Volume and fat infiltration of spino-pelvic musculature in adults with spinal deformity

AIM: To investigate fat infiltration and volume of spino-pelvic muscles in adults spinal deformity(ASD) with magnetic resonance imaging(MRI) and 3D reconstructions.METHODS: Nineteen female ASD patients(mean age 60 ± 13) were included prospectively and consecutively and had T1-weighted Turbo Spin Echo sequence MRIs with Dixon method from the proximal tibia up to T12 vertebra. The Dixon method permitted to evaluate the proportion of fat inside each muscle(fat-water ratio). In order to investigate the accuracy of the Dixon method for estimating fat vs water, the same MRI acquisition was performed on phantoms of four vials composed of different proportion of fat vs water. With Muscl'X software, 3D reconstructions of 17 muscles or group of muscles were obtained identifying the muscle's contour on a limited number of axial images [Deformation of parametric specific objects(DPSO) Method]. Musclar volume(Vmuscle), infiltrated fat volume(Vfat) and percentage of fat infiltration [Pfat, calculated as follow: Pfat = 100 ×(Vfat/Vmuscle)] were characterized by extensor or flexor function respectively for the spine, hip and knee and theirs relationship with demographic data were investigated. RESULTS: Phantom acquisition demonstrated a non linear relation between Dixon fat-water ratio and the real fat-water ratio. In order to correct the Dixon fatwater ratio, the non linear relation was approximated with a polynomial function of degree three using the phantom acquisition. On average, Pfat was 13.3% ± 5.3%. Muscles from the spinal extensor group had a Pfat significantly greater than the other muscles groups, and the largest variability(Pfat = 31.9% ± 13.8%, P < 0.001). Muscles from the hip extensor group ranked 2nd in terms of Pfat(14% ± 8%), and were significantly greater than those of the knee extensor(P = 0.030). Muscles from the knee extensor group demonstrated the least Pfat(12% ± 8%). They were also the only group with a significant correlation between Vmuscle and Pfat(r =-0.741, P < 0.001), however this correlation was lacking in the other groups. No correlation was found between the Vmuscle total and age or body mass index. Except for the spine flexors, Pfat was correlated with age. Vmuscle and Vfat distributions demonstrated that muscular degeneration impacted the spinal extensors most.CONCLUSION: Mechanisms of fat infiltration are not similar among the muscle groups. Degeneration impacted the spinal and hip extensors most, key muscles of the sagittal alignment.

Long-Term Follow-Up of Microsurgical Reconstruction for Pelvic Tumor Focusing on Spinal Deformity and Quality of Life

Background: To provide patients with a superior quality of life (QOL) after their pelvic tumor resection, ensuring the stability of the trunk as well as satisfactory lower extremity function is important. Although microsurgical reconstructions for the pelvic ring and hip are used clinically, the details of postoperative long-term spinal deformity and QOL remain unclear. Methods: The patients were 66- and 43-year-old men and a 43-year-old woman. The mean postoperative follow-up period was 134 months. The surgical procedures performed on these patients were: pelvic ring reconstruction using a double-barreled free vascularized fibular graft (FVFG) in Patient 1;simultaneous pelvic ring reconstruction using FVFG and hip arthrodesis in Patient 2;and latissimus dorsi free flap without pelvic ring reconstruction in Patient 3. As indicators of spinal deformity, we measured the Cobb angle, thoracic kyphosis angle, lumbar lordosis angle, pelvic angle on the sagittal plane, and sagittal plane balance using whole spine radiography. To assess the patients’ QOL, we examined the International Society of Limb Salvage (ISOLS) score, the Roland-Morris Disability Questionnaire (RDQ), activities of daily living (ADL) satisfaction using a visual analogue scale (VAS), and the SF-36. Results: Spinal alignment in the frontal plane worsened in order from Patient 1 to 3. Spinal alignment and pelvic tilt in the sagittal plane were at appropriate levels in Patients 1 and 2. The trunk tilt in the sagittal plane was at an appropriate level only in Patient 1. In the QOL assessment, the function of the affected limb worsened in order from Patient 1 to 3. RDQ scores were lower than the national norm in Patients 2 and 3. With respect to ADL satisfaction and the SF-36, Patient 3 had a markedly low VAS, physical functioning, role-physical, and role-emotional scores. Conclusion: In the long-term clinical course after pelvic tumor resection, in order to obtain satisfactory spinal alignment and QOL, pelvic ring reconstruction and hip arthrodesis are important.

