马方和类马方综合征合并脊柱侧凸患者肺功能障碍的模式及影响因素

目的 探讨合并脊柱侧凸的马方和类马方综合征患者肺功能损害的模式及其影响因素.方法 回顾性分析1998年2月至2007年9月行脊柱侧凸矫形内固定手术且有术前肺功能资料的25例马方和类马方综合征患者(A组)的临床资料,其中男性11例,女性14例;年龄11～20岁,平均15岁.分析其肺功能指标(实测值与预计值的比值)与冠状面Cobb角、胸弯顶椎位置、受累节段数以及胸椎后凸角的关系.并与同期行脊柱侧凸矫形内固定术且弯型与此匹配的38例青少年特发性脊柱侧凸(MS)患者(B组)的肺功能指标进行比较分析.结果 A组患者肺活量(VC)、用力肺活量(FVC)、第1秒最大呼气容积(FEVI)等指标与冠状面Cobb角呈显著负相关(r=0.514、-0.503、-0.464,P<0.05);VC、FVC、FEV1以及最大呼气中期流量(MMEF)等指标明显小于B组(P<0.05);顶椎位置在T_(4～8)与在T_(9～12)的患者之间肺功能指标差异无统计学意义;受累节段≥8的患者,VC、FVC、FEV1和最大自主通气量(MVV)等指标小于受累节段<8者(P<0.05);胸椎后凸角与肺功能指标之间无明显相关性.结论 合并脊柱侧凸的马方和类马方综合征患者肺功能损害较MS患者严重,其肺功能主要受胸弯受累节段数和胸弯冠状面Cobb角共同影响.     

青少年特发性脊柱侧凸患者术前肺功能影响因素分析及临床意义

目的 分析影响青少年特发性脊柱侧凸患者术前肺功能的相关影像学参数及其临床意义.方法 回顾性研究2009年7月～2012年8月本院收治的青少年特发性脊柱侧凸患者24例,术前肺功能检查、胸部CT扫描资料完整.分析肺功能结果与站立位全长X线片Cobb角、顶椎偏移、椎体旋转分度（Nash/Moe法）、顶椎肋椎角差值、矢状位T5-12后凸角和胸段累及椎体数目之间相关性.结果 患者年龄平均14.8岁,Cobb角平均52.8°;主弯Cobb角与术前肺活量占预计值百分比、第1秒最大呼气容积占预计值百分比、用力肺活量占预计值百分比、最大通气量占预计值百分比、肺总量占预计值百分比、一氧化碳弥散量占预计值百分比和一氧化碳弥散量呈负相关;顶椎偏移与肺总量占预计值百分比、一氧化碳弥散量占预计值百分比及一氧化碳弥散量呈明显负相关;站立位顶椎凸凹侧肋椎角差值分别与肺总量占预计值百分比、肺总量、一氧化碳弥散量占预计值百分比和一氧化碳弥散量呈负相关;Bending位顶椎凸凹侧肋椎角差值与肺总量、一氧化碳弥散量呈负相关;胸段累及椎体数≥7个组患者50％肺活量时最大呼气流量、75％肺活量时最大呼气流量、最大用力呼气中段流速占预计值百分比、最大通气量占预计值百分比及一氧化碳弥散量占预计值百分比数值,比胸段累及椎体数＜7个组患者有减少（P＜0.05）.结论 术前站立位主弯Cobb角愈大,主弯顶椎偏移增大,站立位以及Bending位顶椎凸凹侧肋椎角差值增加,肺功能下降.近胸弯≥30°组较之＜30°组,胸段累及椎体数≥7个组较之＜7个组,肺功能数值下降.     

退变性脊柱侧凸手术治疗研究进展

退变性脊柱侧凸是指既往无脊柱侧凸病史的患者在骨骼发育成熟后发生的冠状位x线片上(站立位)>10°的脊柱侧凸,主要发生在50岁以上的中老年人.侧凸常见于胸腰段和腰段,侧凸角较特发性成人侧凸小,累及节段通常较少;顶椎位置一般位于L<2～3>或L3～4,也可位于L1和L2,多伴随椎间横向移位、椎体旋转和椎管狭窄;患者常以腰背疼痛和下肢根性疼痛而就医.     

