学因素、肌肉骨骼系统发育异常、生长发育的影响和生物力学因素这几个方面作一综述.     

青少年特发性脊柱侧弯的手术治疗

特发性脊柱侧弯是青少年常见病,约占脊柱侧弯的70%,其发病原因至今不明,治疗也比较复杂[1,2].     

青少年特发性脊柱侧弯病因及治疗

青少年特发性脊柱侧弯(adolescent idiopathic scoliosis,AIS)尚有较多争论和未解决的问题,尤其是病理发病机制不清楚。通过查阅近年来有关AIS的国内外治疗研究与进展的文献资料,本文就AIS病因及国内外治疗现状作一综述,以期为有效预防和治疗AIS提供科学依据。     

青少年特发性脊柱侧弯矫正术后护理体会

通过对8例青少年特发性脊柱侧弯患者手术前进行心理护理,评估呼吸功能,指导患者呼吸功能锻炼,手术后加强体位、呼吸道、胸腔引流管的护理,术后未发生并发症,疗效满意.     

青少年特发性脊柱侧弯围手术期的护理

目的:总结青少年特发性脊柱侧弯围手术期的护理。方法:回顾分析我科3例青少年特发性脊柱侧弯围手术期的护理工作。结果:经正确治疗护理,均治愈出院。结论:对青少年特发性脊柱侧弯矫形术,术前认真充分准备,术后严密观察,防止并发症的发生,做好功能锻炼的指导,可以提高手术的成功率。     

矫形器治疗青少年特发性脊柱侧弯的护理体会

目的:探讨矫形器治疗青少年特发性脊柱侧弯的疗效及护理。方法:选取我院2009年9月-2010年10月间收治的172例脊柱侧弯患者,cobb’s角在20°～40°之间,应用色努式矫形器治疗该组患者特发性脊柱侧弯,观察疗效。结果:172例脊柱侧弯患者疗效显著,cobb’s角平均减小17度,无严重并发症发生。结论:对于轻中度脊柱侧弯利用矫形器来保守治疗,其疗效显著,治疗过程中需加强护理,以保证穿戴时间和压迫强度,配合治疗。     

青少年特发性脊柱侧弯合并截瘫的手术治疗

我院自 1 984年至 1 998年对 5例严重的青少年特发性脊柱侧弯合并截瘫的病人采用术前颅骨 ,双侧股骨髁上牵引 ,后路Ｈａｒｒｉｎｇｔｏｎ和Ｌｕｑｕｅ器械内固定 ,“剃刀背”肋骨切除及脊柱融合术治疗 ,使患者病情改善 ,截瘫减轻 ,经 5～ 1 5年随访观察 ,就其利弊分析报告如下。1　临床资料5例中男 3例 ,女 2例 ;年龄 1 4～ 1 8岁 ;截瘫时间 :1～ 2个月 3例 ,3个月 1例 ,5个月 1例 ;截瘫指数 :指数 3 ,3例 ,指数 4,2例 ;5例均为胸段脊柱侧凸 ;术前均行 4～ 6周颅骨 ,双侧股骨髁上牵引 ,牵引重量 1 6～ 2 2ｋｇ ;Ｈａｒｒｉｎｇｔｏｎ手术 2…     

俯卧位CT扫描及椎弓根参数测量改良提高青少年特发性脊柱侧弯置钉定位的精准性

目的研究俯卧位64排CT扫描及改良椎弓根置钉参数测量方法对青少年特发性脊柱侧弯手术置钉的精确定位作用。方法 21例青少年特发性脊柱侧弯,术前采用俯卧位64排CT扫描,在常规测量内倾角、旋转角及进针深度的基础上,行进针点三维定位,并测量椎弓根松质骨宽度及矢状角,对手术置钉进行精确定位。术后低剂量CT扫描评估置钉准确率及冠位主弯Cobb’s角平均矫正角度。结果共植入螺钉226枚,置钉偏差5枚,置钉准确率97.8%,无椎弓根膨胀性改变和椎间盘损伤。术后冠位主弯cobb’s角平均矫正角度15.6°(2.0°～58.3°)。结论俯卧位64排CT扫描及改良椎弓根置钉参数测量方法对青少年特发性脊柱侧弯手术置钉的定位准确性高,具有临床推广价值。     

