青少年脊柱侧弯症椎旁肌神经终末支配的观察

特发性脊柱侧弯症（简称ＩＳ）患者凸侧椎旁肌Ｉ型（慢肌）纤维占优势，肌横断面积较大的改变已被许多作者证实．为探索这种肌性改变与脊柱侧向弯曲的关系，本组研究从肌肉的神经支配角度入手，对２３例ＩＳ病人双侧椎旁肌标本做了神经镀银染色，观察了神经终末支配率（ＴＩＲ值）及终板内分枝的情况，进行了自身凸凹侧比较，并将上述指标与１１例先天性脊柱侧弯症（简称ＣＳ）进行了比较．结果显示ＩＳ和ＣＳ凸侧椎旁肌ＴＩＲ值较大，运动终板以Ｔ１型为主，提示该侧肌肉的神经支配率较高，结合其中新生终板较多等现象，认为凸侧肌处于一种长期力量负荷较大的改建过程中．这种力量负荷是凸侧椎旁肌在脊柱侧方弯曲后该侧力距较大，肌肉需不断做功代偿的结果．ＣＳ组病人病程长，Ｃｏｂｂ角大，因此凸侧肌肉改建的表现更明显．本组观察认为ＩＳ椎旁肌肌力不均是一种继发改变．早期对ＩＳ患儿行器械矫正，有利于终止这种改建，从而提高儿童脊柱侧弯的治疗效果．

TheStudyoftheNeverBranchinParaverterbralMusclesofIdiopathicandCongenitalScoliosis

Thechangesofmuscletypeinparaverterbralmusclesofidiopathicandcongenitalscolio-sishavebeenconfirmedbymanyinvestigators,however,therelationshipbetweenthemusclechangesandspinelateralcurveisnotclear.Baseduponthefactsthatmuscletypesaremainlydeterminedbytheirneverinnervations,theterminalinnervationratio(TIR)andaxonalterminalbranchofmotorend-platesinparaverterbralmusclebiopsysamplesof23idiopathicscoliosis(IS)patientsand11congenitalscoliosis(CS)patientswerecomparedinordertoofersomeinsightstotheabovequestion.TheresultsshowedthevaluesofTIRintheconvexsidearesignificantlyhigherthanthoseofconcaveinbothISandCSgroups.Themotorend-platesinconcexismanlyconsistofT1type,whereastheconcavesideareofT0type.Mostofthepathologicmotorend-platesinconvexarenew-born,withthecharactorsofsproutandcolateralreinnervationwhicharediferentfromtheretrogressivcchangesintheconcave,whicharecharacterizedbyswolen,tiny,andirregularshapeandpoorlyramified.Ourfindingsindicat-edthatthemusclesinconvexaremoreactiveinnervecontrol.Theauthorsbelievethatmusclechangesinconvexsidearecausedbylongtermover-load,whichistheconseqenceofspinaldeformation.InCSpatienttheseneuromusclechangesappeartobesignificantbecauseoftheirlongercourseofilnessandilnenlargerCobbangles.Inordertostopthesechangesandavoidthetrunkimbalance,wesuggesttoinstalthemetalinstrumentationinearlyageinISpatient.