成人胸段侧凸患者心脏结构和功能的研究

目的 分析成人胸段侧凸患者心脏结构和功能的特点并探讨使其发生改变的影响因素.方法 回顾分析41例主弯为胸弯的成人脊柱侧凸患者的心脏彩色超声以及与脊柱侧凸相关的临床、ⅱ影像学资料,男9例,女32例;年龄22～57岁,平均31.29岁.对照组为椎间盘突出症患者35例,男7例,女28例;年龄25～44岁,平均31.17岁.研究侧凸方向、侧凸角、侧凸累及椎体数量、侧凸弧度类型、顶椎位置以及年龄对成人脊柱侧凸患者心脏结构和功能的影响.结果 侧凸角和侧凸累及椎体的数量分别影响心脏舒张功能(E/A比值)和收缩功能(左室短轴缩短率).此外,侧凸弧度类型以及顶椎位置影响成人脊柱侧凸患者的主肺动脉径.成人侧凸组患者与对照组患者之间舒张末期室间隔厚度、舒张末期左室后壁厚度、舒张末期左窒前后径、收缩末期左室前后径、左房前后径、右室前后径、主动脉根径、主肺动脉径等心脏结构指标存在显著性差异.结论 成人胸段侧凸患者的心脏结构和功能指标总体并未偏离正常范围,但是脊柱畸形仍对患者的心脏结构和舒缩功能产生一定影响.主要影响因素可能包括侧凸角、侧凸累及椎体数量、侧凸弧度类型以及顶椎位置.     

脊柱侧凸诊疗问答(二)

3 什么是特发性脊柱侧凸?有哪几种类型? 生长发育期间原因不明的脊柱侧凸称为特发性脊柱侧凸. 根据年龄特点一般将特发性脊柱侧凸分为3种类型:婴幼儿型(0～3岁)、少年型(4～9岁)和青春型(10 ～16岁). 按脊柱侧凸顶椎所在的解剖位置又分为:①颈弯:顶椎在第1～6颈椎之间.②颈胸弯:顶椎在第7颈椎至第1胸椎之间.③胸弯:顶椎在第2 ～11胸椎之间.④胸腰弯:顶椎在第12胸椎至第1腰椎之间.⑤腰弯:顶椎在第2～4腰椎之间.⑥腰骶弯:顶椎在第5腰椎或第1骶椎.     

成人胸腰段或腰段脊柱侧凸合并Chiari畸形和脊髓空洞症的三维矫形及融合策略

[目的]探讨合并Chiari畸形和脊髓空洞症的成人胸腰段或腰段脊柱侧凸的三维矫形及融合策略.[方法]回顾性研究2002年1月～2008年5月本科收治的13例合并Chiari畸形和脊髓空洞症的成人胸腰段或腰段脊柱侧凸,全部采用后路椎弓根螺钉系统三维矫形,并根据侧凸结构性特点选择内固定及融合节段.测量术前、术后、末次随访时冠状面Cobb' s角、侧凸矫正率、骨盆倾斜、顶椎旋转度、顶椎偏距、躯干偏移、矢状面胸椎后凸角和腰椎前凸角.[结果]冠状面Cobb' s角从46.8°减少到9.2°,侧凸矫正率80.7%;骨盆倾斜从9.9°减少到3.2°;顶椎旋转度从1.9°减少到0.3°;顶椎偏距从3.6 cm减少到0.8 cm;躯干偏移从16.8 cm减少到1.6 cm;胸椎后凸角从18.2°增加到23.5°;腰椎前凸角从37.4°增加到41.8°.术后平均随访22.2个月,无明显矫形丢失、躯干失平衡、假关节形成,且未发生原有神经症状加重及新的不可逆性神经功能损害.[结论]后路椎弓根螺钉系统三维矫形及融合术治疗合并Chiari畸形和脊髓空洞症的成人胸腰段或腰段脊柱侧凸效果满意.     

