胸腰椎骨折分型、损伤评分、后凸畸形及神经功能损伤的关联研究

目的 探究腰椎骨折损伤程度与骨折的分型、损伤评分、后凸畸形和神经功能损伤的关联.方法 将患者根据后方韧带复合体(PLC)损伤程度分为PLC完整组和PLC损伤组.通过评判两组患者的骨折分型、损伤评分、后凸畸形及神经功能损伤情况,研究他们与PLC损伤的关系.结果 PLC损伤租的载荷分享评分系统(LCS)评分(7.1士0.8)分和严重程度评分(TLICS) (8.2±0.6)分均比PLC完整组的LCS评分(5.7士0.5)分和TLICS(4.6±0.7)分高.PLC损伤组患者的Denis分型和AO分型亦更严重.PLC损伤组的Cobb角为29°,PLC完整组的Cobb角为19°.PLC损伤组的神经功能不全比例89％,PLC完整组的这一比例为60％.结论 胸腰椎骨折与后方韧带复合体关系密切.PLC损伤程度与骨折分型、损伤评分、后凸畸形和神经损伤程度呈正相关的关系.     

后路半椎体切除内固定矫治先天性脊柱侧后凸

目的评价后路一期半椎体切除椎弓根钉矫形治疗先天性半椎体所致脊柱侧后凸的临床效果。方法11例患者,平均年龄9.3岁,4例位于胸椎,5例位于腰椎,均为完全分节型,手术采用后路一期半椎体切除,椎弓根器械矫形并植骨融合。结果手术固定节段2-7个椎体,平均3.3个椎体。术后随访6-30个月,平均14.5个月。全脊柱正侧位X线片示冠状面Cobb角由术前平均41.15°矫正至15.35°,平均矫正率61.53％,矢状面Cobb角由术前平均34.15°矫正至13.26°,平均矫正率60.27％,顶椎偏移由术前25.34mm矫正至11.46mm,最后随访时侧凸和后凸Cobb角平均分别为16.86°和14.08°,与术后相比无纠正丢失。无任何手术并发症,无内固定断裂脱落,均融合。结论一期后路半椎体切除椎弓根器械矫形是治疗先天性脊柱侧后凸安全、有效的术式,能够获得满意的矫正。     

改良式颈前路椎间盘切除减压融合术治疗退变性颈椎后凸患者的疗效分析

【摘要】 目的：探讨颈前路经椎间隙扩大减压融合术（anterior trans-intervertebral space decompression and fusion,ATIDF）治疗退变性颈椎后凸患者的临床疗效。方法：回顾性分析2017年6月～2019年6月在我科接受ATIDF手术治疗的65例退变性颈椎后凸患者的临床资料。其中男性37例,女性28例;年龄63.4±11.2岁（35～85岁）,病程18.2±8.4个月（4~28个月）。接受两节段ATIDF患者16例（C3~C5 7例、C4~C6 9例）,三节段ATIDF患者38例（C3~C6 18例、C4~C7 20例）,四节段ATIDF（C3~C7）患者11例。纳入患者中僵硬型后凸患者35例（53.85%）,柔韧性后凸患者30例（46.15%）;僵硬型后凸患者在减压时均采用了部分钩椎关节切除。分别于术前、术后第2天及末次随访时采用日本骨科学会（Japanese Orthopedic Association,JOA）评分、颈椎功能障碍指数（neck disability index,NDI）及疼痛视觉模拟评分（visual analogue scale,VAS）对患者的神经功能和疼痛情况进行评估;拍摄颈椎正侧位及动力位X线片评价颈椎曲度（C2~C7 Cobb角）、手术节段Cobb角、手术节段椎间隙高度、C2~C7矢状位轴向垂直距离（sagittal vertical axis,SVA）,并计算后凸的矫正率。采用颈椎MRI平扫和CT评估患者神经减压情况和植骨融合情况。记录纳入患者随访期间相关并发症出现情况。结果：纳入患者随访时间为33.5±5.4个月（24~50个月）。手术时间为158.2±31.4min（105~215min）,术中出血量为117.6±36.3ml（65~200ml）。纳入患者均取得了满意的神经功能改善,术后和末次随访时JOA评分、NDI和VAS评分均较术前明显改善（P＜0.05）。所有纳入患者术后颈椎后凸角度均取得一定程度的改善,后凸矫正率为147.43%。术后第2天和末次随访时C2~C7 Cobb角、手术节段局部Cobb角较术前明显增加（P＜0.05）,SVA较术前明显改善（P＜0.05）。手术节段的平均椎间隙高度从术前的2.14±1.53mm增加至术后第2天的5.94±3.11m（P=0.001),末次随访时为5.36±2.47mm（P=0.001)。随访期间有8例（12.31%）患者出现颈部轴性症状,术后第2天有33例（50.77%）患者主诉吞咽困难,3例（4.62%）患者出现C5神经根麻痹,经对症处理后均改善。结论：ATIDF治疗退变性颈椎后凸可取得满意的临床疗效和后凸矫正,对于存在严重椎间隙狭窄、钩椎关节增生的僵硬型颈椎后凸具有良好的矫形和减压作用。     

