青年特发性脊柱侧凸的基本影像判读及Lenke分型

目的探讨青年特发性脊柱侧凸的基本影像特征,并检测 Lenke 分型中脊柱侧凸类型的发病率及 Lenke 分型与手术方法的关系.资料与方法分析105例青年特发性脊柱侧凸的临床及影像学资料,按 Lenke 方法分型,统计各种侧凸类型的发病率,检测 Lenke 分型方法与手术方法的关系.结果105例脊柱侧凸均采用 Lenke 分型方法归类,其中 Lenke 1型最多,占51%;腰椎修正型:A 型45例(43%),B 型17例(16%),C 型43例(41%);胸椎矢状位修正型:“-”型18例(17%),N 型79例(75%),“+”型8例(8%).本组综合分型最常见的类型是1AN(22例,21%)、5CN(13例,12%)、2AN(10例,9.5%)及3CN(8例,7.6%).Lenke 分型定义为结构性弯曲中90%进行了固定融合.结论青年特发性脊柱侧凸的基本影像特征及 Lenke 分型对手术指征的评估、手术方法的选择有重要的指导意义,其结构性弯曲的诊断标准较为实用.     

腰椎退行性滑脱脊柱—骨盆矢状位平衡的临床研究

目的:研究退行性腰椎滑脱症患者矢状位脊柱-骨盆位影像变化.方法:回顾研究48例退行性腰椎滑脱症单节段椎间融合器融合退变性腰椎滑脱患者资料,术前及随访均拍摄站立位全脊柱正侧位片,测量手术前后胸椎后凸(TK)、腰椎前凸角(LL)、C7矢状面平衡(SVA)、腰骶角(LSA)、骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS),Pearson相关系数对影像学结果进行相关性分析.结果 从脊柱-骨盆相关参数中,除TK其他各参数手术前后比较差异均有统计学意义(P＜0.05),P＜0.01).LSA的变化与PT、PI、LL、SS及SVA的变化存在线性关系.结论:手术有效的恢复矢状位及骨盆参数,避免矢状位失衡,可改善低度退行性腰椎滑脱症患者的脊柱骨盆矢状位平衡,有利于患者临床症状的改善     

不同背包方式行走对大学生脊柱角度的影响

目的:探索不同背包方式行走对大学生脊柱角度的影响,为人们合理背包和防止背包给人体带来的损伤提供科学的参考依据。方法:选取12名苏州大学在校男性大学生为研究对象,使其负重10%BW背包以不同背包方式(后、前、右、左、后前交替、右左交替)行走10min,运用Vicon红外高速运动捕捉系统采集到脊柱各骨性标志点的空间坐标数据,然后通过Matlab数学软件计算出不同背包条件行走后各脊柱角度在矢状面和额状面的角度值,再通过SPSSl7.0统计学软件包对各角度数据进行比较分析。结果:1不同方式背包时,C7-T7-T12角度在矢状面和额状面的变化均有统计学意义。前背比后背对C7-T7-T12角度在矢状面的影响更小;后背比前背对其在额状面的影响更小;右背小于左背对C7-T7-T12角度在矢状面和额状面的影响,交替背可缓解单一背包方式对其的影响。2不同方式背包时,T7-T12-SACR角度在矢状面的变化无统计学意义,但单一方式背包对其在矢状面的影响较小,交替背对其的影响则更大;不同背包方式对这一角度在额状面变化的影响有统计学意义,前背小于后背、左背小于右背对T7-T12-SACR角度在额状面的影响,交替背可缓解单一方式背包对其的影响。结论:1不同方式背包明显影响胸椎在矢状面和额状面的弯曲角度;前后交替背和左右交替背能缓解单一背包方式对胸椎的影响。2不同背包方式对下胸椎至腰椎段在矢状面的角度变化无明显影响;不同方式背包对下胸椎至腰椎段在额状面的角度变化有明显影响,前背对下胸椎至腰椎段在额状面的角度影响最小,交替背能缓解下胸椎至腰椎段的侧弯。     