Adjacent Segment Disease after Long Spinal Fusion Ending at L5 for Adult Spinal Deformity: A Retrospective Cohort Study

Study Design: This is a retrospective cohort study using data from the adult spinal deformity (ASD) database of a single institution. Purpose: To investigate the incidence of proximal junctional failure and distal junctional failure (DJF) after ASD surgery with a lower instrumented vertebra (LIV) at L5. Overview of Literature: Spinopelvic fixation from the lower thoracic vertebra to the pelvis is the current gold standard treatment for ASD. However, the LIV at L5 is acceptable in some cases. Methods: Fifty-six patients who underwent corrective surgery for ASD with LIV at L5 were included. The upper instrumented vertebra (UIV) was T7 in one patient, T9 in 14, T10 in three, T11 in four, T12 in eight, L1 in 10, and L2 in 16. Regarding clinical parameters, age, sex, curve types of Scoliosis Research Society-Schwab classification, number of levels fused, follow-up period, hip bone mallow density, revision surgery rate, and radiographic measurements were compared between the T (UIV: T7 - 10) and TL (UIV: T11 - L2) groups. Results: The revision surgery rate was 19.6% overall. In the T and TL groups, it was 27.8%, and 15.8%, respectively (p = 0.305). The rate of DJF in the T group (33.3%) was significantly higher than in the TL group (5.3%). The rate of proximal junctional kyphosis in the T group (55.6%) was higher than in the TL group (28.9%), with no significant difference. The mean global alignment, sagittal vertical axis, and C7 plumb line-central sacral vertical line were not different between both groups. Conclusions: ASD surgery with LIV set at L5 and UIV set at the thoracic vertebrae (T7 - T10) has a risk of adjacent segment disease.

Different types of mechanical complications after surgical correction of adult spine deformity with osteotomy

AIM To determine the incidence and risk factors for mechanical complications （MC） after surgical correction of adult spinal deformity （ASD） with osteotomy.METHODSA retrospective study was performed. Inclusion criteria： Surgical correction of ASD using osteotomy; male or female; 〉 20 years old; follow-up ≥ 24 mo or revision. The MC of spine and spinal instrumentation were studied separately. Risk analysis included assessment of the association between more than 50 different characteristics （demographic, clinical, radiographic, and instrumentation） with different types of MC.RESULTSThe medical records of 94 operations in 88 subjects were analyzed： Female （68%）, mean age 58.6 （SD, 12.7） years. Cumulative incidence of MC at 2 year follow-up was 43.6%. Of these, 78% required revision （ P 〈 0.001）. The following characteristics had significant （ P ≤ 0.05） association with MC： （1） Preoperative： osteoporosis, smoking, previous spinal operation, sagittal vertical axis （SVA） 〉 100 mm, lumbar lordosis （LL） 〈 34°; （2） postoperative： SVA 〉 75 mm; operative correction： SVA 〉 75 mm, LL 〉 30°, thoracic kyphosis 〉 25°, and pelvic tilt 〉 9°; a fall; pseudarthrosis; and （3） device and surgical technique： use of previously implanted instrumentation; use of domino and/or parallel connectors; type of osteotomy （PSO vs SPO） if preoperative SVA 〈 100 mm; lumbar osteotomy location; in-situ rod contouring 〉 60°; and fxation to sacrum/pelvis.CONCLUSIONRisk of MC after surgical correction of ASD is substantial. To decrease this risk over- and/or insuffcient correction of the sagittal imbalance should be avoided.

Spinal deformities in a wild line of Poecilia wingei bred in captivity:report of cases and review of the literature

Objective:To describe the occurrence of various spinal deformations in a captive-bred wild line of Poecilia wingei(P.wingei).Methods:Fish belonging to a wild line of P.wingei caught from Laguna de Los Patos,Venezuela,were bred in an aquarium home-breeding system during a period of three years(2006-2009).The spinal curvature was observed to study spinal deformities in P.wingei.Results:Out of a total of 600 fish,22 showed different types of deformities(scoliosis,lordosis,kyphosis),with a higher incidence in females.Growth,swimming and breeding of deformed fish were generally normal.Conclusions:Possible causes for spinal curvature in fish are discussed on the basis of the current literature.While it is not possible to determine the exact cause(s)of spinal deformities observed in the present study,traumatic injuries,nutritional imbalances,genetic defects or a combination of these factors can be supposed to be involved in the pathogenesis of such lesions.

