先天性无痛无汗症（congenital insensitivitv to pain with anhidmsis，CIPA）又称遗传性感觉和自主神经障碍（HSAN）Ⅳ型，为常染色体隐性遗传病，是一种罕见病，首先由Dcarbom于1932年报道，目前国内外文献报道仅数十例。其主要表现...先天性无痛无汗症（congenital insensitivitv to pain with anhidmsis，CIPA）又称遗传性感觉和自主神经障碍（HSAN）Ⅳ型，为常染色体隐性遗传病，是一种罕见病，首先由Dcarbom于1932年报道，目前国内外文献报道仅数十例。其主要表现为先天性全身性痛觉缺失，常合并无汗、智力发育迟缓等，全身关节囊松弛，各关节活动度超过正常范围，常发生关节脱位，浅表关节囊肿胀等，并可引发骨关节的破坏性改变即神经性关节病（Charcot关节病）。既往文献对CIPA伴神经性关节病的报道较少。展开更多
Objective: Severe scoliosis refers to scoliosis with serious and stiff curve. It always combins with trunk imbalance in coronal and sagittal contour. Besides complex pathological changes, cardiopulmonary deficits and ...Objective: Severe scoliosis refers to scoliosis with serious and stiff curve. It always combins with trunk imbalance in coronal and sagittal contour. Besides complex pathological changes, cardiopulmonary deficits and other concomitant diseases increase treatmental difficulties. So the treatment of severe scoliosis is always a great challenge to spine surgeon.Methods:Thirty-six patients with severe scoliosis received one stage posterior correction followed by anterior release during July 1997 to January 2003, including 9 males and 27 females. Mean age was 17.2 years. Of them, 33 was idiopathic scoliosis and 3 was neurofibromatosis scoliosis( Cobb angle: 85-116 degree); 20 cases were abnormal in sagital plane. Three-dimensional devised instrumentation were applied such as CD, CD-Horizon, TSRH or Isola in posterior procedure followed by anterior release during the same anesthesia. 31 cases of this group received thoracic plasty.Results: The correction in the frontal plane achieved an average of 48.5%. In the sagittal plane, the pathological shape of the spine was reduced and distinctly ameliorated. 80.6% of the patients maintained or achieved balance of sagittal plane. There were no complications of severe neurological deficit, hook displacement, rod broken, and deep infection at follow-up. One case occurred traumatic pleurisy after operation and another appeared pseudarthrosis 2 years later. One case demonstrated imbalance 11 months after operation. One patient was presented loss of correction more than 10 degree at one year follow-up and 5.2 degree in average.Conclusion:The study indicates that the one stage posterior correction combined with anterior release in treatment of severe scoliosis can achieve satisfactory correction. Appropriate choice of cases, preoperational detailed assessment and application of SEP and wake-up test during operation can possibly reduce severe complication. The long-term outcomes still need further observation.展开更多
Objective To retrospectively analyze the relationship between curve types and clinical results in surgical treatment of scoliosis in patients with neurofibromatosis type 1 (NF-1). Methods Forty-five patients with scol...Objective To retrospectively analyze the relationship between curve types and clinical results in surgical treatment of scoliosis in patients with neurofibromatosis type 1 (NF-1). Methods Forty-five patients with scoliosis resulting from NF-1 were treated surgically from 1984 to 2002. Mean age at operation was 14.2 years. There were 6 nondystrophic curves and 39 dystrophic curves depended on their radiographic featu- res. According to their apical vertebrae location, the dystrophic curves were divided into three subgroups: thoracic curve (apical vertebra at T8 or above), thoracolumbar curve (apical vertebra below T8 and above L1), and lumber curve (apical vertebra at L1 and below). Posterior spine fusion, combined anterior and posterior spine fusion were administrated based on the type and location of the curves. Mean follow-up was 6.8 years. Clinical and radiological manifestations were investigated and results were assessed. Results Three patients with muscle weakness of low extremities recovered entirely. Two patients with dystrophic lum- bar curve maintained their low back pain the same as preoperatively. The mean coronal and sagittal Cobb’s angle in nondy- strophic curves was 80.3o and 61.7o before operation, 30.7o and 36.9o after operation, and 32.9o and 42.1o at follow-up, respectively. In dystrophic thoracic curves, preoperative Cobb’s angle in coronal and sagittal plane was 96.5o and 79.8o, postoperative 49.3o and 41.7o, follow-up 54.1o and 45.3o, respectively. In thoracolumbar curves, preoperative Cobb’s angle in coronal and sagittal plane was 75.0o and 47.5o, postoperative 31.2o and 22.8o, follow-up 37.5o and 27.8o, respectively. In lumbar curves preoperative Cobb’s angle in coronal plane was 55.3o, postoperative 19.3o, and follow-up 32.1o. Six patients with dystrophic curves had his or her curve deteriorated more than 10 degrees at follow-up. Three of them were in the thoracic subgroup and their kyphosis was larger than 95 degrees, and three in lumbar subgroup. Hardware failure occurred in 3 cases. Six patients had 7 revision procedures totally. Conclusions Posterior spinal fusion is effective for most dystrophic thoracic curves in patients whose kyphosis is less than 95 degrees. Combined anterior and posterior spinal fusion is stronger recommended for patients whose kyphosis is larger than 95 degrees and those whose apical vertebra is located below T8. Patients should be informed that repeated spine fusion might be necessary even after combined anterior and posterior spine fusion.展开更多