先天性脊柱侧凸合并高肩胛征的影像学特征

目的:探讨先天性脊柱侧凸(congenital scoliosis,CS)合并高肩胛征患者的影像学特征,并分析高肩胛征与双肩平衡的相关性。方法:回顾性分析2000年1月～2015年10月在我科以脊柱畸形首诊且影像学资料完整的24例CS合并高肩胛征患者,其中男11例,女13例,平均年龄11.8±6.0岁(2～31岁)。通过站立位全脊柱正侧位X线,测量并记录患者侧凸类型、Cobb角、顶椎位置、上下端椎位置、双肩高度差、高肩胛的位置及半椎体位置等。并对双肩高度差和弯型参数进行Spearman相关性分析。结果:24例患者均表现为颈胸椎或胸椎侧凸畸形,平均侧凸Cobb角49.5°±23.3°。侧凸顶椎位于T1～T11,其中16例患者表现为单节段或多节段半椎体畸形,半椎体发生于T4及以上节段10例;合并肋骨畸形15例,其中9例发生于脊柱侧凸的凹侧,3例发生于侧凸凸侧,3例发生于侧凸两侧。高肩胛发生于脊柱侧凸凸侧15例(62.5%)、凹侧7例(29.2%)、双侧2例(8.3%)。高肩胛位于侧凸凸侧的15例患者均为凸侧肩高于凹侧;高肩胛位于侧凸凹侧的7例患者中,5例凹侧肩高于凸侧,2例凸侧肩高于凹侧。双肩高度差平均为15.7±21.0mm。Spearman相关性分析显示,双肩高度差与Cobb角、顶椎位置、上下端椎位置等无明显相关性(P0.05)。结论 :CS合并高肩胛征患者多表现为颈胸段和胸段侧凸畸形,以T4以上节段半椎体多见,高肩胛征及合并的肋骨畸形均多见于脊柱侧凸的凸侧,而双肩高度差与弯型特征无明显相关性。     

青少年特发性胸椎侧凸患者的脊髓偏移及临床意义

[目的]揭示青少年胸椎特发性侧凸患者椎管内脊髓的偏移，明确其变化趋势，并探讨其可能的发生机制和临床意义。[方法]本研究包括39名以右胸弯为主弯的青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者。测量主胸弯节段内（T5-12）椎管内脊髓与凸凹侧椎弓根之间的距离，计算脊髓的偏移，揭示其变化趋势，并分析顶椎区脊髓偏移与主胸弯Cobb＇s角和顶椎相对偏移之间的相关性。[结果]在T5-12节段椎管内，脊髓与凸侧椎弓根之间的距离显著大于与凹侧椎弓根之间的距离（P〈0．05），即脊髓向凹侧椎弓根偏移，且以顶椎区最为显著，而逐渐向两侧端椎区递减。顶椎区脊髓偏移与主胸弯Cobb’s角和顶椎相对偏移存在显著的正相关（相关系数分别为0．631和0．546）。[结论]胸椎特发性脊柱侧凸患者存在侧凸节段椎管内脊髓偏移的现象，且以顶椎区最显著。研究结果提示脊髓偏移可能与脊椎偏移后凹侧脊神经的牵拉有关，而且凹侧置钉的风险高于凸侧。     

