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51.
The development of congenital kyphosis was studied radiographically and histologically in 32 female and 34 male Ishibashi rats between the fourth and thirty-sixth week after birth. The major congenital spinal anomalies were defects of segmentation in the lumbar area. The malformation was classified into four groups according to the state of non-segmentation seen in radiographs. The progression of kyphosis was closely related to various changes at intervertebral spaces. The spinal deformity resulting from narrowing of the intervertebral spaces without bony fusion did not progress with growth, and the epiphyseal plates remained relatively intact unrelated to the existence of disc tissue. The deformity resulting from ventral bony fusion without radiographic bony anomalies showed histologically dysplastic epiphyseal plates on the ventral side. Progression of the kyphosis occurred in this type of deformity. The kyphosis resulting from bony fusion and ventral wedge-vertebrae progressed in the males. Progressive kyphosis appeared to be due to a difference in growth potential between the ventral and dorsal epiphyseal plates. 相似文献
52.
ABSTRACT. The thoracic kyphosis and the lumbar lordosis were studied in 1101 healthy children in consecutive age-groups between 8 and 16 years of age. The sagittal curves were estimated with a spinal pantograph–a noninvasive device–with the child standing in a relaxed position. The accuracy and the reproducibility of this technique are studied and shown to be acceptable. The thoracic kyphosis varied in both boys and girls. The least pronounced kyphosis was seen at the age of 10–12 years. At the age of 8 and 14–16 the mean range of the kyphosis increased statistically significantly. A positive correlation was also seen between the velocity of growth and the range of the kyphosis. In the lordosis, a similar trend could not be seen, but instead a slow continuous increase. A positive correlation was also observed between the ranges of the kyphosis and lordosis in most of the age-groups. An individual variation was, however, seen and wide ranges of kyphosis as well as lordosis must be accepted as normal variations. 相似文献
53.
Arnell K 《Acta neurochirurgica》2006,148(3):293-297
Summary When operating on a child with a large myelomeningocele and kyphosis, coverage with skin of high quality and a supporting
layer of subcutaneous tissue can be difficult. The dermal circulation in the newborn is finite and an extensive mobilisation
of the skin is a risky venture.
Between 1988 and 2003 five children with large thoraco-lumbal myelomeningocele and kyphosis underwent subcutaneous insertion
of silicon tissue expanders due to skin cover difficulties. In three children the skin surface was allowed to granulate over
the myelomeningocele. In the other two children closure of the myelomeningocele was attempted but failed leading to secondary
epithelialisation.
Four of the children had two tissue expanders inserted at the age of 8–12 months; two of them before delayed operation for
the myelomeningocele and two before elective spinal column surgery. The fifth child was nine years old when two tissue expanders
were inserted before delayed myelomeningocele repair. Saline was injected into the expanders every 3–7 days during six to
eight weeks. The expansion treatment was well tolerated. The result was an excellent skin and subcutaneous coverage in four
of the children. For the fifth child who was the oldest and obese, one filling port was damaged during one of the injections,
leading to insufficient tissue expansion. An extensive skin mobilisation was required and the result was not optimal.
Tissue expansion is a simple, but a less known technique for acquiring good skin and subcutaneous coverage in children with
large myelomeningocele and kyphosis. The expansion can be done either before delayed myelomeningocele repair or after failed
primary operation thus eliminating the need for extensive musculo-cutaneous flaps. 相似文献
54.
Summary
Background. This was a retrospective study of clinical and radiological results of cervical arthroplasty using the Bryan cervical disc
prosthesis to evaluate the efficacy of arthroplasty in clinical applications.
Methods. A total of 46 patients underwent arthroplasty of a single level using the Bryan disc prosthesis. Clinical outcome was assessed
using the visual analogue scale (VAS) and the neck disability index (NDI). All patients were evaluated using preoperative
and postoperative static cervical spine radiographs to compare cervical sagittal balance. Dynamic cervical spine radiographs
were used to compare movement at the level of the procedure, movement at the adjacent level and movement of the whole cervical
spine.
Findings. With the exception of four patients with aggravated neck pain, the NDI and VAS scores decreased significantly in late follow-up
evaluations. The range of movement of the whole cervical spine, the functional segmental unit, and the adjacent segments were
preserved after arthroplasty. The sagittal alignment of the cervical spine showed kyphosis after surgery but restored lordosis
at a later time. The postulated cause of kyphotic changes include “over-milling” at the dorsal endplate, inappropriate angle
of disc insertion, structural absence of lordosis in the Bryan disc, removal of posterior longitudinal ligament, and pre-existing
kyphosis.
Conclusions. Arthroplasty using the Bryan disc appears to be safe and provided a favorable preliminary clinical and radiological outcome.