青少年特发性脊柱侧弯的流行病学研究进展

青少年特发性脊柱侧弯（AIS）是一种表现为脊柱旋转不对称的疾病。正如它命名中“特发性”所指，尽管学者们做了大量研究，但迄今为止它的病因仍然不明，这就给它的早期干预、早期治疗带来了困难。AIS的流行病学研究能够帮助人们进一步认识AIS疾病的发展规律。我们从AIS的分布规律、危险因素、早期筛查、预后等方面对AIS的流行病学研究进展进行综述。     

青少年特发性脊柱侧凸术前柔韧性影响因素及评估方法研究进展

脊柱侧凸柔韧性评估是青少年特发性脊柱侧凸患者术前常规检查,其对确定融合节段、选择手术入路、预测术后矫形效果等方面都有重要意义。随着矫形理念的革新和内固定矫形器械不断发展,作为以往脊柱侧凸柔韧性评估“金标准”—仰卧位侧屈位法逐渐暴露出重复性差、术后预测准确性低等的缺点。因此,许多学者开始提出新的脊柱柔韧性评估方法。本文主要就青少年特发性脊柱侧凸柔韧性的的影响因素、不同脊柱柔韧性评估方法及评价作一综述,以便更多的脊柱外科医生对其有充分的认识了解,并指导在以后的临床工作中选择合适的评估方法对青少年特发性脊柱侧凸进行柔韧性评估。     

青少年特发性脊柱侧凸患者术后脊柱骨盆矢状面参数的变化

目的　分析青少年特发性脊柱侧凸（AIS）患者脊柱后路矫形术后不同远端固定椎脊柱骨盆矢状面参数的差异。方法　回顾性分析2010年1月至2019年11月于我院行脊柱后路矫形内固定术的49例AIS患者的一般资料及术前和最近1次随访（至少术后24个月）的影像学参数,包括胸椎后凸角（TK）、腰椎前凸角（LL）、矢状面轴向偏距（SVA）、骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）,以及近胸弯、主胸弯、胸腰弯/腰弯Cobb角,并计算PI-LL。根据下固定椎将患者分为T12～L2组和L3～L5组,比较两组的一般资料和影像学参数。结果　T12～L2组31例AIS患者,L3～L5组18例患者。两组患者的年龄、性别、随访时间、Risser征、融合椎体数差异均无统计学意义（P均＞0.05）。术前两组患者的SVA、PI、PT、SS、TK、LL和PI-LL差异均无统计学意义（P均＞0.05）。术后L3～L5组的LL较术前明显增加（P＜0.05）,T12～L2组LL较术前显著减小（P=0.027）。术后T12～L2组和L3～L5组PI-LL较术前均显著增加（P均＜0.05）,但L3～L5组PI-LL变化值大于T12～L2组（P＜0.05）。结论　当脊柱远端固定至L3～L5时,LL会增加,引起PI与LL不匹配。术前应根据PI预测出合适的LL,避免术中过度弯棒。     

长海支点侧屈位X线片在骨骼发育成熟的特发性脊柱侧弯柔韧性评估中的应用

目的 评价长海支点侧屈位X线片在骨骼发育成熟的特发性脊柱侧弯患者术前柔韧性评估中的作用和价值.方法 选取2013年6月至2015年2月19例骨骼发育成熟的特发性脊柱侧弯患者,女性15例,男4例;年龄20～30岁,平均(23.1±3.5)岁.采用第二军医大学长海医院自行研制的可升降可测重长海支点侧屈位装置对患者的25个胸椎及腰椎侧弯进行术前影像学柔韧性评估.评估内容包括术前站立前后位X线片、长海支点侧屈位X线片(基础支点侧屈位、最大支点侧屈位)、仰卧侧屈位X线片、传统支点侧屈位X线片以及术后1周站立前后位X线片.术前与术后参数间比较采用配对t检验,参数间的相关性采用Pearson相关性分析.结果 19例患者共包括25个结构性弯曲,其中17个主胸弯、8个胸腰/腰弯.仰卧侧屈位、传统支点侧屈位、长海基础支点侧屈位Cobb角与术后1周站立前后位Cobb角相比差异均有统计学意义(P均＜0.05);传统支点侧屈位、长海基础支点侧屈位Cobb角与长海最大支点侧屈位Cobb角相比差异均有统计学意义(P均＜0.05).主胸弯和胸腰/腰弯2种侧弯的评估结果与整体评估结果一致.整体数据的相关性分析提示长海基础支点侧屈位、长海最大支点侧屈位柔韧性指数与手术矫正率均呈正相关(r=0.84、0.87,P均＜0.01);长海最大支点侧屈位支点高度与支点上所测得的最大重量呈正相关(r=0.67,P=0.001),高度变化与支点重量变化也呈正相关(r=0.60,P=0.001).结论 与传统的支点侧屈位X线片及仰卧侧屈位X线片相比,长海支点侧屈位X线片可以更好地反映骨骼发育成熟的特发性脊柱侧弯患者的柔韧性,可用于辅助脊柱侧弯患者的术前柔韧性评估;长海支点侧屈位X线片的结果更接近椎弓根螺钉系统矫形的结果.     

