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年一2005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例分另U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。     

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.     

Postural adjustments in adolescent idiopathic thoracic scoliosis during walking

IntroductionAdolescent idiopathic scoliosis (AIS) is the most common type of three-dimensional spinal deformity. Identifying the postural adjustments or changes for different phases and events is needed for developing programs to improve the AIS gait, but such information has been limited. The current study aimed to fill the gap via three-dimensional motion analysis of quiet standing and level walking in patients with severe thoracic AIS.Materials and MethodsSixteen female adolescents with AIS (Lenke 1 or 2, age: 14.9 ± 1.7 years, height: 154.7 ± 5.0 cm, mass: 41.7 ± 7.2 kg) and sixteen sex-, age- and BMI-matched healthy controls (age: 14.8 ± 2.7 years, height: 154.9 ± 5.6 cm, mass: 44.7 ± 6.3 kg) participated in the current study with informed written consent. The kinematic and kinetic changes between the trunk, pelvis, and lower limb segments, and at the lumbosacral level at different gait events were measured during quiet standing and level walking.ResultsThe homogeneity of the current patient group helped reduce the effects of the level and severity of spinal deformity on inter-subject variability that has been associated with controversies over reported gait variables in AIS. The current results support the hypothesis that postural adjustments involving the trunk, pelvis and lower limb segments were needed in severe thoracic AIS during both quiet standing and level walking, and differed between concave and convex sides at different key gait events during level walking.ConclusionsAlthough scoliotic spinal deformity occurred mainly in the frontal plane, postural adjustments in all three planes were present at key events during level walking with associated joint loading changes in patients with severe thoracic AIS. Monitoring of such adjustments and the associated joint kinetic changes will be helpful for assessing the disease and treatment outcomes.     

The effect of aerobic training in girls with idiopathic scoliosis

The purpose of the present study was to investigate the effect of aerobic training in girls with idiopathic scoliosis, in selective respiratory parameters (VC, FVC, FEV₁, FEV₁/VC% FEV₁/FVC) as well as the ability to perform aerobic work (PWC₁₇₀). The training group consisted of 20 young girls with a mean age of 13.51±0.16 years. They wore a Boston-type brace for a mean period of 0.30±0.04 years and suffered from a scoliotic curve (27.4±1.9°). They followed a two-month training program on the cycloergometer. Each training session lasted 30 min and was performed four times a week. The control group consisted of 20 girls with a mean age of 13.61±0.18 years and they wore the same type of brace for a mean period of 0.24±0.04 years. They also suffered from a scoliosis (29.5±1.8°). The results of the study revealed that aerobic training sustained (VC, FEV₁, FEV₁/VC) or improved significantly (FVC, FEV₁/FVC) the parameters of pulmonary function, while the respective parameters (VC, FVC) for the control group were reduced during the two-month period. The ability to perform aerobic work increased 48.1% ( P <0.01) in the training group, while it decreased 9.2% ( P <0.01) in the control group.     

Lumbopelvic postural differences in adolescent idiopathic scoliosis: A pilot study

BackgroundA primary etiology of adolescent idiopathic scoliosis (AIS) is currently unknown, but poor postural control of the spinal extensor musculature has been identified as an AIS risk factor. Identifiable postural differences would aid in advancing the precise postural behaviors that should be modified during Physiotherapy Scoliosis Specific Exercise (PSSE) to help limit the progression of AIS.Research questionAre there any determinable differences in lumbopelvic posture or range of motion between subjects with AIS and controls?MethodsThis prospective cohort pilot study consisted of 53 subjects (27 AIS and 26 control) aged 11–17 years. Subjects had their lumbopelvic posture assessed and monitored using the ViMove DorsaVi sensor package. All subjects underwent a live assessment to obtain initial lumbopelvic (LP) range of motion (ROM) measurements. Subjects were then monitored while continuing with normal activities of daily living (ADLs) for 12 h. With an alpha level of 0.05, nonparametric analyses were performed for each variable via a Mann-Whitney U-test.ResultsDuring the live assessment, controls exhibited a significantly greater anterior pelvic tilt ROM in the sitting position than the AIS group (p = 0.0433). When compared to female controls, females with AIS had a sitting pelvic tilt ROM that was significantly more retroverted (p = 0.0232) and less anteverted (p = 0.0010). During ADLs, female controls exhibited a higher total number of extension events than their female with AIS (p = 0.0263). These associations did not strengthen with greater spinal deformity.SignificanceThis work demonstrates postural differences between patients with AIS and controls. Further study is necessary to determine why patients with AIS adopt these postures, and if PSSEs can be utilized to limit the progression of AIS.     