先天性脊柱侧凸合并脊髓纵裂的临床特点及手术疗效

目的 :研究手术治疗先天性脊柱侧凸合并脊髓纵裂的患者的临床特点,评估其手术疗效及并发症发生情况。方法:回顾性分析2005年3月～2017年3月间我院收治并行手术治疗的先天性脊柱侧凸合并脊髓纵裂患者69例,其中女性41例,男性28例,平均年龄13.9±4.5岁(7～34岁)。所有患者术前均行全脊柱正侧位X线、CT及MRI检查,术后即刻及末次随访行全脊柱正侧位X线检查,测量影像学参数(主弯Cobb角、次弯Cobb角、主弯顶椎偏距、躯干偏移、胸椎后凸角及腰椎前凸角),分析先天性脊柱侧凸合并脊髓纵裂的影像学特点及临床表现,并评估脊柱侧凸矫形率及相关并发症[矫形率=(术前Cobb角-术后即刻Cobb角)/术前Cobb角]。结果:在69例脊髓纵裂患者中,单纯膜性纵裂50例,骨性纵裂4例,膜性合并骨性纵裂15例。合并椎板畸形38例,半椎体24例,肋骨畸形25例,37例同时存在其他椎管内畸形,椎管外畸形8例。临床表现主要有:背部毛发10例,跛行6例,腰背痛4例,截瘫2例。双下肢/双足异常8例,神经系统阳性体征20例。脊髓纵裂好发于下胸段及腰段,占72.4%(50/69),纵裂累及椎体节段平均为4.2±2.7个。所有患者中,1例在矫形前行骨嵴切除,余均未对纵裂做预防性切除,仅单纯行侧凸矫形内固定术。60例得到随访,随访率为86.9%。平均随访时间32.4±22.7个月(13～115个月)。术前主弯Cobb角平均为71.8°±29.4°,次弯Cobb角为46.4°±17.3°,胸椎后凸角为39.5°±36.1°,腰椎前凸角为50.4°±17.3°;主弯顶椎偏距为6.2±3.6cm,躯干偏移平均为2.8±3.0cm。术后即刻主弯Cobb角28.8°±21.6°,次弯Cobb角25.6°±14.5°,胸椎后凸角25.5°±19.1°,腰椎前凸角42.3°±15.4°;主弯顶椎偏距4.2±3.3cm,躯干偏移2.4±2.8cm,主弯顶椎旋转度所有患者术后即刻冠状位主弯矫形率为(59.9±22.0)%,末次随访时矫形率为(53.6±25.7)%。术后即刻与术前相比,主弯Cobb角、次弯Cobb角、胸椎后凸角、腰椎前凸角及主弯顶椎偏距均有明显统计学差异(P0.01),主弯顶椎旋转度及躯干偏移无明显统计学差异。末次随访时主弯Cobb角平均为33.3°±25.9°,次弯Cobb角为27.1°±16.9°,胸椎后凸角为25.1°±16.1°,腰椎前凸角为45.6°±17.6°;主弯顶椎偏距为4.9±6.0cm,躯干偏移平均为2.1±2.0cm,末次随访与术后相比,均无明显统计学差异(P0.05)。术后共6例出现神经系统并发症,发生率为8.7%,均为不完全神经损伤,无截瘫发生。内固定相关并发症3例,包括螺钉松动2例,内固定棒断裂1例。2例螺钉松动患者无任何临床症状,予以随访观察;1例内固定棒断裂患者手术翻修,未再次出现并发症。结论:先天性脊柱侧凸合并SCM手术治疗患者纵裂好发于下胸段及腰段,椎体畸形以混合型最多见;中下胸段肋骨畸形的伴发率最高。     

特发性与先天性脊柱侧凸患者肺功能障碍的差异性比较

目的：比较特发性脊柱侧凸（idiopathic scoliosis，IS）与先天性脊柱侧凸（congenital scoliosis．CS）患者肺功能参数的差异性。方法：术前检测214例脊柱侧凸患者的肺活量（vital capacity，VC）、用力肺活量（forced vital capacity，FVC）、第1秒用力呼气容积（forced expiratory volume in one second，FEV1）、最大呼气中期流量（maximal mid-expiratory flow，MMEF）、最大自主通气量（maximal voluntary ventilation，MVV），计算实测值占预计值百分比（实／预％），其中IS 141洌（IS组），CS73例（CS组），将肺功能指标与Cobb角进行相关分析。依据主弯顶椎所在位置分为胸段及非胸段侧凸两组，胸段侧凸依据Cobb角大小分为：Cobb角〈600（A组）、60&#176;≤Cobb角〈90&#176;（B组）、Cobb角≥90&#176;（C组）3组。分析胸段及非胸段IS、CS患者术前肺功能参数的差异．同时比较年龄≤10岁的IS、CS患者各参数的差异。结果：脊柱侧凸患者VC、FVC、FEV1、MMEF及MVV的实／预％与Cobb角呈显著性负相关（r=-0．40--0.55）。在胸段侧凸患者中，CS组的FEV1实／预％为64．2％，明显低于IS组患者的80．0％（P〈0．05）；不同Cobb角CS组患者的VC、FVC、FEV1、MVV实／预％值都较相应Cobb角的IS组患者低（P〈0．05）。非胸段侧凸患者中，CS组的VC、FVC、MVV的实／预％较IS组患者低（P〈0．05）。年龄≤10岁的CS与IS患者肺功能指标比较也具有显著性差异（P〈0．05）。结论：IS和CS患者均存在肺功能损害，但损害模式不同，IS以限制性通气功能障碍为特征，CS表现为混合性通气功能障碍；年龄和Cobb角相匹配时．无论在胸段还是非胸段，CS患者的肺功能损害均较IS患者严重；且两者肺功能损害的差异性在青春期前就存在。     