EOS~(TM)在青少年脊柱侧凸中的应用

脊柱侧凸是青少年常见的脊柱畸形。传统的X线摄影只能从二维平面评估侧凸畸形,且辐射剂量高。近年来新出现的EOS影像采集系统采用低于传统X线及CT的辐射剂量即可同步获得人体站立位正侧位全脊柱影像,并能通过三维重建获得多种测量参数,从而量化评估脊柱轴面旋转,有助于脊柱侧凸的诊断、分级、手术方案制定及术后随访,尤其适用于青少年特发性脊柱侧凸病人。就EOS的原理、优势及在青少年脊柱侧凸中的应用予以综述。     

脊柱侧弯矫形术的手术配合

青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）是指10岁以上儿童至发育成熟前的一种脊柱侧凸畸形,是小儿骨骼肌肉系统中最常见的畸形之一,约占青少年人口的2%～3%,占整个脊柱侧凸发病率的80%,严重危害着青少年的健康〔1〕。我院从2005～2010年对7例脊柱侧凸病人实施了矫形手术,均取得了满意效果,现将手术护理配合总结如下。     

中国优秀艺术体操运动员脊柱侧弯特征

目的:分析和研究中国优秀艺术体操运动员脊柱侧弯的特征。方法:使用LDR-01(Low-Dose Directly Digital Radiographic Device)低剂量数字化全脊柱摄影技术,获得26名国家队优秀艺术体操运动员自然站立姿势下的全脊柱无缝拼接影像。通过专业分析软件Img Viewer对X线片进行处理和测量,获得所有受试者在三解剖学平面上的脊柱侧弯Cobb角、顶椎位置、颈椎和腰椎曲度、椎体旋转程度等特征指标。结果:(1)冠状面脊柱侧弯发生率为53.85%;(2)矢状面脊柱侧弯发生率达100%,均出现颈椎反弓、腰椎曲度异常现象;(3)水平面脊柱侧弯发生率达88.46%,86.79%的旋转椎体位于脊柱胸段。结论:中国艺术体操国家队优秀运动员的脊柱侧弯发生率高。具有冠状面侧弯顶椎集中在下胸段并凸向右侧、矢状面脊柱曲度明显消失、水平面易发上胸段椎体右旋畸形的三维特征。     

脊椎畸形与假骨折

有脊椎畸形外伤儿童的CT影象可显出椎体假骨折征,导致不正确诊断。作者做了9例腹部钝伤儿童的CT检查,女6例,男3例,年龄9—16岁,均有胸腰椎或腰椎弯曲。3例为脊椎后凸,6例有20°或更大的侧凸。用GE9800扫描机检查,层厚10mm,间隔10mm。其中4例2个腰椎的部分容积平均提示有腰椎椎体假骨折的CT影象。2例脊椎侧凸,假骨折方向为矢面。2例后凸,假骨折方向为冠状面。假骨折不仅与CT取层有关,也与脊椎畸形程度有关,4例脊椎均弯曲在40°或更大。作者指出,脊柱侧凸或后凸的CT检查,可出现类似脊椎骨折的影象,此种非真实的假骨折,总是显     

脊柱测量尺和Spinal Mouse脊柱测量仪测量胸椎后凸角、腰椎前凸角的信度和效度

目的:探讨脊柱测量尺和Spinal Mouse脊柱测量仪在测量胸椎后凸角、腰椎前凸角两个指标中的信度和效度。方法:随机筛选29名高中生作为受试对象,其中14名男生,15名女生。使用侧位全脊柱X线片作为胸椎后凸角和腰椎前凸角测试的金标准,分别使用Spinal Mouse脊柱测量仪、脊柱测量尺(Flexible ruler)对胸椎后凸角和腰椎前凸角进行测量。检验Spinal Mouse脊柱测量仪和脊柱测量尺测量脊柱矢状面角度的效度与信度,并检验两种仪器的重测信度。结果:Spinal Mouse脊柱测量仪测量的胸椎后凸角与X线片一致性最高,ICC为0.803(0.622,0.902),脊柱测量尺测量的胸椎后凸角ICC值为0.753(0.538,0.876);脊柱测量尺和Spinal Mouse脊柱测量仪测量的腰椎前凸角与X线片的测量结果相比,ICC值均低于0.4,一致性不高。在重复测量分析方面,使用Spinal Mouse脊柱测量仪和脊柱测量尺测量胸椎后凸角的ICC均高于0.8,使用Spinal Mouse测量腰椎前凸角的ICC为0.809(0.633,0.906),而使用脊柱测量尺测量腰椎前凸角的ICC为0.704(0.459,0.849)。结论:Spinal Mouse脊柱测量仪和脊柱测量尺在测试胸椎后凸角和腰椎前凸角中均具备良好的重测信度。与X线片对比,Spinal Mouse脊柱测量仪和脊柱测量尺测量胸椎后凸角具备一定的效度,可以在一定程度上替代X线片作为测量方法,且Spinal Mouse脊柱测量仪优于脊柱测量尺。但两种测试方法测量腰椎前凸角效度不佳。     