Complications occur frequently after surgical treatment of scoliosis.In order to prevent from them effectively,101 cases with failure and postoperative complications were analysed.They included ...Complications occur frequently after surgical treatment of scoliosis.In order to prevent from them effectively,101 cases with failure and postoperative complications were analysed.They included rod fracture in 22 cases(15 Harrington rods,4 Zielke rods,and 3 Luque rods);recurrence of curve severity in 12 cases;broken or loossened luque wires in 15 cases;loss of thoracic kyphosis(flat back) in 6 cases;progressive kyphosis with or without paraplegia following incorrect posterior decompression in 5 cases;and increased unbalance of shoulders after instrumentation in 2 cases due to neglect of the tilting of the first thoracic vertebra.Infection occurred in 8 cases(incision infection 7 cases,deep wound infection in 1 case);and pneumothorax in 1 case.They were induced by biomechanical factors in 23 cases(22 8%),incorrect selections of indications in 29 cases(28 7%),operational mistakes in 37 cases(36 6%),internal fixation factors in 15 cases(14 9%).The authors hold that there are quite a lot of factors leading to occurrence of complications and the effective way for prevention from them is to understand the factors and main technical points related to internal fixation.展开更多
Objective:To introduce a key-vertebral-screws technique(KVST) in the surgical treatment of scoliosis extending to main thoracic levels, and to find the role of fulcrum bending in predicting the result of surgical trea...Objective:To introduce a key-vertebral-screws technique(KVST) in the surgical treatment of scoliosis extending to main thoracic levels, and to find the role of fulcrum bending in predicting the result of surgical treatment for scoliosis by this technique. Methods: Seventeen consecutive patients with scoliosis extending to main thoracic spine,who underwent pure posterior fusion without anterior or posterior release by KVST between January 2004 and July 2005 were evaluated for fulcrum bending flexibility, surgical correction rate, fulcrum bending correction index (FBCI) in main thoracic curves. Universal Spine System (USS) instrumentation was used in 15 cases,Monarch in another 2 cases. The severity of the curves was measured by Cobb's method using Rad Work 6. 0 software. Preoperative standing AP radiographs, preoperative fulcrum bending anterioposterior (AP) radiographs, postoperative standing AP radiographs, and most recent follow-up standing AP radiographs for spine were measured and recorded. All the data were analyzed with two-sample paired t-test by Origin 7. 0 software. Results: Infection and neurological complications were not noted. No major complications were found. Just one case had some axial back pain, which got a full recovery from physiotherapy for 2 weeks. In the X-ray, there was an average correction of 71. 5% of the fused main thoracic curves, which had no significant lose of correction in final follow-up. For the whole fused main thoracic curves, the fulcrum bending flexibility were lower to operation correction rate (P = 0. 013). The average FBCI was 123%. From the data, the more rigid curves (especially fulcrum bending flexibility <50%), the more correction rate operation could get, compared with fulcrum bending flexibility. Conclusion: (1) KVST is a good method in the surgical treatment of thoracic scoliosis, which can get satisfying result with lower medical cost. (2) Fulcrum bending flexibility is lower than operative correction rate by KVST in main thoracic curves (P<0. 05). In the more rigid curves assessed by fulcrum-bending radiograph, the operative corrective could be gained, especially in the curves which FBCI is lower than 50%.展开更多
OBJECTIVE: To discuss the causes and treatments of wound infections after scoliosis surgery. METHODS: Nine hundred and twenty-four caes of scoliosis were reviewed, and the clinical data of 15 cases of postoperative in...OBJECTIVE: To discuss the causes and treatments of wound infections after scoliosis surgery. METHODS: Nine hundred and twenty-four caes of scoliosis were reviewed, and the clinical data of 15 cases of postoperative infection were analysed retrospectively. RESULTS: All 15 cases underwent spinal posterior fusion with autologous bone graft using instrumentations. Seven were diagnosed as early infection, and 8 were delayed infection. Radical debridement was performed in all 15 cases. The duration of antibiotics administration was 10 to 34 days with continuous closed irrigation for 2 to approximately 4 weeks and primary closure for the wounds. All patients were followed up for an average of 3.5 years (2 to 7.5 years) with good outcomes and no recurrence. CONCLUSION: Wound infection following surgical correction of scoliosis primarily results from intraoperative seeding, although host-related and operation-related factors may contribute to its development. Once the infections are diagnosed, good results can be achieved by prompt surgical debridement, irrigation and reasonably administered antibiotics. Removal of hardware may be necessary in deep infections.展开更多