脊柱侧凸患者术前肺功能、手术方式与术终气管拔管时间的相关性分析

目的对脊柱侧凸患者术前肺功能指标、手术方式与术终拔管时间的相关性进行回顾性研究。方法选取我院脊柱外科于2000年9月至2005年6月收治的115例脊柱侧凸患者为研究对象,应用多元线性回归分析对患者术前肺功能及手术方式与拔管时间的关系进行相关性分析。结果术终气管拔管时间经胸组与未经胸组之间无显著差异,而行胸廓成形术组显著大于不行胸廓成形术组（P=0．009）。多元线性回归分析结果显示侧凸患者术终气管拔管时间与肺活量百分比、最大通气量百分比、第一秒最大呼气容积百分比、用力呼气中期流速百分比及是否行胸廓成形术之间呈显著负相关。结论肺活量百分比、最大通气量百分比、第一秒最大呼气容积百分比、用力呼气中期流速百分比及是否行胸廓成形术是影响术终气管拔管时间的主要因素。术前肺功能测定及术式的选择对术终气管拔管时间的判断有指导意义。     

Ⅰ型神经纤维瘤病合并脊柱侧凸患者肺功能损害模式的研究

目的 分析I型神经纤维瘤病(NF1)合并脊柱侧凸患者肺功能损害的模式,以及影响其肺功能的影像学因素.方法 选取2003年1月至2009年6月间收治的NF1合并脊柱侧凸患者36例(NF1组),特发性脊柱侧凸(IS)患者64例(IS组),术前检测患者的肺活量(VC)、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、最大呼气中期流量(MMEF)、最大自主通气量(MVV).比较两组肺功能参数的差异.按照弯型部位及有无萎缩性改变将NF1组患者分类并分类比较肺功能损害的差异,分析影响肺功能的影像学指标.结果 两组肺功能参数VC、FVC、FEV1、MMEF、MVV差异均无统计学意义(P>0.05).NF1组胸弯患者肺功能显著低于非胸弯患者;营养不良型患者与非营养不良型患者肺功能损害差异无统计学意义(P>0.05);顶椎位置以及Cobb角与肺功能参数显著相关(P<0.05).结论 NF1合并脊柱侧凸患者的肺功能损害模式与IS患者类似,胸弯患者比非胸弯患者肺功能损害严重,侧凸位置以及Cobb角大小是影响患者肺功能的主要因素.     

Results of preoperative pulmonary function testing of adolescents with idiopathic scoliosis. A study of six hundred and thirty-one patients

BACKGROUND: Previous research has suggested a correlation between pulmonary impairment and thoracic spinal deformity. The curve magnitude, number of involved vertebrae, curve location, and decrease in thoracic kyphosis independently contribute to pulmonary impairment, but the strength of these associations has been variable. The objectives of this study were to test the hypothesis that increased thoracic deformity is associated with decreased pulmonary function and to determine which, if any, radiographic measurements of deformity predict pulmonary impairment. METHODS: Preoperative pulmonary function testing and radiographic examination were performed on 631 patients with adolescent idiopathic scoliosis. Correlation analysis and subsequent stepwise multiple regression analysis were carried out to assess the associations between radiographic measurements of deformity and the results of pulmonary function testing. RESULTS: The magnitude of the thoracic curve, the number of vertebrae involved in the thoracic curve, the thoracic hypokyphosis, and coronal imbalance had a minimal but significant effect on pulmonary function. While these four factors were associated with an increased risk of moderate or severe pulmonary impairment, they explained only 19.7%, 18.0%, and 8.8% of the observed variability in forced vital capacity, forced expiratory volume in one second, and total lung capacity, respectively. The degrees of scoliosis that were associated with clinically relevant decreases in pulmonary function were much smaller than previously described, but the majority of the observed variability in pulmonary function was not explained by the radiographic characteristics of the deformity. CONCLUSIONS: Some patients with adolescent idiopathic scoliosis may have clinically relevant pulmonary impairment that is out of proportion with the severity of the scoliosis, and this may alter the decision-making process regarding which fusion technique will produce an acceptable clinical result with the least additional effect on pulmonary function.     

