Three-dimensional spinal curvature in idiopathic scoliosis

Scoliosis is usually considered as a deformity of the spine in the frontal plane, without reference to curvatures in other planes. In this study, the three-dimensional shape of the spine of 104 patients with untreated idiopathic scoliosis (5-55 degrees Cobb) was studied by means of stereo radiographs to determine relationships between curvature of the spine in the frontal plane view, in the lateral view, and in the intermediate views. There was a weak but statistically significant correlation (r = 0.2) relating greater scoliosis with lesser kyphosis or greater lordosis. In the thoracic region, the sagittal plane spinal curvature was less than that measured in a population without scoliosis (mean difference, 7.72 +/- 9.9 degrees). Seventy-four of 76 scolioses in the upper region of the spine with lateral curvature greater than 5 degrees Cobb were kyphotic. Sixty-four of 84 curves greater than 5 degrees Cobb in the lower region were lordotic. Measuring curvatures in the plane of symmetry of the rotated apical vertebra altered these ratios to 69 of 76 kyphotic in the upper region and 68 of 84 lordotic in the lower region. The plane of maximum curvature of sections of the spine with scoliosis was not related to the plane of symmetry of the rotated apical vertebra, for in kyphotic regions of the spine the rotations of these two planes were in opposite directions. In all cases, the magnitudes of the rotations were quite different, i.e., by a factor of -0.22 for curves in thoracic region and by a factor of 0.24 for curves in the lumbar region. This implies that mechanical measures to correct this spinal deformity or to prevent progression should apply different rotations to the apex from those applied to the curve as a whole and, in opposite senses, in curves in kyphotic regions. There was no evidence of an abnormality of sagittal curvature of a magnitude to implicate it in the etiology or in the treatment.     

The relationship between jaw deformity and scoliosis

Objectives To analyze the relationship between lateral displacement of the mandible and scoliosis. Methods From April 2002 through July 2003, we examined posteroanterior cephalometric radiographs and chest X-rays from 85 patients with jaw deformities and a control group of 20 patients with no jaw deformities. To measure the lateral shift of the mandible, we drew a horizontal baseline (X axis) on the cephalogram connecting the intersection of the external margins of the orbits and the most lateral points of the greater wings of the sphenoid. A vertical baseline (Y axis) was then marked perpendicular to the X axis, intersecting the ethmoid crista galli. Then, we measured the lateral displacement of the mandibular mentum from the Y axis. Displacement to the right was designated positive; that to the left was designated negative. Cobb's method was used to measure scoliosis curves on chest X-rays; the direction of the curve was designated similarly. Results Of the 85 patients with jaw deformity, 23 (27.1%) had a Cobb angle exceeding 10°. None of the control group had scoliosis exceeding 10°. No correlation was found between the direction of mandibular displacement and the direction of scoliosis. Conclusion This study suggests a relationship between jaw deformities and scoliosis, as scoliosis was found in 27.1% of the patients with a main complaint of jaw deformity.     

前后路联合三维矫形手术治疗青少年特发性僵硬型胸椎侧凸

目的:评价前路松解联合后路三维矫形治疗青少年特发性僵硬型胸椎侧凸的效果,探讨术中、术后并发症的预防措施。方法:青少年特发性僵硬型胸椎侧凸34例,男5例,女29例;年龄8～21岁,平均14.7岁。均为右侧凸。均采用经前路松解植骨融合联合后路三维矫形内固定治疗,其中前路经胸入路26例,胸腔镜前路松解植骨融合矫形术8例。随访时均摄全脊柱X线片。术前、术后所摄X线片进行以下各项测量指标比较:Cobb角、顶椎的旋转度、下融合椎旋转度、躯干偏移距离。随访时观察有无脊柱失平衡、假关节形成及其他并发症的发生。结果:全部病例均获随访,时间12～39个月,平均22个月。所有患者Cobb角术后平均矫正率80.62%,其中18例患者出现矫正度数丢失,丢失度数3°～10°,平均4.3°(术后平均14.2°,1年后随访平均18.5°)。所有患者术后胸椎生理性后凸得到重建。术后胸椎融合弯顶椎的旋转改善率62.91%,下融合椎旋转改善率47.60%,躯干偏移平均距离3.3mm,未见脊柱失平衡现象。围手术期并发症包括低氧血症1例,胸腔积液2例,均经保守治疗后痊愈。术后6个月肺功能检查,未见有明显下降。脊柱胸弯融合段未发现假关节形成。结论:前路松解联合后路矫形内固定植骨融合治疗青少年特发性僵硬型胸椎侧凸可明显改善顶椎的旋转度,得到满意的三维矫形效果。术前积极准备、合理手术设计,术中严格操作,术后重视预防并发症能减少手术并发症的发生。     