Development of spinal deformities in the tight-skin mouse

Tight-skin （TSK） mice are commonly used as an animal model to study the pathogenesis of Marfan syndrome （MFS）, but little is known of their skeletal phenotype and in particular of the development of the spinal deformities, common in MFS. Here we examined growth of the axial skeletons of TSK and wild-type（B6） mice during their period of rapid growth. The whole bodies of mice, 4-12 weeks of age, were scanned after sacrifice, by micro-computed tomography （microCT）. We reconstructed three-dimensional models of the spine and ribs, and measured vertebral body heights and rib lengths using the Mac-based image-processing software ＂OsiriX＂. Although the TSK mice were smaller than the B6 mice at 4 weeks, they experienced an early growth spurt and by 8 weeks the height, but not the width, of the vertebral body was significantly greater in the TSK mice than the B6 mice. Measurement of the angles of scoliotic and kyphotic curves postmortem in the mice was problematic, hence we measured changes that develop in skeletal elements in these disorders. As a marker of kyphosis, we measured anterior wedging of the vertebral bodies; as a marker for scoliosis we measured asymmetries in rib length. We found, unlike in the B6 mice where the pattern was diffuse, wedging in TSK mice was directly related to spinal level and peaked steeply at the thoracolumbar junction. There was also significant asymmetry in length of the ribs in the TSK mice, but not in the B6 mice. The TSK mice thus appear to exhibit spinal deformities seen in MFS and could be a useful model for gaining understanding of the mechanisms of development of scoliosis and kyphosis in this disorder.

成年脊柱畸形患者和无症状受试者脊柱骨盆肌肉体积的比较研究

目的探讨成年脊柱畸形患者和无症状受试者脊柱骨盆肌肉体积及其临床意义。方法选取脊柱畸形患者80例,分为有症状组(n=34)和无症状组(n=46)。收集两组一般临床资料、影像学指标和脊柱骨盆肌肉体积,分析患者症状表现与脊柱骨盆肌肉体积的相关性。结果有症状组脊柱骨盆肌肉体积、臀大肌、臀中肌和臀小肌相对横截面积则显著低于无症状组,脂肪浸润则显著高于无症状组(P<0.05)。Person分析显示,患者的症状刀背样畸形、半椎体畸形、腰背部僵硬感、呼吸困难、髋部疼痛以及活动受限与患者的骨盆肌肉体积均存在显著的负相关关系(P<0.05)。结论成年脊柱畸形患者脊柱骨盆肌肉的体积显著低于无症状受试者。

术前牵引对重度脊柱畸形矫形手术发生神经损伤并发症的影响

目的:探讨术前牵引对重度脊柱畸形矫形手术患者神经损伤并发症的影响。方法:对2019年12月~2022年12月在我院住院行矫形手术治疗的196例重度脊柱畸形患者进行回顾性分析,其中38例极重度僵硬性脊柱畸形患者术前应用头盆环牵引(Halo-pelvic traction,HPT),男17例,女21例;年龄14~30岁(20.12±7.82)岁,纳入HPT组;158例一般重度脊柱畸形患者术前采用枕颌带-下肢牵引带皮牵引(skin traction:ST),男61例,女97例;年龄10~30岁(15.55±10.38),纳入ST组。牵引后均一期行后路矫形固定融合术。收集两组患者的一般资料、手术相关资料和治疗前后的影像学资料(牵引前、牵引后和手术后),计算术前牵引和手术对畸形矫正的贡献率,记录两组患者术中发生神经电生理监测(intra-operative neurophysiological monitoring,IONM)异常和术后神经损伤并发症发生的情况。结果:HPT组患者术前侧凸Cobb角为142.48°±18.77°,头盆环牵引后改善至72.56°±13.26°,改善率为49.07%;手术矫形术后改善至55.76°±15.87°,改善率为60.87%;>Ⅳ级截骨5例,占13.16%;术中IONM出现异常10例,占26.32%;神经损伤3例,占7.90%。ST组患者术前侧凸Cobb角为97.90°±19.25°,牵引后为76.51°±12.68°,改善率为21.85%;矫形术后改善至41.58±15.84°,改善率为57.53%;>Ⅳ级截骨10例,占6.33%;术中IONM出现异常21例,占13.29%;神经损伤9例,占5.70%。两组脊柱高等级截骨无显著性差异(P>0.05);两组术中IONM出现异常的发生率有显著性差异(P<0.05),但术后神经损伤并发症的发生率无显著性差异(P>0.05)。结论:脊柱畸形矫形术患者术前应用头盆环牵引或枕颌带-下肢牵引带皮牵引安全、有效,可减少重度脊柱畸形患者截骨矫形术中神经损伤并发症的风险。