中医综合疗法对青少年特发性脊柱侧凸患者肺功能及表面平均肌电比值的影响

目的 评价中医综合疗法(导引、推拿、小针刀)对青少年特发性脊柱侧凸(AIS)患者肺功能和表面平均肌电(AEMG)比值的影响.方法 120例AIS门诊患者随机分为中医治疗组(治疗组)和支具对照组(对照组).治疗组采用脊柱平衡导引(2次/d,40min/次,每天坚持直至骨骼发育成熟)、脊柱平衡推拿(3次/周,25min/次,12个月)及小针刀整体松解(1次/周,共10次)治疗.对照组采用Milwaukee支具治疗(22h/d,12个月).观察治疗前及治疗后12个月时的肺功能指标[肺活量(VC)、第1秒用力呼气容积占用力肺活量的百分比(FEV1/FVC)、每分钟最大通气量(Mw)]改变,治疗前及治疗后12、24个月时的Cobb角改变,治疗前及治疗后6、12、18、24个月时AEMG比值变化,并对各指标进行组间比较.结果 治疗后12个月治疗组和对照组Cobb角矫正率(分别为51.4％、47.8％)差异无统计学意义(p＞o.05),而治疗后24个月治疗组Cobb角矫正率(62.5％)明显高于对照组(34.7％,P＜0.05).与治疗前比较,治疗组治疗后12个月VC、FEV1/FVC、MVV明显升高(P＜0.05),而对照组治疗后12个月各指标均有不同程度下降(p＜0.05).治疗组治疗后6、12、18、24个月时AEMG比值持续降低并趋向于1,表明侧凸两侧的肌张力趋于平衡,而对照组比值AEMG比值逐渐增加,表明侧凸两侧的肌张力不平衡加剧.两组治疗中均未发生明显的不良反应.结论 基于改善AIS脊柱内外平衡失调的中医脊柱平衡法能显著改善肌力的不平衡,减轻侧凸,提高肺功能,值得推广应用.AEMG比值可用于评价AIS的治疗效果及评估侧凸的进展.     

Imaging of painful scoliosis

Scoliosis is defined as a lateral deviation of the spine from the normal plumb line. Commonly, there is a rotational component and deviation also in the sagittal plane (kyphosis or hyperlordosis). When scoliosis presents in adults, it is often painful. In contrast, back pain in a child is considered rare, and serious underlying pathology should be excluded, particularly since idiopathic scoliosis is typically painless. A painful scoliosis in a child or adolescent, especially if the patient has a left-sided curve, should be examined thoroughly. The aim of this review is to illustrate the causes of a painful scoliosis in children, adolescents and adults.     

MR analysis of regional brain volume in adolescent idiopathic scoliosis: neurological manifestation of a systemic disease

Purpose

To investigate whether regional brain volumes in adolescent idiopathic scoliosis (AIS) patients differ from matched control subjects as AIS subjects are reported to have poor performance on combined visual and proprioceptive testing and impaired postural balance in previous studies.

Materials and Methods

Twenty AIS female patients with typical right‐convex thoracic curve (age range,11–18 years; mean, 14.1 years) and 26 female controls (mean age, 14.8 years) underwent three‐dimensional magnetization prepared rapid acquisition gradient echo (3D‐MPRAGE) MR imaging. Volumes of 99 preselected neuroanatomical regions were compared by statistical parametric mapping and atlas‐based hybrid warping.

Results

Analysis of variance statistics revealed significant mean volumetric differences in 22 brain regions between AIS and controls. Ten regions were larger in AIS including the left frontal gyri and white matter in left frontal, parietal, and temporal regions, corpus callosum and brainstem. Twelve regions were smaller in AIS, including right‐sided descending white matter tracts (anterior and posterior limbs of the right internal capsule and the cerebral peduncle) and deep nucleus (caudate), bilateral perirhinal cortices, left hippocampus and amygdala, bilateral precuneus gyri, and left middle and inferior occipital gyri.

Conclusion

Regional brain volume difference in AIS subjects may help to explain neurological abnormalities in this group. J. Magn. Reson. Imaging 2008. © 2008 Wiley‐Liss, Inc.     

Time-to-contact and multiscale entropy identify differences in postural control in adolescent idiopathic scoliosis

Previous reports on changes in postural control in adolescent idiopathic scoliosis (AIS) compared to healthy controls have been inconsistent. This may suggest center of pressure (COP) sway parameters are not sufficient for determining the ability to maintain quiet upright stance indicating more complex measures may be needed to examine postural control in AIS. The purpose of this investigation was to compare postural control between AIS of different severity levels and healthy controls using time-to-contact (TtC), the complexity index of multiscale entropy (C_r), and COP sway parameters. Thirty-six AIS patients were classified as pre-bracing or pre-operative and compared to 10 healthy control subjects. Overall, the AIS patients showed significantly greater COP sway in mediolateral direction, but deficits with respect to the anteroposterior direction were only systematically identified with the time-to-contact and entropy measures. The multiscale entropy (C_r) results indicate that those with AIS utilize a different control strategy from healthy controls in the mediolateral direction that is more constrained, less complex and less adaptable. AIS severity further reduced this adaptability in the anteroposterior direction. These results indicate it is necessary to examine both planes of motion when investigating postural control in AIS. Additionally, the application of the measures used to assess the nature of the postural control changes in AIS should also be considered.     

后路减压联合不同融合节段固定治疗退变性脊柱侧凸的临床研究

目的比较后路减压联合短节段融合与长节段融合治疗退变性脊柱侧凸的临床疗效。方法回顾性分析50例采用后路减压联合椎弓根钉固定融合治疗的退变性脊柱侧凸患者,按融合范围分为短节段组（28例）和长节段组（22例）。收集患者术前、术后1周影像学指标（侧凸Cobb角、Cobb角矫正率）、ODI评分以及并发症发生率。结果短节段组融合节段2．4个（1～3个）,长节段组5．7个（4～7个）,两组之间差异有统计学意义（P〈0．05）。术前短节段组侧凸Cobb角为（21．4±3．7）°,术后（13．6±214）。,矫正率36．4％;长节段组术前（32．9＋6．2）。,术后（11．3＋3．5）。,矫正率65．7％,两组手术前后差异均有统计学意义,且两组侧凸Cobb角纠正率之间差异有统计学意义。短节段组6例发生并发症,长节段组10例发生并发症,长节段组术后并发症发生率较短节段组高。两组患者ODI评分差异无统计学意义。结论后路加压联合椎弓根螺钉固定融合治疗退变性脊柱侧凸疗效肯定;侧凸Cobb角较小、脊柱平衡保持较好者可以选择短节段融合,侧凸严重甚至侧方严重滑脱者宜选用长节段融合。