Axial rotation component of thoracic scoliosis

The axial rotation (rotation about a vertical axis) of the vertebrae, of the ribs, and of the back surface are components of the deformity recognized clinically as the "rib hump" in thoracic scoliosis. Relationships of these rotations to the lateral deviation and lateral curvature of the spine were studied in 40 patients with idiopathic scoliosis. Stereoradiographs of the spine and rib cage were used to measure three components of axial rotation: rotation of the vertebrae, of the rib cage, and of the plane of maximum curvature of the spine. Stereotopographs of the back surface were digitized to measure the axial rotation of the back surface. In individual patients, there were high correlations of all components of axial rotation at each spinal level with the corresponding vertebral lateral deviation from the spinal axis. By regression analyses of the maximum values of each rotation in each curve, the rotation of the apex vertebra was found to be generally of lesser magnitude than the rotation of the plane of maximum curvature of the spine and in an opposite sense in kyphotic curves. The rib cage rotation was generally of lesser magnitude than the vertebra rotation, and the back surface rotation was less than both of these skeletal rotations. Vertebra rotation correlated most closely with lateral deviation of the spine. Simple segmental coupling of axial rotation and lateral bending could not be responsible for this axial rotation.     

Patient-specific mechanical properties of a flexible multi-body model of the scoliotic spine

The flexibility of the scoliotic spine is an important biomechanical parameter to take into account in the planning of surgical instrumentation. The objective of the paper was to develop a method to characterisein vivo the mechanical properties of the scoliotic spine using a flexible multi-body model. Vertebrae were represented as rigid bodies, and intervertebral elements were defined at every level using a spherical joint and three torsion springs. The initial mechanical properties of motion segments were defined fromin vitro experimental data reported in the literature. They were adjusted using an optimisation algorithm to reduce the discrepancy between the simulated and the measured Ferguson angles in lateral bending of three spine segments (major or compensatory left thoracic, right thoracic and left lumbar scoliosis curves). The flexural rigidity of the spine segments was defined in three categories (flexible, nominal, rigid) according to the estimated mechanical factors (α). This approach was applied with ten scoliotic patients under-going spinal correction. Personalisation of the model resulted in an increase of the initial flexural rigidity for seven of the ten lumbar segments (1.38≤α≤10.0) and four of the ten right thoracic segments (1.74≤α≤5.18). The adjustment of the mechanical parameters based on the lateral bending tests improved the model's ability to predict the spine shape change described by the Ferguson angles by up to 50%. The largest differences after personalisation were for the left lumbar segments in left bending (4⁰±3⁰). Thein vivo identification of the mechanical properties of the scoliotic spine will improve the ability of biomechanical models adequately to predict the surgical correction, which should help clinicians in the planning of surgical instrumentation manoeuvres.     

不同方式记忆合金加压钉矫正山羊脊柱侧凸模型的效果对比

目的通过不同型号、不同数量记忆合金加压钉矫正山羊脊柱侧凸模型效果的比较,探讨其调节脊柱生长的最佳干预方式。方法20只山羊用不对称拴系的方法建立脊柱侧凸模型。成模后解除拴系,随机分为4组（n=5）进行处理：3个治疗组行开胸手术,将相应型号的Staple钉植入椎体凸侧,对照组仅解除拴系。术后定期摄胸椎X线片,比较Cobb角变化。结果3个治疗组术后即刻矫形效果明显（P〈0．01）,且侧凸的Cobb角随时间减小。各治疗组的有效矫形角度（矫形术后即刻Cobb角-术后2个月Cobb角）均较对照组大（P〈0．05）,其中双排单间隙钉组的有效矫形角度最大,数据也较集中,但各治疗组之间差异无统计学意义（P〉0．05）。结论3种Staple钉的植入方式均可以有效的矫正脊柱侧凸,且矫形效果无显著差异。     