有限元法构建退行性脊柱侧弯模型:病因与治疗中的生物力学分析

背景:退行性脊柱侧弯是指发生在成年之后,脊柱冠状面Cobb角度>10°伴有矢状面畸形和旋转脱位,常常产生脊髓、神经受压症状,如腰疼、下肢疼痛、麻木、无力、神经源性跛行等。有限元法是一种计算机建模的力学分析技术,通过建立数字化网格模型,能真实还原人类脊柱模型并可进行脊柱力学研究。目的:综述有限元法在退行性脊柱侧弯病因及治疗中的应用。方法:在文献数据库中国知网、PubMed、Web of Science中检索2023年10月之前发表的有关有限元分析法在退行性脊柱侧弯中应用的文献,英文检索词为finite element anaysis,biomechanics,stress analysis,degenerative scoliosis,adult spinal deformity,中文检索词为有限元分析法、生物力学、应力分析、退变性脊柱侧凸、成年性脊柱侧凸。最终纳入文献54篇。结果与结论:①运用有限元法构建的退行性脊柱侧弯模型得出的生物力学研究结果,与体内试验研究结果相同,证明有限元法在退行性脊柱侧弯中具有较高的实用价值;②通过有限元法对退行性脊柱侧弯的病因与治疗进行研究,有利于预防其发生、减缓其进展、制定出更合适的治疗方案、减少手术并发症出现、促进患者术后康复等;③有限元法从材料单一的骨性结构逐渐发展到纳入肌肉韧带等软组织的阶段,且小样本含量越来越无法满足研究需要;④有限元法在退行性脊柱侧弯领域有较大的发展空间。

退行性脊柱侧凸冠状面影像学参数研究进展

退行性脊柱侧凸(DS)是因脊柱退变导致的脊柱畸形,在DS中冠状面失衡较常见,且老年患者发生率较高,临床主要以影像学参数来评价脊柱平衡状态。目前,脊柱冠状面平衡的影像学评价参数主要包括Cobb角、冠状平衡差、椎体倾斜度、椎体平衡差、双肩相对平衡差等。冠状面影像学参数因测量便捷、运用灵活及其临床指导意义而备受脊柱外科医师关注。这些参数在DS临床症状的发生、侧凸的进展、脊柱稳定性以及临床诊断分型与治疗策略选择中均有重要的作用及价值。关于DS冠状面参数的研究,逐渐侧重于脊柱整体平衡的评价,未来动态参数也将运用于脊柱侧凸的影像诊断。

退行性脊柱畸形患者的自我管理现状及影响因素研究

背景近年来,退行性脊柱畸形(DSD)的患病率逐年上升,从疾病发生到需手术干预之前,患者将与疾病长期共存,期间自我管理对DSD的发展及转归至关重要。然而,DSD患者的自我管理现状及影响因素尚不明确,无法针对性地制订有效的干预措施。目的研究DSD患者的自我管理现状并分析其影响因素,为制订针对性的干预方案提供临床参考。方法采用便利抽样法对2020年6月—2022年12月于陆军军医大学第一附属医院骨科就诊的200例DSD患者进行问卷调查,收集患者的人口统计学资料、视觉模拟评分、Oswestry功能障碍指数问卷(ODI)评分、医疗社会支持量表(MOS-SSS)评分以及慢病自我管理行为量表评分。构建多元线性回归模型分析患者慢病自我管理行为量表评分的影响因素。结果共回收有效问卷191份(95.5%),患者的平均年龄为(62.6±11.6)岁,其中脊柱侧弯144例(75.4%),后凸37例(19.4%),侧后凸10例(5.2%)。慢病自我管理行为量表总分为(22.94±11.97)分,各维度标准化得分由高到低依次为认知症状管理(26.27±15.83)分、医患交流(23.53±16.27)分和运动锻炼(18.42±11.00)分。相关性分析结果显示,年龄、BMI、家庭人均月收入、受教育程度、吸烟史、ODI评分、MOSSSS评分与慢病自我管理行为量表各维度评分和总分显著相关(P<0.05)。多元线性回归分析模型结果显示,MOSSSS评分、受教育程度、家庭人均月收入和骨密度是DSD患者慢病自我管理行为量表评分的影响因素(P<0.05)。结论DSD患者的自我管理行为水平较低,MOS-SSS评分、受教育程度、经济水平和骨密度是DSD患者自我管理的影响因素,医护人员在临床实践中应从加强教育、提升社会支持等方面增强患者的自我管理行为,帮助患者有效管理疾病。

