An unusual case of congenital scoliosis associated with rib agenesis in the upper part of the concavity treated by VEPTR vertebra to vertebra

Background contextRib agenesis in congenital scoliosis is rarely encountered, and its disposal in the application area of the proximal vertical expandable prosthetic titanium rib (VEPTR) module is a challenge to the orthopedic surgeon.PurposeTo present a case in which known treatment methods in early-onset scoliosis were not possible to apply.Study designCase report.MethodsA patient aged 1 year and 10 months, presenting a congenital scoliosis with the following characteristics: left T3 hemisegmented hemivertebra, T5–T6–T7 hemivertebral segment, T9, T10 trapezoidal vertebrae, right side I–IV rib agenesis with T1–T2–T4 hemivertebral hypoplasia (T3 agenesis) and bilateral XIIth rib agenesis, and V–VI and VII–VIII–IX fused ribs on the right side. We applied a standard VEPTR in a new construct, vertebra to vertebra.ResultsThe VEPTR vertebra to vertebra proved to be an efficient and stabile construct after 1.5 years of follow-up and three device distractions in a row. The curve corrected from 100 to 58 Cobb degrees.ConclusionsWe believe that the vertebra-to-vertebra construct with eventual modifications may be a solution in the treatment of early-onset scoliosis needing surgery, which associate rib agenesis in the area where the proximal module has to be applied.     

Identification of multisegmental nociceptive afferents that modulate locomotor circuits in the neonatal mouse spinal cord

Compared to proprioceptive afferent collateral projections, less is known about the anatomical, neurochemical, and functional basis of nociceptive collateral projections modulating lumbar central pattern generators (CPG). Quick response times are critical to ensure rapid escape from aversive stimuli. Furthermore, sensitization of nociceptive afferent pathways can contribute to a pathological activation of motor circuits. We investigated the extent and role of collaterals of capsaicin‐sensitive nociceptive sacrocaudal afferent (nSCA) nerves that directly ascend several spinal segments in Lissauer's tract and the dorsal column and regulate motor activity. Anterograde tracing demonstrated direct multisegmental projections of the sacral dorsal root 4 (S4) afferent collaterals in Lissauer's tract and in the dorsal column. Subsets of the traced S4 afferent collaterals expressed transient receptor potential vanilloid 1 (TRPV1), which transduces a nociceptive response to capsaicin. Electrophysiological data revealed that S4 dorsal root stimulation could evoke regular rhythmic bursting activity, and our data suggested that capsaicin‐sensitive collaterals contribute to CPG activation across multiple segments. Capsaicin's effect on S4‐evoked locomotor activity was potent until the lumbar 5 (L5) segments, and diminished in rostral segments. Using calcium imaging we found elevated calcium transients within Lissauer's tract and dorsal column at L5 segments when compared to the calcium transients only within the dorsal column at the lumbar 2 (L2) segments, which were desensitized by capsaicin. We conclude that lumbar locomotor networks in the neonatal mouse spinal cord are targets for modulation by direct multisegmental nSCA, subsets of which express TRPV1 in Lissauer's tract and the dorsal column. J. Comp. Neurol. 521:2870–2887, 2013. © 2013 Wiley Periodicals, Inc.     

选择性骶骨切除对骨盆生物力学稳定性的影响

目的用生物力学测试的方法分析新鲜人骨盆模型不同骶骨平面切除对骨盆稳定性的影响。方法选用8具男性新鲜尸体L5-骨盆标本,平稳加载至1 000 N,对各个测试点保留完整骶骨及不同平面骶骨切除骨盆模型的剪切应力、最大主应力、位移及刚度变化依次测试,并比较各组间的差异。进行骨盆环的测量,记录骨折部位和骨折类型。结果随着骶骨切除平面的增高,各个测试点的剪切应力、最大主应力及骶骨下沉位移均有不同程度增大,骨盆的轴向刚度逐渐减小。当切除平面到达S_1时变化明显,尤以经过1/4 S_1组、1/2S_1组变化显著,与S_0组比较差异均有统计学意义(P0.05)。结论骶骨的切除范围与骨盆的生物力学稳定性密切相关,残留骶髂关节各种应力随着骶骨切除平面升高而急剧增高,骨盆的稳定性明显下降。当骶骨切除到S_1椎体时,极易发生骨折,需要通过腰骶髂局部重建的方式增强骶髂关节的稳定性。     

单纯后路骶骨整块切除治疗S_2水平原发恶性骶骨肿瘤

目的探讨单纯后路骶骨整块切除、纱布填塞技术治疗累及S_2水平原发恶性骶骨肿瘤的手术入路、切口选择、手术方法及并发症。方法采用单纯后路骶骨整块切除、纱布填塞技术治疗9例累及S_2水平的原发恶性骶骨肿瘤患者,均未行腰骶部重建,其中脊索瘤6例,Ewing肉瘤2例,软骨肉瘤1例。用VAS评分评价手术前后疼痛程度,用改良Biagini评分评价手术前后神经功能。结果 9例患者瘤体均顺利切除,截骨水平位于S_26例,S33例。手术时间150~320(221.7±35.6)min,术中出血800~1 800(1 144±332.5)ml。患者均获得随访,时间25~61个月。4例出现皮肤坏死后伤口感染,二次手术后伤口愈合。术前9例神经功能基本正常;术后2例括约肌功能基本正常,6例括约肌功能障碍、排尿排便刺激感存在,1例括约肌功能丧失、不能感觉排便刺激。6例术后存在神经性疼痛,治疗4个月后VAS评分为0.5~3分。1例Ewing肉瘤与1例软骨肉瘤复发;1例脊索瘤患者术后32个月死于心血管系统疾病。结论单纯后路骶骨整块切除、纱布填塞技术能顺利完成S_2水平骶骨整块切除手术,方法可靠,可达到彻底的肿瘤切除边缘;但其并发症发生率较高,对患者大小便功能影响较大。     

腹腔镜骶骨固定术相关并发症的回顾：7年单中心临床分析

目的回顾性分析重庆市妇幼保健院行腹腔镜骶骨固定术7年的临床资料,分析总结该术式的相关并发症及处理。 方法收集2012年1月至2019年11月接受腹腔镜骶骨固定术的238例患者的临床随访资料,统计分析手术前后POP-Q的Ba、Bp、C、D位点等各指示点及生存质量和性生活状态评分的变化,术后各类并发症的处理情况。 结果腹腔镜骶骨固定术治疗中盆腔缺陷的有效方式,其治愈率为98.74%;Ba、Bp、C、D位点,以及PFDI-20和PISQ-12问卷均有明显改善,术后生存质量及性生活状态改善。术后的并发症发生率约15.55%,其中便秘发生率最高(约5.04%),其次为疼痛3.78%,网片暴露、新发尿失禁、骶前出血、尿潴留的发生率均1.26%;复发、严重感染发生率0.84%,性生活障碍、输尿管折叠梗阻、尿道损伤发生率0.42%;所有并发症均经相应处理治愈。 结论腹腔镜骶骨固定术是治疗中盆腔缺陷的有效方式,效果满意,但需重视手术网片并发症的预防及处理,对并发症的合理治疗可以改善患者的预后。