MSCT多平面重组技术对诊断特发性脊柱侧凸畸形的应用价值

目的探讨MSCT多平面重建技术对诊断特发型脊柱侧凸畸形的应用价值。方法回顾性分析我院48例特发型脊柱侧凸畸形的病例,利用螺旋CT采集各向同性的数据,采用不同角度的多平面重建技术进行图像后处理并对照分析。应用MPR技术模拟手术做出3种不同的位置和层面:1)侧凸畸形椎体与棘突同一层面的横轴位图像;2)显示双侧椎弓根较好的长轴位;3)能显示和适合测量Cobb角最理想的冠状位。分析以上3种方法对特发型脊柱侧凸畸形的诊断作用及有无统计学意义。结果第一种方法检出47例,检出率为97.91%;第二种方法检出47例,检出率为97.91%;第三种方法检出48例,检出率为100%。3种方法之间比较P0.05,差异无统计学意义;组间两两对比P0.05,差异无统计学意义。结论 MSCT的MPR技术可以从任意不同角度不同层面对脊柱侧凸畸形进行测量,大大提高了对本病诊断的准确程度。其中测量的双侧椎弓根的深度和宽度又能为临床手术提供有力的技术支持和保障。     

退行性腰椎侧凸：冠状面影像对常规腰椎MRI神经根受压的补充价值

正摘要目的退行性脊柱侧凸的放射痛是手术的主要指征,但MR横断面和矢状面影像对于神经根受压的识别能力有限,因此旨在评估冠状面影像对退行性脊柱侧凸神经根受     

脊柱病变多层螺旋CT的应用价值

目的：探讨多层螺旋CT对于脊柱病变的诊断价值。方法：搜集脊柱病变患者18例，其中脊柱骨折7例，颈椎后纵韧带骨化2例，腰椎结核2例，特发性脊柱侧弯7例。所有患者经多层螺旋CT扫描，MIP、MPR／CPR、3D-SSD与4D-Angio重建，分析不同处理后图像的应用价值。结果：MRP／CPR应用简捷，可矢状、冠状观察骨性病变的部位与程度，但对于胸椎骨折或侧弯，由于受到肋骨重叠的显示而不适用于评价胸椎骨折；3D-SSD可观察骨性结构的破坏，但缺乏对椎管形态的显示，4维重建可清晰评价脊柱骨折与脊柱侧弯的所有相关表现，通过调节不同密度阈值可显示出椎管内形态，尤其适用观察骨折、侧弯的分类与椎管的状况。结论：多层螺旋CT可全脊柱扫描，其多种后处理技术的应用可全面评价脊柱病变，4维重建可清晰评价脊柱病变的所有相关表现，而MIP不适用于对脊柱的评价。     

X线平片与螺旋CT对先天性脊柱侧弯的应用价值

目的探讨多层螺旋CT(MSCT)和X线平片对于先天性脊柱侧弯的诊断价值。方法对临床诊断为先天性脊柱侧弯的40例患者行脊柱CT扫描,经最大密度投影(MIP)、多平面图像重组(MPR)、表面容积遮盖(SVR)及表现遮盖图像(SSD)后处理,并对照X线平片分析不同的处理后图像的应用价值。结果术前X线平片诊断脊椎形成障碍18例,脊椎分节障碍15例,混合型7例。MSCT诊断脊椎形成障碍13例,脊椎分节障碍12例,混合型15例,伴有脊柱纵裂6例,肋骨畸形8例,椎管内纵行骨嵴4例。SVR图像可较全面地评价先天性脊柱侧弯的所有相关表现。结论MSCT的多种后处理图像较X线平片更具优势,能准确和全面判断脊柱畸形的类型和范围。     