基于Roussouly分型的脊柱形态和GAP评分对成人脊柱畸形术后临床疗效的影响

目的评估成人脊柱畸形(ASD)手术前后的Roussouly矢状面脊柱形态及全脊柱序列比例(GAP)评分对术后临床疗效的影响。方法回顾性分析2016年1月至2021年12月在宁夏医科大学总医院行手术治疗的72例ASD患者临床资料,其中男性20例,女性52例,年龄(46.9±19.0)岁。将纳入患者按照“当前”[依据骶骨倾斜角(SS)]和“理论”[依据骨盆入射角(PI)]Roussouly分型脊柱形态进行划分。根据一个恒定参数(PI)判断出患者“理论”形态,然后将此种类型的理想形态参数与实际参数作对比,若术后3个月患者的“当前”Roussouly脊柱形态与其“理论”Roussouly脊柱形态各项参数均符合则归入匹配组,否则归入非匹配组。根据相关参数计算两组患者手术前后GAP评分,并收集术前、术后3个月和末次随访时的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)及术前和末次随访时SRS-22评分(包括总分、疼痛、功能、自我形象、心理健康和治疗满意度),同时记录患者随访时机械并发症发生情况。比较两组患者的影像学参数、GAP评分、临床疗效评分及机械并发症中的差异。结果72例ASD患者术前以RoussoulyⅠ型和Ⅱ型脊柱形态为主,术后以RoussoulyⅡ型和Ⅲ型为主。所有患者术后影像学参数和临床疗效评分较术前均得到改善(P均<0.05)。组间比较,非匹配组末次随访骨盆倾斜角和躯干整体倾斜角大于匹配组(P均<0.05),术后3个月及末次随访,匹配组GAP评分均低于非匹配组(P均<0.05),匹配组较非匹配组在术后3个月和末次随访有更好的VAS评分、ODI评分及SRS-22评分(包括总分、疼痛、功能和治疗满意度)(P均<0.05)。匹配组术后机械并发症发生率更低(P<0.05),腰椎前凸顶点位于理想位置可降低机械并发症发生率。结论ASD术后脊柱矢状面匹配理想Roussouly分型的患者临床疗效和GAP评分更好、机械并发症发生率更低,PI术中应尽可能矫正至理想Roussouly分型脊柱形态。

人工智能在脊柱畸形领域研究热点的可视化分析

背景:随着人工智能技术在治疗脊柱畸形领域的不断完善与进步,已有大量的研究投入到该领域当中,但主要研究现状、热点和发展趋势尚不明确。目的:采用文献计量学的方法可视化分析人工智能在脊柱畸形领域的相关文献,明确该领域的研究热点和不足,为今后研究工作研究提供参考。方法:在Web of Science核心集数据库检索建库至2023年收录的人工智能在脊柱畸形领域相关文献,通过Citespace 5.6.R5和VOSviewer 1.6.19软件对文献数据进行可视化分析。结果与结论:(1)共纳入文献165篇,此领域年发文量呈波动上升趋势,发文量最多的作者是Lafage V,发文量最多的国家是中国。(2)关键词分析结果显示,青少年早发性脊柱侧弯、深度学习、分类、精度和机器人是该研究领域的主要高频关键词。(3)文献共被引和高被引文献深度分析结果显示,人工智能在脊柱畸形领域有3大热点,包括利用U型架构(深度学习卷积神经网络的一种成熟模式)来自动测量影像学参数(Cobb角、棘旁肌准确分割等)、多视图相关网络架构(即脊柱曲度评估框架)及机器人引导脊柱手术。(4)在人工智能治疗脊柱畸形领域,基因组学等机制研究十分薄弱,未来可利用无监督分层聚类等机器学习技术,运用全基因组关联分析等基因组学研究方法,来进行脊柱畸形领域的易感基因等基础机制研究。