后路全椎节切除、双轴旋转矫形手术治疗重度陈旧结核性后凸的疗效分析

目的:分析后路全椎节切除、双轴旋转矫形手术治疗重度陈旧结核性后凸的手术效果,探讨影响疗效的因素。方法:2004年5月~2011年9月,采用后路全椎节切除、双轴旋转矫形固定融合术治疗重度陈旧结核性后凸畸形患者33例。男15例,女18例;平均年龄34.7±14.1岁(11~63岁),其中年龄≥35岁18例,35岁15例;术前平均后凸角98.9°±18.2°(70.0°~130.0°),其中≥100°者17例,100°者16例;后凸顶点位于上中胸椎(T10及以上)19例,胸腰段及腰椎(T11及以下)14例。脊髓损伤Frankel分级A、B级各1例,C级5例,D级12例,E级14例。ODI术前平均19.5±9.4分。根据年龄、后凸顶点位置、后凸角度、术前Frankel分级、有无并发症等情况进行分组。对所有患者行手术前后及末次随访时的后凸局部和全脊柱正侧位X线摄片,测量后凸Cobb角,对合并侧凸的患者测量侧凸Cobb角。对手术前和随访时的患者进行脊柱矢状位平衡测量、实际身高测量、Frankel神经功能分级、Oswestry评分、VAS评分和手术PSI满意指数的评定。总结患者术中和术后并发症,并积极采取相应处理。结果:所有患者术前平均后凸Cobb角98.9°±18.2°,术后平均为30.9°±11.3°,矫正率为69.1%,末次随访时平均为34.8°±15.1°,矫正率为65.3%。患者脊柱矢状位平衡、身高测量、神经功能Frankel分级、生活质量Oswestry评分、腰背痛VAS评分均改善,手术总体满意率为87.9%。并发症发生率为54.5%,其中术中并发症12例、术后短期并发症2例、术后中远期并发症4例。所有并发症均及时采取相应处理。发生并发症者的总体后凸矫正率与未发生并发症者相当,但严重神经并发症发生者在神经功能恢复和生活质量改善方面均明显不如无并发症者。结论:后路全椎节切除、双轴旋转矫形手术是治疗重度陈旧结核性后凸畸形的有效方法,可以获得较好的手术效果,但需要尽量防止严重神经并发症的发生。     

Idiopathic scoliosis: biomechanics and biology

For whatever reason, right-left asymmetry has attracted an illogical proportion of research effort. Non-structural scoliosis, for example secondary to a leg length inequality, is indeed a problem of right-left asymmetry, but structural scoliosis is a complex three-dimensional deformity involving all planes. Biomechanical, biological and clinical evidence indicates clearly that the problem is one of front-back asymmetry and not right-left. The importanc of biological factors lies in their ability to bring the spinal column to and beyond its buckling threshold. Thus a taller and more slender spine is more liable to bend and, being stiffer in the sagittal plane, favours movement into other planes. This epitomises the spine of the scoliosis patient who is growing faster with a spinal template similar to other family members allowing idiopathic scoliosis to express itself genetically. It is the opposite condition to idiopathic hyperkyphosis (Scheuermann's disease), but this deformity is rotationally stable, thus remaining in the sagittal plane. The presence of an adjacent area of lordo-scoliosis below the region of hyperkyphosis testifies to the common nature of the pathogenesis of idiopathic scoliosis and Scheuermann's disease. It is the area of compensatory hyperlordosis below the Scheuermann's area that has obligatorily buckled and represents a human model supporting the lordosis theory, as does surgically tethering the back of the young growing human spine, which crankshafts accelerated progression. Similarly the only successful animal model of the formation of idopathic follows creation of a lordotic spinal segment in an otherwise kyphotic spine. For centuries, engineers have recognised that the mechanical behaviour of a column under load is influenced by geometry, as well as by material properties; it is clear that the spinal column also obeys these well-described laws.     