Influence of the structural deformity of the spine on the gait pathology in scoliotic patients

Scoliosis is not only a spinal deformity, but also leads to the development of a pathological gait pattern. Nearly all studies examining walking in scoliotic patients report some degree of gait abnormality, however the results are somewhat contradictory. Therefore the aim of this study is to explore the relationship between gait pathology and degree of scoliotic deformity in a group of patients with idiopathic scoliosis. Sixty three females with idiopathic scoliosis, aged between 12 and 17 participated in the study. They were not treated previously, neither surgically, nor conservatively. They underwent objective gait analysis with a VICON 460 system. Data for the following parameters were analysed: gait velocity, cadence, step length, pelvic tilt, pelvic retraction, pelvic range of motion in the transverse plane, pelvic obliquity, hip and knee range of motion in the sagittal plane, knee flexion at initial contact, ankle dorsiflexion in swing, foot progression angle. Additionally a Gillette Gait Index (GGI) was calculated. Prior to the gait analysis all patients underwent a clinical examination, an X-ray, clinical tests and anthropometric measurements. In conclusion our results indicate that the gait pathology of the patients with idiopathic thoraco-lumbar (i.e. double curve) scoliosis depends on the severity of the spinal deformity and the type of pelvic deformity.     

Treatment planning in severe scoliosis: the role of MRI

The use of magnetic resonance imaging (MRI) in the preoperative investigation of children with idiopathic scoliosis is controversial. Syringomyelia and other intraspinal lesions may be risk factors for neurological injury during surgical correction. Our purpose was to investigate whether pathology of the neuraxis is associated with scoliosis and to detect lesions which may threaten neurological sequelae during distraction and instrumented correction. We obtained T1- and T2-weighted images of 40 children (28 girls, 12 boys), mean age 12.7 years with severe idiopathic scoliosis (Cobb angle 50–70 °) obtained in coronal, sagittal and axial planes from the posterior cranial fossa to the sacrum, and these were assessed by two neuroradiologists and an orthopaedic surgeon prior to further treatment planning. Abnormalities of the neuraxis were found in 24 patients (60 %); five (12 %) had two or more lesions. No abnormalities of the neuraxis were found in 16 patients (40 %). There were 15 patients (38 %) with intraspinal abnormalities who deteriorated clinically and nine (22 %) who showed no clinical changes. We transferred 16 patients (40 %) from the orthopaedic to the neurosurgical department for further assessment. Our results suggest that one should investigate the neuraxis with MRI before contemplating orthopaedic surgical correction of severe idiopathic scoliosis, because the findings may lead to a change of procedure. Received: 14 July 2000 Accepted: 5 September 2000     

特发性脊柱侧弯胸主动脉与相邻椎体空间关系的CT测量

目的: 利用螺旋CT测量特发性脊柱侧弯胸主动脉与相邻椎体的空间关系.材料和方法: 32例特发性胸椎侧弯者,在T4～12椎体平面的CT图像上作双侧肋骨小头前缘连线l,l与椎体右缘交点至主动脉后壁的切线m,测量l与m的夹角A;当A<0时,即l穿过主动脉,沿l 测量椎体与主动脉的距离d,将A和d作为主动脉和椎体空间关系的参数,评价脊柱侧弯前路矫形术的安全性.结果: 当A>0时,椎体与主动脉空间关系被定义为"安全"(211,74.6%);当A<0,d>2mm时, 被定义为"可疑"(45,15.9%);当A<0,d<2mm时,被定义为"危险"(27,9.5%).结论: CT测量可以准确描述脊柱侧弯者胸主动脉与相邻椎体的空间关系,为前路矫形术椎体螺钉的安全置入提供参考.     