磁控制生长棒治疗脊柱畸形领域研究文献的可视化分析

背景:随着磁控制生长棒技术在治疗脊柱畸形领域的不断完善进步,已有大量的研究投入到该项领域当中,但主要研究现状、热点与发展趋势尚不够明确。目的:基于文献计量学探讨来自不同国家运用磁控制生长棒治疗脊柱畸形研究领域中文章的质量和数量,旨在阐明磁控制生长棒在全球发展趋势以及评估在世界范围内研究生产力、研究趋势与研究热点。方法:主要基于Web of Science核心集数据库对1998-2023年发表的文章进行检索。使用CiteSpace 5.8和VOSviewer 1.6.19软件对数据进行分析,并生成可视化知识图谱。对所有研究进行以下参数的评估:发表论文总数、中心性、h指数、国家、作者、期刊的贡献,通过文献共被引、高被引文献和文献关键词爆发等分析来进行趋势与热点的探究。结果与结论:①最终纳入138篇文献。在2009-2020年,该领域发表的文章数量逐渐增加。美国发文量最多(53篇,37.32%),同时美国的文章研究h指数及中心性最高。②关键词分析结果显示,排名前10位的关键词例如早发性脊柱侧弯、外科手术及并发症等,客观真实地反映了磁控制生长棒在治疗脊柱畸形领域的现状和热点;因磁控制生长棒例如锚钉拔出、植入失败和杆断裂等风险因素而导致的治疗失效、相应医学分级的精准运用、生活质量和大脑性瘫痪等并发症的监测治疗是该领域近年来的研究热点。③文献共被引结果显示,结合磁控制生长棒技术的创新性和有效性研究,对应脊柱畸形的分型应用以及相关并发症的监测治疗可能是该领域的研究趋势。④诸多高被引文献进一步强调了磁控制生长棒技术的治疗运用效果,为矫正脊柱畸形领域提供一种有效的治疗新思路与技术支持。⑤文献关键词爆发分析结果显示,磁控制生长棒应用的风险因素、医学分级、生活质量和大脑性瘫痪可能成为该领域的研究前沿。⑥文章结果证实,磁控制生长棒技术对脊柱畸形的分型运用以及相关并发症的深度研究是该领域的发展趋势,但要深入了解磁控制生长棒技术治疗脊柱畸形的有效性与安全性,还需要一个长期的随访证据;该领域整体研究水平近年来稳步提升,但也存在高质量文献数量较少及各地区研究发展不平衡等问题。

Large deflection deformation behavior of a Zr-based bulk metallic glass for compliant spinal fixation application

A novel compliant spinal fixation designed based on the concept of compliant mechanisms can reduce the stress-shielding effect and adjacent segment degeneration(ASD)effectively,but propose higher requirements for the properties of the used materials.Bulk metallic glasses(BMGs),as a kind of young biomaterials,exhibiting excellent comprehensive properties,which are attractive for compliant spinal fixation.Here,according to the practical service condition of the basic elements in compliant spinal fixation,large deflection deformation behaviors of Zr_(61)Ti_(2)Cu_(25)Al_(12)(at.%,ZT1)BMG beam,including elastic,yielding and plastic were investigated systematically.It was shown that the theoretical nonlinear analytical solution curve as the benchmark not only with the capacity to predict the nonlinear load-deflection relation within the elastic deformation regime,but also assists to capture the yielding event roughly,which can be used as a powerful design tool for engineers.To capture the beginning of the yielding event exactly,bending proof strength(σ_(p),0.05%)accompanied with tiny permanent strain of 0.05% was proposed and determined for BMGs in biomedical implant applications,which is of significance for setting the allowable operating limits of the basic flexible elements.By approach of interrupted loading-unloading cycles,plastic deformation driven by the bending moment can be classified into two typical stages:the initial stage which mainly characterized by the nucleation and intense interaction of abundant shear bands when the plastic strain below the critical value,and the second stage which dominated by the progressive propagation of shear bands and coupled with the emergence of shear offsets on tensile side.The plasticity of BMG beam structures depends on the BMG's inherent plastic zone size(rp).When the half beam thickness less than that of the rp,the plastic deformation of BMGs will behave in a stable manner,which can be acted as the margin of safety effectively.