针刀松懈术联合手法治疗脊柱侧弯的临床观察

目的:探讨针刀松懈术联合手法对脊柱侧弯的治疗有效性,并做随访记录。方法:选取2012年1月至2016年9月期间宜昌市中心人民医院收治的脊柱侧弯患者34例,并分为2组,观察组使用针刀松懈术配合手法进行治疗,对照组佩戴支具进行治疗,比较2组患者的治疗总有效,以及在治疗前后VAS评分差异和Cobb角矫正效果,对针刀松懈术联合手法使用的有效性和可行性进行深入探讨。结果:观察组的优良率为94.12%高于对照组的82.35%,且前者的治疗效果为优的患者高达70.59%远远大于后者的29.41%,P0.05;但是观察组平均评分更低为(2.6±0.5),对照组为(4.8±1.9)分,P0.05;观察组矫正率为50.4%,对照组的平均矫正率为20.7%,P0.05,2组治疗前后Cobb角比较均有统计学意义,P0.05;术后半年进行随访,观察组平均身高增加了(5.1±0.6)cm,对照组为(4.6±0.7)cm,P0.05。结论:针刀松懈术联合手法治疗不但可以有效缓解患者疼痛,还能起到一个良好的矫正效果,增加身高,提高预后,是一个可靠的、有效的治疗脊柱侧弯的方案。     

基于姿势解密技术的手法治疗青少年特发性脊柱侧弯的疗效观察

目的 观察基于姿势解密技术的手法治疗青少年特发性脊柱侧弯（AIS）的临床疗效。 方法 选取36例AIS患者随机分为观察组和对照组,每组18例,但治疗期间,因个人原因观察组脱落1例,对照组脱落2例,最终完成本研究33例。2组患者均采用侧移训练矫正疗法作为常规康复训练,侧移训练每周4次,每次训练10 min,共治疗4周;在此基础上,观察组增加姿势解密技术手法治疗,对照组则增加悬吊训练治疗,每周治疗1次（错开侧移训练日）,每次治疗20 min,共治疗4周。分别于治疗前和治疗4周结束后（治疗后）,对2组患者的脊柱侧方弯曲度（Cobb角）、锁骨角（CA）、躯干旋转角（ATR）、椎体旋转度（VR）、脊柱侧凸研究会患者问卷表22项(SRS-22) 进行评估。 结果 治疗后,观察组患者的Cobb角［（16.76±6.67）°］、锁骨角［（1.35±0.50）°］、ATR［（6.18±3.23）°］和SRS-22评分［（88.18±5.47）分］均较组内治疗前［（20.12±6.98）°、（2.53±1.20）°、（8.65±4.15）°、（84.65±6.76）分］有明显改善（P＜0.05）,对照组的Cobb角［（17.31±6.83）°］、ATR［（6.31±2.52）°］、SRS-22评分［（86.25±10.53）分］较组内治疗前［（18.13±7.08）°、（7.06±2.84）°、（85.00±11.02）］ 明显改善（P＜0.05）,但锁骨角改善并不明显（P＞0.05）;且治疗后观察组的Cobb角、ATR、锁骨角和SRS-22评分的改善程度均明显高于对照组（P＜0.05）。而2组患者的VR改善程度组内及组间比较,差异均无统计学意义（P＞0.05）。 结论 姿势解密技术手法能有效改善AIS患者的脊柱侧弯、肩部失衡程度,有更好的整体治疗效果。     

脊柱侧弯后路矫形内固定术的配合与护理

目的探讨脊柱侧弯后路矫形内固定术的配合及护理方法。方法对10例青少年患者行脊柱侧弯后路矫形内固定术,配合医生手术并严密观察病情变化。结果所有患者手术过程顺利,无一例脑脊液漏,脊髓损伤及切口感染等术后并发症发生,术后随访两年脊柱侧弯畸形均得到了明显矫正。结论手术护士熟悉手术步骤,全面掌握各种仪器及器械操作是手术配合成功的关键。完善的术前准备及密切的术中观察是减少脊柱侧弯病人术中并发症的重要因素。