Postoperative kyphosis can be prevented by understanding the biomechanical properties of the Bryan disc. Future studies will
need to address the association between postoperative kyphosis, clinical outcome and adjacent segment disease. 相似文献
55.
56.
目的评价后路经椎弓根楔形截骨矫形内固定术治疗胸腰段陈旧性骨折并后凸畸形的临床疗效。方法回顾性分析2003年7月至2010年7月,采用后路楔形截骨内固定术治疗胸腰段陈旧性骨折并后凸畸形患者31例,其中男21例,女10例;年龄3259岁,平均41.8岁。采用视觉模拟评分(visual analogue scale,VAS)及日本骨科协会(Japanese orthopadeics association,JOA)评分(29分法)评价临床症状的改善情况,测量X线侧位片Cobb角,评价后凸畸形的纠正和植骨融合情况。结果所有患者均获随访,随访时间662个月,平均20个月。后凸Cobb角术前平均为39.6°,术后8.4°;VAS评分术前平均7.1分,术后2.9分;JOA评分术前平均为13.6分,术后24.1分。术前术后比较差异均有统计学意义(P〈0.05)。无血管神经损伤等严重并发症发生,术后6个月植骨牢固愈合。无内固定松动、断裂等相关并发症。结论后路截骨矫形内固定术可获得满意的减压及矫形效果,同时可植骨融合,重建脊柱稳定性,并发症少,创伤较小,是胸腰段后凸畸形较理想的治疗方法。 相似文献
57.
Carolin Schmidt Ulf Liljenqvist Thomas Lerner Tobias L. Schulte Viola Bullmann 《European spine journal》2011,20(7):1118-1126
Posterior pedicle screw fixation is now the standard treatment for surgical correction of idiopathic scoliosis and has largely
replaced anterior techniques, but there have been reports describing a lordogenic effect of segmental pedicle screw instrumentation
in the thoracic spine. This clinical study compared anterior dual rod instrumentation with posterior pedicle screw fixation
for idiopathic thoracic lordoscoliosis, including 42 patients (7 male, 35 female; average age 16 years, range 12–34) who underwent
posterior pedicle screw fixation (n = 20) or anterior dual rod instrumentation (n = 22) at two centers. The average follow-up period was 33 months (24–108 months). Inclusion criteria were a diagnosis of
adolescent idiopathic scoliosis with a structural thoracic curve (Lenke 1–3) and thoracic hypokyphosis (T4–T12 < 20°). The
main thoracic curve magnitude and sagittal profile on standing radiographs were evaluated. Thoracic kyphosis was significantly
restored from preoperatively 10.2° to 23.4° postoperatively in the anterior group and from 7.6° to 12.9° in the posterior
group (P < 0.005). Kyphosis improved significantly better in the anterior group than in the posterior group (P < 0.005). The preoperative and postoperative main thoracic curve values were 63° (48–80°) and 25.2° in the anterior group
and 60.6° (50–88°) and 23.6° in the posterior group, with no significant differences between the groups. No neurological or
other severe complications were observed. Anterior dual rod instrumentation in patients with thoracic lordoscoliosis allows
significantly better restoration of thoracic kyphosis than posterior pedicle screw instrumentation. 相似文献
58.
Ke Han Chang Lu Jing Li Guang-Zhong Xiong Bing Wang Guo-Hua Lv You-Wen Deng 《European spine journal》2011,20(4):523-536
Cervical kyphosis is an uncommon but potentially debilitating and challenging condition. We reviewed the etiology, presentation,
clinical and radiological evaluation, and treatment of cervical kyphosis. Based on the current controversy as to the ideal
mode of surgical management, we paid particular attention to the available surgical strategies. There are three approaches
for cervical kyphosis: the anterior, posterior or combined procedures. The principal indication for the posterior strategy
is a flexible kyphosis or kyphosis caused by ankylosing spondylitis. The main point of debate is between the choice of the
anterior or the combined strategy. The two strategies were compared with regard to clinical outcome, correction of deformity,
rate of fusion, complications, revision surgery, and mortality. The combined strategy appears to result in a greater degree
of correction than the anterior-alone strategy, and it is more likely to improve the cervical alignment to achieve a lordosis.
However, the procedure carries a higher rate of postoperative neurological deterioration, complications, revision surgery,
and mortality. Although the anterior-alone strategy achieves a smaller reduction of cervical kyphosis, it has a lower rate
of postoperative neurological deterioration, complications, revision surgery, and mortality. We recommend that the surgical
treatment of cervical kyphosis should be planned on an individual basis. A multicenter, prospective, randomized controlled
study would be necessary to determine the ideal mode of treatment for complex cervical kyphosis. 相似文献
59.
60.