The position of the aorta relative to the spine: a comparison of patients with and without idiopathic scoliosis

BACKGROUND: There is little information documenting the relationship of the aorta to the thoracic scoliotic spine. Recent studies have suggested that the ends of screws placed during an anterior spinal arthrodesis, and pedicle screws used for the treatment of right thoracic scoliosis, may be in proximity to the aorta. The purpose of this study was to analyze the anatomical relationship between the aorta and the spine in a comparison of patients with idiopathic right thoracic scoliosis and patients with a normal spine. METHODS: Thirty-six patients with adolescent idiopathic scoliosis with a right thoracic curve and forty-three with a normal straight spine were studied. Radiographs were analyzed to determine the Cobb angle, the apex of the curve, and the apical vertebral rotation for the patients with scoliosis. Axial magnetic resonance images from the fourth thoracic vertebra to the third lumbar vertebra at the midvertebral body level were used to measure the distance from the aorta to the closest point of the vertebral body cortex, the distance from the posterior edge of the aorta to the spinal canal, and the aorta-vertebral angle. RESULTS: No differences were found between the groups with respect to age or sex distribution. For the scoliosis and normal groups, boys had greater average vertebral body width and depth for all levels than did girls (p < 0.05). For the scoliosis group, the most common apical vertebra was the eighth thoracic vertebra, the average coronal curve measurement was 55.2 degrees, and the average apical rotation was 17.3 degrees. The average distance from the aortic wall to the vertebral body cortex at the apex of the curve was greater in the patients with scoliosis (4.0 mm) than at similar levels in the normal group (2.5 mm) (p < 0.05). The distance from the posterior aspect of the aorta to the anterior aspect of the spinal canal was less in the scoliosis group (11.1 mm) than in the normal group (19.2 mm) for the fifth to the twelfth thoracic level (p < 0.05). The aorta was positioned more laterally and posteriorly adjacent to the vertebral body at the fifth to the twelfth thoracic level in patients with scoliosis compared with that in normal patients as reflected in a smaller aorta-vertebral angle (p < 0.05). With an increasing coronal Cobb angle in the thoracic curve and apical vertebral rotation, the aorta was positioned more laterally and posteriorly (p < 0.05). CONCLUSION: In patients with right thoracic idiopathic scoliosis, the aorta is positioned more laterally and posteriorly relative to the vertebral body compared with that in patients without spinal deformity.     

Pulmonary function and movement of the thoracic cage in mild idiopathic thoracic scoliosis

It has not yet been studied whether there is a threshold in the degree of scoliotic deformity, above which the pulmonary function is impaired. Neither has it been confirmed whether the pulmonary dysfunction has some relation to the development of scoliosis and its deterioration, if the impairment of pulmonary function does exists in patients with subclinically mild scoliosis. To elucidate these problems, the author investigated the respiratory function and the movement of the thoracic cage as well, in scoliotic patients with mild involvement on their thoracic spine. The results were as follows. In cases with mild deformity of less than fourty degrees, residual volume and functional residual capacity were increased and static lung compliance was decreased, but vital capacity remained within normal limits. Increased residual volume was observed even in the very mild case with a curvature of as much as ten degrees. No correlation was found between the degree of pulmonary dysfunction and the prognosis of scoliosis. The author believed that prognosis of scoliosis could not be predicted by testing the pulmonary functions alone. The movement of the thoracic cage was greater in the concave side of scoliosis than in the convex side on both tidal breathing and vital capacity measurement maneuver. Both the degree of deformity represented by Cobb's angle and that of rib hump correlated significantly with the restriction of the movement of the thoracic cage on the convex side of scoliotic deformity.     