建立骨质疏松性椎体压缩骨折术后再骨折预测模型

目的探讨骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)术后再骨折风险,构建风险预测模型,确定有效防治措施。方法选取2021年8月至2022年6月北京积水潭医院收治的119例OVCF患者作为研究对象,根据术后再骨折与否分为再发组和非再发组,其中再发组22例,男11例,女11例;年龄55~86岁,平均(72.02±5.58)岁。非再发组97例,男50例,女47例;年龄55~86岁,平均(70.79±6.81)岁。统计两组一般资料,采用Lasso-Logistic回归模型筛选OVCF术后再发骨折自变量,采用赤池信息准则(Akaike’s information criterion,AIC)、贝叶斯信息准则(Bayesian information criterion,BIC)比较全变量Logistic回归、逐步Logistic、Lasso-Logistic回归预测效能,构建诺莫图模型,采用受试者工作特征曲线(receiver operating characteristic,ROC)、校准曲线分析OVCF术后再发骨折诺莫图模型效能。结果术后随访8~20个月,平均(12.00±2.40)个月。单因素分析显示,再发组身体质量指数(body mass index,BMI)、骨密度T值、抗酒石酸酸性磷酸酶(tartrate-resistant acid phosphatase 5b,TPACP-5b)、核因子kB受体激活因子配体(receptor acti-vator nuclear factor kappa B ligand,RANKL)、骨保护素(osteoprotegrin,OPG)、术后抗骨质疏松治疗、白细胞介素(interleukin,IL)-17、长期糖皮质激素使用史、脊柱畸形指数(spinal deformity index,SDI)值、手术段Cobb角、后凸角度与非再发组比较,差异有统计学意义(P<0.05);Lasso-Logistic回归模型分析显示lambda.lse值0.049为最优模型,此时进入模型的变量涉及骨密度、SDI值、IL-17、术后抗骨质疏松治疗,经BIC、AIC验证表明所构建模型拟合和预测效果相对较好;诺莫图模型的ROC下面积(area under the curve,AUC)为0.865,敏感度及特异度分别为95.45%、68.04%,且校准曲线显示,其预测效能与实际吻合较好。结论OVCF术后再骨折的发生受围手术期多方面影响,涉及骨密度T值、SDI值、IL-17、术后抗骨质疏松治疗,基于以上因素可有效预测患者再骨折风险,为临床防治再骨折提供参考依据。

脊柱手术机器人治疗脊柱疾病的研究发展趋势及热点剖析

背景:近年来在脊柱外科领域,手术机器人的应用已成为研究热点,但目前中国尚缺乏脊柱手术机器人的的文献可视化分析相关研究。目的:对脊柱手术机器人治疗脊柱疾病的研究热点进行文献可视化分析,以期为中国脊柱手术机器人的研究和发展提供有益的参考。方法:在Web of Science核心集数据库中检索脊柱手术机器人治疗脊柱疾病的相关文献,最终纳入900篇文献。采用VOSviewer 1.6.19软件对纳入文献的发文量、期刊、机构、国家、关键词、共被引文献和高被引文献进行可视化分析。结果与结论:(1)脊柱手术机器人治疗脊柱疾病研究领域的文献呈逐年上升趋势,尤其在2023年达到了发文量的高峰。美国、中国和德国是该领域的研究热点国家。中国国家自然科学基金是该领域的主要资助基金。(2)中国北京积水潭医院和美国特殊外科医院在该领域的研究具有较高的发文量。(3)《World Neurosurgery》《Spine》和《Operative Neurosurgery》是该领域的主要发文期刊。(4)关键词分析显示,研究主要集中在机器人辅助脊柱手术的准确性、微创手术、机器人脊柱手术和导航技术等方面。(5)文献共被引分析结果显示了机器人辅助技术在脊柱手术中具有显著优势,与传统手术相比,脊柱手术机器人如ROSA?Spine,ExcelsiusGPS,Mazor X及TiRobot等,具有高精度导航、精确椎弓根螺钉置入及实时反馈等优点,它们通过减少手术中X射线辐射暴露,降低患者并发症风险,提高手术成功率,显示出其在脊柱外科领域的应用前景。(6)尽管如此,相关技术的应用和精确度仍需不断积累经验以提高;机器人手术技术在降低手术辐射暴露和提高手术精度方面显示出成本效益,但还需深入探讨其在椎弓根螺钉置入过程中的精确度、手术时间影响及经济效益。(7)2021-2024年的高被引文献分析结果进一步显示,目前该领域最新研究热点主要集中在虚拟现实和增强现实技术的应用、机器人辅助椎弓根螺钉置入的准确性提升以及导航机器人脊柱手术平台的应用等。例如,通过创新技术如有机电化学神经元为脑机接口、假肢和智能软机器人技术提供了新的集成方案。同时,虚拟现实和增强现实技术在脊柱畸形矫正等领域展示了广泛应用前景。

后路脊柱融合术治疗青少年特发性脊柱侧凸的畸形相关并发症

青少年特发性脊柱侧凸(AIS)是一种发生于青春期累及脊柱3个平面的脊柱畸形,发病机制未明。后路脊柱融合术(PSF)是目前治疗AIS应用最广泛的术式,但其术后并发症逐渐引起了人们的重视,其中畸形相关并发症如叠加现象、近端交界性后凸、远端交界处后凸、冠状面失衡和术后双肩不平衡是AIS术后最常见的并发症,了解这些并发症的定义、诊断标准、发生率、自然史、危险因素和预防措施对于制定AIS的手术策略至关重要。本文对近年来关于AIS患者PSF治疗后出现畸形相关并发症的最新研究进展进行了概述。