文摘先天性无痛无汗症（congenital insensitivitv to pain with anhidmsis，CIPA）又称遗传性感觉和自主神经障碍（HSAN）Ⅳ型，为常染色体隐性遗传病，是一种罕见病，首先由Dcarbom于1932年报道，目前国内外文献报道仅数十例。其主要表现为先天性全身性痛觉缺失，常合并无汗、智力发育迟缓等，全身关节囊松弛，各关节活动度超过正常范围，常发生关节脱位，浅表关节囊肿胀等，并可引发骨关节的破坏性改变即神经性关节病（Charcot关节病）。既往文献对CIPA伴神经性关节病的报道较少。
基金Supported by the National Natural Science Foundationof China(No.0 2 4 1190 2 7)
文摘Objective: Severe scoliosis refers to scoliosis with serious and stiff curve. It always combins with trunk imbalance in coronal and sagittal contour. Besides complex pathological changes, cardiopulmonary deficits and other concomitant diseases increase treatmental difficulties. So the treatment of severe scoliosis is always a great challenge to spine surgeon.Methods:Thirty-six patients with severe scoliosis received one stage posterior correction followed by anterior release during July 1997 to January 2003, including 9 males and 27 females. Mean age was 17.2 years. Of them, 33 was idiopathic scoliosis and 3 was neurofibromatosis scoliosis( Cobb angle: 85-116 degree); 20 cases were abnormal in sagital plane. Three-dimensional devised instrumentation were applied such as CD, CD-Horizon, TSRH or Isola in posterior procedure followed by anterior release during the same anesthesia. 31 cases of this group received thoracic plasty.Results: The correction in the frontal plane achieved an average of 48.5%. In the sagittal plane, the pathological shape of the spine was reduced and distinctly ameliorated. 80.6% of the patients maintained or achieved balance of sagittal plane. There were no complications of severe neurological deficit, hook displacement, rod broken, and deep infection at follow-up. One case occurred traumatic pleurisy after operation and another appeared pseudarthrosis 2 years later. One case demonstrated imbalance 11 months after operation. One patient was presented loss of correction more than 10 degree at one year follow-up and 5.2 degree in average.Conclusion:The study indicates that the one stage posterior correction combined with anterior release in treatment of severe scoliosis can achieve satisfactory correction. Appropriate choice of cases, preoperational detailed assessment and application of SEP and wake-up test during operation can possibly reduce severe complication. The long-term outcomes still need further observation.
文摘Objective To retrospectively analyze the relationship between curve types and clinical results in surgical treatment of scoliosis in patients with neurofibromatosis type 1 (NF-1). Methods Forty-five patients with scoliosis resulting from NF-1 were treated surgically from 1984 to 2002. Mean age at operation was 14.2 years. There were 6 nondystrophic curves and 39 dystrophic curves depended on their radiographic featu- res. According to their apical vertebrae location, the dystrophic curves were divided into three subgroups: thoracic curve (apical vertebra at T8 or above), thoracolumbar curve (apical vertebra below T8 and above L1), and lumber curve (apical vertebra at L1 and below). Posterior spine fusion, combined anterior and posterior spine fusion were administrated based on the type and location of the curves. Mean follow-up was 6.8 years. Clinical and radiological manifestations were investigated and results were assessed. Results Three patients with muscle weakness of low extremities recovered entirely. Two patients with dystrophic lum- bar curve maintained their low back pain the same as preoperatively. The mean coronal and sagittal Cobb’s angle in nondy- strophic curves was 80.3o and 61.7o before operation, 30.7o and 36.9o after operation, and 32.9o and 42.1o at follow-up, respectively. In dystrophic thoracic curves, preoperative Cobb’s angle in coronal and sagittal plane was 96.5o and 79.8o, postoperative 49.3o and 41.7o, follow-up 54.1o and 45.3o, respectively. In thoracolumbar curves, preoperative Cobb’s angle in coronal and sagittal plane was 75.0o and 47.5o, postoperative 31.2o and 22.8o, follow-up 37.5o and 27.8o, respectively. In lumbar curves preoperative Cobb’s angle in coronal plane was 55.3o, postoperative 19.3o, and follow-up 32.1o. Six patients with dystrophic curves had his or her curve deteriorated more than 10 degrees at follow-up. Three of them were in the thoracic subgroup and their kyphosis was larger than 95 degrees, and three in lumbar subgroup. Hardware failure occurred in 3 cases. Six patients had 7 revision procedures totally. Conclusions Posterior spinal fusion is effective for most dystrophic thoracic curves in patients whose kyphosis is less than 95 degrees. Combined anterior and posterior spinal fusion is stronger recommended for patients whose kyphosis is larger than 95 degrees and those whose apical vertebra is located below T8. Patients should be informed that repeated spine fusion might be necessary even after combined anterior and posterior spine fusion.