Is a gradual reduction of stiffness on top of posterior instrumentation possible with a suitable proximal implant? A biomechanical study

Background Context

Proximal junctional kyphosis (PJK) is a challenging complication after rigid posterior instrumentation (RI) of the spine. Several risk factors have been described in literature so far, including the rigidity of the cranial aspect of the implant.

新型腰椎前凸计算回归方程对成人脊柱畸形矫形术后机械性并发症的预测作用

目的:探讨由骨盆入射角(pelvic incidence,PI)和胸椎后凸(thoracic kyphosis,TK)计算腰椎前凸的新型回归方程对成人脊柱畸形(adult spinal deformity,ASD)矫形术后机械性并发症的预测作用.方法:回顾性分析2011年1月～2019年3月于我科接受后路矫形的ASD患...     

The sagittal balance of the spine in children and adolescents with osteogenesis imperfecta

In severe forms of osteogenesis imperfecta, multiple compression fractures of the spine, as well as vertebral height shortening could be responsible for an increased thoracic kyphosis or a diminished lumbar lordosis. Theses progressive changes in sagittal shapes of the trunk could be responsible for a global sagittal trunk imbalance. We compare the parameters of sagittal spinopelvic balance in young patients with OI to those parameters in a control group of healthy volunteers. Eighteen patients with osteogenesis imperfecta were compared to a cohort of 300 healthy volunteers. A standing lateral radiograph of the spine was obtained in a standardized fashion. The sacral slope, pelvic tilt, pelvic incidence, lumbar lordosis, thoracic kyphosis, T1 and T9 sagittal offset were measured using a computer-assisted method. The variations and reciprocal correlations of all parameters in both groups according to each other were studied. Comparison of angular parameters between OI patients and control group showed an increased T1T12 kyphosis in OI patients. T1 and T9 sagittal offset was positive in OI patients and negative in control group. This statistically significant difference among sagittal offsets in both groups indicated that OI patients had a global sagittal balance of the trunk displaced anteriorly when compared to the normal population. Reciprocal correlations between angular parameters in OI patients showed a strong correlation between lumbar lordosis (L1L5 and L1S1) and sacral slope. The T9 sagittal offset was also strongly correlated with pelvic tilt. Pelvic incidence was correlated with L1S1 lordosis, T1 sagittal offset and pelvic tilt. In OI patients, the T1T12 thoracic kyphosis was statistically higher than in control group and was not correlated with other shape (LL) or pelvic (SS, PT or PI) parameters. Because isolated T1T12 kyphosis increase without T4T12 significant modification, we suggest that vertebral deformations worsen in OI patients at the upper part of thoracic spine. Further studies are needed to precise the exact location of most frequent vertebral deformities.     

Scheuermann’s disease: focus on weight and height role

The aim of this cross-sectional case-control study is the comparison of the weight and height between a group of children with Scheuermann’s disease (SD) and a comparable group of healthy ones and also the correlation of them with the degree and the morphology of the kyphotic curve. Following a school-screening program of 10,057 school students, aged between 11 and 17 years old, 175 adolescents with Scheuermann’s disease were diagnosed. The mean height and weight of 175 adolescents diagnosed to have SD compared with this of a group of normal children taken randomly from the group of 9,882 healthy children screened. The control group was comparable with the study group concerning age (p = 0.605) and sex. The weight, height and body mass index (BMI) were significantly lower in the healthy (control) group (p < 0.001). However, there was no correlation between weight (r = –0.019, p = 0.804), height (r = 0.053, p = 0.484) and BMI (r = –0.177, p = 0.019) with the magnitude of kyphotic curve. There was also no correlation between weight (r = –0.27, p = 0.722), height (r = –0.025, p = 0.744) and BMI (r = –0.038, p = 0.619) with Voutsinas index as well. Scheuermann’s disease is probably a multifactorial skeletal deformity. Weight and height do not seem to affect the magnitude and morphology of the main kyphotic curve in SD. It seems probably that this observation is not part of the pathogenetic mechanism of SD but a result of its cascade. The increased weight and height of these patients may be the secondary result of other disturbances (i.e. hormonal), which may play more crucial role in Scheuermann’s disease pathogenesis.     

SRS-Schwab Grade 4 osteotomy for congenital thoracolumbar kyphosis: a minimum of 2 years follow-up study

Background Context

Several osteotomy techniques including pedicle subtraction osteotomy and vertebral column resection have been employed in the correction of congenital kyphosis (CK) and satisfying outcomes have been demonstrated. However, the Scoliosis Research Society (SRS)-Schwab Grade 4 osteotomy, defined as resection of posterior elements, partial vertebral body, and superior adjacent disc, is rarely reported in the treatment of CK.