多层螺旋CT后处理技术在脊柱侧弯中的应用

目的探讨16排多层螺旋CT后处理技术在脊柱侧弯诊疗中的应用价值。资料与方法搜集脊柱侧弯患者23例,在16排多层螺旋CT机上扫描后,均行多平面重建(MPR)、表面遮盖重建(SSD)与容积再现(VRT)重建。评价不同的图像后处理技术的作用和优势。结果MPR因脊柱侧弯的改变而显示不连续,矢状位可观察椎管内情况;SSD可观察全脊柱影及侧弯的曲度,但缺乏对椎管内形态的显示;VRT通过调节不同密度的阈值并辅以不同的伪彩依次可显示骨质及椎管的形态,也可清晰显示全脊柱侧弯所有相关表现,尤其适用于观察侧弯的分类与椎管的状况。结论多层螺旋CT可一次性完成全脊柱扫描。横轴位结合其丰富的后处理图像能提供脊柱侧弯非常有价值的空间结构信息,其表现接近靶组织的解剖,有利于临床医师选择治疗方案和制定手术路径。     

The prevalence of disc aging and back pain after fusion extending into the lower lumbar spine. A matched MR study twenty-five years after surgery for adolescent idiopathic scoliosis

PURPOSE: To determine the long-term outcome after fusion for adolescent idiopathic scoliosis in terms of degenerative disc findings diagnosed using MR imaging and to elucidate the clinical consequences. MATERIAL AND METHODS: Thirty-two patients with adolescent idiopathic scoliosis, who had undergone spinal fusion using Harrington rods to the lower lumbar spine with one or two unfused discs below the fusion, were re-examined 25 years after the fusion. The re-examinations included validated questionnaires, clinical examination, full standing frontal and lateral radiographs and MR examination of the lower lumbar region. Curve size and degenerative findings on MR images were evaluated by two unbiased radiologists, blinded to the clinical findings. A matched control group of 32 persons without scoliosis was subjected to the same examinations. RESULTS AND CONCLUSION: There were significantly more degenerative disc changes (p<0.0001), disc height reduction (p=0.0010) and end-plate changes (p<0.0001 for both upper and lower end-plates) in the lowest unfused disc in the patient group compared with the control group. The MR findings in the lowest unfused disc, but not the one above, in the patient group correlated to lumbar pain intensity as well as to the diminished lumbar lordosis.     

特发性脊柱侧凸不同固定术式疗效分析

目的 分析治疗特发性脊柱侧凸的不同手术方法和效果.方法 对1989年～2005年收治的34例特发性脊柱侧凸术前、术后临床资料进行分析,总结所采用不同术式的治疗效果.结果 34例分别采用了Harrington术式、联合Harrington-Luque(H-L)术式、Cotrel-Dubousset(C-D)双棍法及Texas Scottish-Rite Hospital(TSRH)三维矫正,平均矫正率分别为36.42%、45.18%、55.68%、63.28%,采用H-L、C-D和TSRH手术方法的矫正度均高于Harrington方法,其中以TSRH、C-D三维矫正系统效果最好.结论 手术矫正特发性脊柱侧凸效果是明显的,尤以近年运用的三维矫正系统效果更为优良.     

A procedure to detect abnormal sensorimotor control in adolescents with idiopathic scoliosis

This work identifies, among adolescents with idiopathic scoliosis, those demonstrating impaired sensorimotor control through a classification procedure comparing the amplitude of their vestibular-evoked postural responses. The sensorimotor control of healthy adolescents (n = 17) and adolescents with idiopathic scoliosis (n = 52) with either mild (Cobb angle ≥ 15° and ≤30°) or severe (Cobb angle >30°) spine deformation was assessed through galvanic vestibular stimulation. A classification procedure sorted out adolescents with idiopathic scoliosis whether the amplitude of their vestibular-evoked postural response was dissimilar or similar to controls. Compared to controls, galvanic vestibular stimulation evoked larger postural response in adolescents with idiopathic scoliosis. Nonetheless, the classification procedure revealed that only 42.5% of all patients showed impaired sensorimotor control. Consequently, identifying patients with sensorimotor control impairment would allow to apply personalized treatments, help clinicians to establish prognosis and hopefully improve the condition of patients with adolescent idiopathic scoliosis.