文摘Complications occur frequently after surgical treatment of scoliosis.In order to prevent from them effectively,101 cases with failure and postoperative complications were analysed.They included rod fracture in 22 cases(15 Harrington rods,4 Zielke rods,and 3 Luque rods);recurrence of curve severity in 12 cases;broken or loossened luque wires in 15 cases;loss of thoracic kyphosis(flat back) in 6 cases;progressive kyphosis with or without paraplegia following incorrect posterior decompression in 5 cases;and increased unbalance of shoulders after instrumentation in 2 cases due to neglect of the tilting of the first thoracic vertebra.Infection occurred in 8 cases(incision infection 7 cases,deep wound infection in 1 case);and pneumothorax in 1 case.They were induced by biomechanical factors in 23 cases(22 8%),incorrect selections of indications in 29 cases(28 7%),operational mistakes in 37 cases(36 6%),internal fixation factors in 15 cases(14 9%).The authors hold that there are quite a lot of factors leading to occurrence of complications and the effective way for prevention from them is to understand the factors and main technical points related to internal fixation.
文摘Objective:To introduce a key-vertebral-screws technique(KVST) in the surgical treatment of scoliosis extending to main thoracic levels, and to find the role of fulcrum bending in predicting the result of surgical treatment for scoliosis by this technique. Methods: Seventeen consecutive patients with scoliosis extending to main thoracic spine,who underwent pure posterior fusion without anterior or posterior release by KVST between January 2004 and July 2005 were evaluated for fulcrum bending flexibility, surgical correction rate, fulcrum bending correction index (FBCI) in main thoracic curves. Universal Spine System (USS) instrumentation was used in 15 cases,Monarch in another 2 cases. The severity of the curves was measured by Cobb's method using Rad Work 6. 0 software. Preoperative standing AP radiographs, preoperative fulcrum bending anterioposterior (AP) radiographs, postoperative standing AP radiographs, and most recent follow-up standing AP radiographs for spine were measured and recorded. All the data were analyzed with two-sample paired t-test by Origin 7. 0 software. Results: Infection and neurological complications were not noted. No major complications were found. Just one case had some axial back pain, which got a full recovery from physiotherapy for 2 weeks. In the X-ray, there was an average correction of 71. 5% of the fused main thoracic curves, which had no significant lose of correction in final follow-up. For the whole fused main thoracic curves, the fulcrum bending flexibility were lower to operation correction rate (P = 0. 013). The average FBCI was 123%. From the data, the more rigid curves (especially fulcrum bending flexibility <50%), the more correction rate operation could get, compared with fulcrum bending flexibility. Conclusion: (1) KVST is a good method in the surgical treatment of thoracic scoliosis, which can get satisfying result with lower medical cost. (2) Fulcrum bending flexibility is lower than operative correction rate by KVST in main thoracic curves (P<0. 05). In the more rigid curves assessed by fulcrum-bending radiograph, the operative corrective could be gained, especially in the curves which FBCI is lower than 50%.
文摘OBJECTIVE: To discuss the causes and treatments of wound infections after scoliosis surgery. METHODS: Nine hundred and twenty-four caes of scoliosis were reviewed, and the clinical data of 15 cases of postoperative infection were analysed retrospectively. RESULTS: All 15 cases underwent spinal posterior fusion with autologous bone graft using instrumentations. Seven were diagnosed as early infection, and 8 were delayed infection. Radical debridement was performed in all 15 cases. The duration of antibiotics administration was 10 to 34 days with continuous closed irrigation for 2 to approximately 4 weeks and primary closure for the wounds. All patients were followed up for an average of 3.5 years (2 to 7.5 years) with good outcomes and no recurrence. CONCLUSION: Wound infection following surgical correction of scoliosis primarily results from intraoperative seeding, although host-related and operation-related factors may contribute to its development. Once the infections are diagnosed, good results can be achieved by prompt surgical debridement, irrigation and reasonably administered antibiotics. Removal of hardware may be necessary in deep infections.