Schroth exercises improve health-related quality of life and radiographic parameters in adolescent idiopathic scoliosis patients

Background:Finding an optimal treatment strategy for adolescent idiopathic scoliosis (AIS) patients remains challenging because of its intrinsic complexity. For mild to moderate scoliosis patients with lower skeletal growth potential (Risser 3–5), most clinicians agree with observation treatment; however, the curve progression that occurs during puberty, the adolescent period, and even in adulthood, remains a challenging issue for clinicians. The aim of the study is to investigate the efficacy of Schroth exercise in AIS patients with lower skeletal growth potential (Risser 3–5) and moderate scoliosis (Cobb angle 20°–40°).Methods:From 2015 to 2017, data of 64 patients diagnosed with AIS in Peking University Third Hospital were reviewed. Forty-three patients underwent Schroth exercise were classified as Schroth group, and 21 patients underwent observation were classified as observation group. Outcomes were measured by health-related quality of life (HRQOL) and radiographic parameters. HRQOL was assessed using the visual analog scale (VAS) scores for back, Scoliosis Research Society-22 (SRS-22) patient questionnaire. Radiographic spinopelvic parameters were obtained from anteroposterior and lateral X-rays. The pre-treatment and post-treatment HRQOL and radiographic parameters were tested to validate Schroth exercise efficacy. The inter-rater reliability of the radiographic parameters was tested using the interclass correlation coefficient (ICC). The paired t test was used to examine HRQOL and radiographic parameters. Clinical relevance between C2-C7 sagittal vertical axis (SVA) and thoracic kyphosis was analyzed using Spearman correlation.Results:In Schroth group, VAS back score, SRS-22 pain, and SRS-22 self-image domain were significantly improved from pre-treatment 3.0 ± 0.8, 3.6 ± 0.5, and 3.5 ± 0.7 to post-treatment 1.6 ± 0.6 (t = 5.578, P = 0.013), 4.0 ± 0.3 (t = −3.918, P = 0.001), and 3.7 ± 0.4 (t = −6.468, P < 0.001), respectively. No significant improvements of SRS-22 function domain (t = −2.825, P = 0.088) and mental health domain (t = −3.174, P = 0.061) were observed. The mean Cobb angle decreased from 28.9 ± 5.5° to 26.3 ± 5.2° at the final follow-up, despite no statistical significance was observed (t = 1.853, P = 0.102). The mean C2-C7 SVA value decreased from 21.7 ± 8.4 mm to 17.0 ± 8.0 mm (t = −1.224 P = 0.049) and mean T1 tilt decreased from 4.9 ± 4.2 ° to 3.5 ± 3.1° (t = 2.913, P = 0.011). No significant improvement of radiographic parameters and HRQOL were observed in observation group.Conclusions:For AIS patients with a Risser 3–5 and a Cobb angle 20°–40°, Schroth exercises improved HRQOL and halted curve progression during the follow-up period. Both cervical spine alignment and shoulder balance were also significantly improved after Schroth exercises. We recommend Schroth exercises for patients with AIS.     