特发性胸椎左侧凸患者的临床及影像学特征

目的探讨特发性胸椎左侧凸患者的临床及影像学特征。方法通过对病史、查体、X线、全脊髓MRJ等检查,回顾性分析11例特发性胸椎左侧凸患者（A组）的临床资料,测量冠状面及矢状面影像学参数,并将相关指标与特发性胸椎右侧凸患者（B组）进行比较分析。结果特发性胸椎左侧凸以男性多见,男：女为7：4。11例患者弯型分布为：三弯1例,双弯（胸主弯／代偿性腰弯）2例,单胸弯8例。主弯的上端椎分布于T5-T8,下端椎分布于T11～L3,平均跨度达7．1＋1．4节,顶椎分布于T8～T11,单胸弯（75％）型患者中6例顶椎位于T9。与右侧凸型相比,特发性胸椎左侧凸型患者胸椎后凸角（T5-T12）较大（31．20±21．8°VS12．8°±9．4°）,差异有显著统计学意义（P〈0．01）,其余影像学参数两组间比较均无统计学差异。结论特发性胸椎左侧凸患者影像学上具有一定的特征性：在冠状面上,特发性胸椎左侧凸的侧凸模式与右侧凸型相似,呈“镜像”模式;但在矢状面上,特发性胸椎左侧凸型患者胸椎后凸角趋于正常,甚至呈过度后凸,与右侧凸型不同。     

Comparison of influence of esophageal carcinoma operations on pulmonary function.

OBJECTIVE: To study the change of pulmonary function after three kinds of esophageal carcinoma operations. METHODS: Esophageal carcinoma operations were performed on 60 consecutive patients, including 20 cases of supra-aortic gastro-esophageal anastomosis, 20 cases of sub-aortic gastro-esophageal anastomosis and 20 cases of apico-thoracic retro-aortic gastro-esophageal anastomosis. Lung function was checked for every patient 3 days before the operation and 3, 6, 12 months after the operation. RESULTS: VC%, FEV1% and MVV% are significantly lower in supra-aortic anastomosis group than in sub-aortic anastomosis group after the operation (P < 0.05). VC%, FEV1%, and MVV% are significantly lower in supra-aortic anastomosis group than in apico-thoracic retro-aortic anastomosis group after the operation (P<0.05). VC%, FEV1% and MVV% are not significantly different between apico-thoracic retro-aortic anastomosis group and sub-aortic anastomosis group after the operation (P > 0.05). CONCLUSIONS: Supra-aortic anastomosis has more negative influence on the post-operative pulmonary function than apico-thoracic retro-aortic anastomosis and sub-aortic anastomosis do.     

Relative anterior spinal overgrowth in adolescent idiopathic scoliosis. Results of disproportionate endochondral-membranous bone growth

We undertook a comparative study of magnetic resonance imaging (MRI) vertebral morphometry of thoracic vertebrae of girls with adolescent idiopathic thoracic scoliosis (AIS) and age and gender-matched normal subjects, in order to investigate abnormal differential growth of the anterior and posterior elements of the thoracic vertebrae in patients with scoliosis. Previous studies have suggested that disproportionate growth of the anterior and posterior columns may contribute to the development of AIS. Whole spine MRI was undertaken on 83 girls with AIS between the age of 12 and 14 years, and Cobb's angles of between 20 degrees and 90 degrees, and 22 age-matched controls. Multiple measurements of each thoracic vertebra were obtained from the best sagittal and axial MRI cuts. Compared with the controls, the scoliotic spines had longer vertebral bodies between T1 and T12 in the anterior column and shorter pedicles with a larger interpedicular distance in the posterior column. The differential growth between the anterior and the posterior elements of each thoracic vertebra in the patients with AIS was significantly different from that in the controls (p < 0.01). There was also a significant positive correlation between the scoliosis severity score and the ratio of differential growth between the anterior and posterior columns for each thoracic vertebra (p < 0.01). Compared with age-matched controls, the longitudinal growth of the vertebral bodies in patients with AIS is disproportionate and faster and mainly occurs by endochondral ossification. In contrast, the circumferential growth by membranous ossification is slower in both the vertebral bodies and pedicles.