Selective fusion in adolescent idiopathic scoliosis

Despite the continual evolution in the surgical treatment of adolescent idiopathic scoliosis （AIS）,the goals of surgery remain to correct and stabilize the deformity in three dimensions, to maintain equilibrium of the shoulders and trunk, and to leave as many mobile spinal segments as possible. The essence is to fuse the smallest possible number of vertebrae to maintain maximum residual mobility, but end with corrected and well-balanced spine. Selective fusion is termed when both the main thoracic and thoracolumbar/lumbar （TL/L） curves deviate completely from the midline （Figure 1）, but only the major curve （the largest Cobb measurement） is fused, leaving the minor curve unfused and mobile. For the single curve, such as thoracic, thoracolumbar, or lumbar curve, there are fewer differences of opinion amongst spinal surgeons regarding the selection of the fusion level than the surgical approach. However, the choice of fusion levels in some types of curves, such as double curves and triple controversy issue. If the fusion is incorrect, it curvature deterioration, curves remains a difficult and decision to perform selective may result in postoperative shoulder imbalance, trunk decompensation, or even produce new deformity, an early revision by extending the fusion or reducing the correction may need. The non-selective approach rarely leads to early troubles that require a second procedure and is often perceived as being safer in the short-term. But it may be more difficult in the long-term as distal degeneration is more likely. This raises the question： ＂Is it better to be safe in the short-term or take a chance avoiding later degenerative problems with a shorter motion-sparing fusion？＂ Thus, the aim of selective fusion is to identify the compensatory curves （minor curve） that will straighten spontaneously after correcting and fusing the major curve, thereby avoid the fusion of these flexible compensatory curves.     

支具治疗青少年特发性脊柱侧凸有效性的研究进展

脊柱侧凸的支具治疗从20世纪60年代应用于临床以来,其疗效一直存在争议。目前,支具种类繁多,但报道的疗效各异。文章就近十年来支具治疗青少年特发性脊柱侧凸有效性的研究成果和主要观点,以及不同观点产生的可能原因进行综述,探索未来研究的一些新动向,以期早日在支具治疗是否有效的问题上得出科学、权威的结论。     

特发性脊柱侧凸矫形术后平衡的影像学评价

特发性脊柱侧凸是脊柱外科的常见病,对于角度较大、进展较快的脊柱侧凸,手术治疗是惟一有效方法,其目的是通过对畸形的三维矫正与稳定,重建脊柱的平衡。评价脊柱侧凸矫形术后的平衡是判断手术效果的一个重要方面。虽然对各平面平衡评价的参数较多,但各个参数的针对性、敏感性不同,目前尚缺乏统一的平衡评价系统。本文对脊柱侧凸术后冠状面、矢状面以及横断面平衡评价的影像学参数作一综述。     

推拿手法加牵引治疗青少年特发性脊柱侧凸畸形

目的:探讨推拿手法加牵引矫正青少年特发性脊柱侧凸的疗效。方法:采用推拿手法加牵引治疗38例轻度青少年特发性脊柱侧凸畸形,本组男11例,女27例,年龄最小12岁,最大19岁,平均14.5岁。Cobb角11°～20°27例,21°～30°11例。结果:治愈15例,显效9例,好转8例,无效6例。结论:推拿手法加牵引治疗青少年特发性脊柱侧凸畸形有明显的治疗效果,具有不影响正常活动,无合并症等优点。     

三亚市青少年脊柱侧凸畸形患病率调查

目的：了解三亚市中小学生特发型脊柱侧凸畸形(AIS)的患病情况。方法采用横断面研究方法,随机抽查三亚市城乡10所中学10~16岁中学生6952名,其中男生3750名,女生3202名。首先通过观察体检者的肩部和肩胛骨的对称性以及Adams试验筛选出疑似患者。对于AIS疑似患者,进一步采用全脊柱正侧位X射线摄片来明确脊柱侧凸诊断。结果6952名中小学生中共检筛出AIS疑似患者375名(男性191名,女性184名),其中358名疑似患者接受进一步检查,最终明确AIS患者88名(1.27%),男性42名(0.60%),女性46名(0.66%),男、女比率为1：0.91,但二者患病率比较差异无统计学意义(χ2=1.39,P>0.05)。结论三亚市公立学校中小学生AIS患病率为1.27%,男女患病率相当。