成人脊柱畸形矫形内固定术后发生断棒的危险因素及治疗策略

目的:探讨成人脊柱畸形矫形内固定术后断棒的发生率、相关危险因素及治疗策略。方法:回顾性分析2015年1月~2019年12月于陆军军医大学第二附属医院骨科就诊并接受后路矫形内固定手术治疗的成人脊柱畸形患者的临床资料,共纳入79例患者,年龄45~75岁(62.1±7.7岁),随访时间24~59个月(30.6±9.2个月)。按照随访期间是否发生断棒分为断棒组和无断棒组。记录两组患者的性别、年龄、身体质量指数(body mass index,BMI)、骨密度(bone mineral density,BMD)T值、合并症以及随访时间。测量两组患者手术前后的矢状面垂直轴(sagittal vertical axis,SVA)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、LL-TK值、PI-LL值以及冠状面Cobb角。收集两组患者的手术相关信息,包括手术时间、术中失血量、固定融合节段数、是否三柱截骨、下端固定椎是否累及骶骨或骨盆以及是否有椎间融合。记录断棒组患者的断棒部位、断棒时间以及是否行翻修手术。采用Spearman检验对两组患者的数据对比分析,将筛选出的阳性指标行多因素Logistic回归分析,计算比值比(OR)及95%置信区间(95%CI)。结果:79例患者中14例患者(17.7%)发生断棒,11例双侧断棒,3例单侧断棒。断棒发生时间为术后6~31个月(平均16个月),其中10例患者(71.4%)发生在术后24个月内,4例患者(28.6%)发生在术后24个月以后。11例患者断棒发生在截骨部位,3例位于T10~T12平面。Spearman检验结果显示较小的年龄(P=0.038)、较多的融合节段数(P<0.001)、三柱截骨(P<0.001)以及较大的术前SVA(P<0.001)与断棒的发生相关。多因素Logistic回归分析结果显示融合节段数较多(P=0.037,OR=2.043,95%CI=1.046~3.992)、三柱截骨(P=0.044,OR=0.113,95%CI=0.014~0.941)以及术前SVA值大(P=0.006,OR=1.119,95%CI=1.032~1.212)是成人脊柱畸形术后断棒发生的高危因素。11例断棒患者(78.6%)因顽固性腰背痛症状或脊柱畸形进展而行翻修手术,均采用后路原切口入路更换断棒,并附加卫星棒技术,其中5例同时一期经腹膜后入路行前路取髂骨植骨融合术,随访效果满意。结论:成人脊柱畸形矫形内固定术后断棒发生率较高。断棒发生的危险因素主要有长节段融合、三柱截骨以及患者术前SVA较大。“多棒技术”以及前路植骨融合技术可用于断棒的翻修手术。

改良Halo骨盆牵引对重度脊柱畸形伴呼吸功能障碍患者的干预效果

目的探讨一期改良Halo骨盆牵引(halo-pelvic traction,HPT)联合二期手术对重度脊柱畸形伴呼吸功能障碍患者的应用效果。方法选取2019年1月至2022年1月北京大望路急诊抢救医院收治的120例重度脊柱畸形伴呼吸功能障碍患者作为研究对象。所有患者均行一期HPT牵引治疗和二期脊柱畸形矫形术。牵引前、牵引末次复查、内固定术后、末次随访,比较患者影像学指标和呼吸功能指标的变化情况。结果牵引前,患者主弯侧凸Cobb角、颈7铅垂线至骶骨正中线的距离(C7PL-CSVL)、顶椎偏距(AVT)、T1倾斜角、影像学肩高度、矢状面偏移(SVA)、腰胸椎后凸角(TK)为(119.17±15.39)°、(33.33±7.2)mm、(103.55±16.56)mm、(20.13±5.94)°、(26.78±6.32)mm、(38.29±5.54)mm、(87.66±11.63)°,高于牵引末次复查[(74.62±15.15)°、(13.23±4.27)mm、(57.70±17.56)mm、(9.29±1.73)°、(10.18±2.00)mm、(14.41±3.24)mm、(52.96±12.11)°]、内固定术后[(60.78±14.40)°、(12.42±3.58)mm、(44.31±13.77)mm、(8.89±2.66)°、(9.38±2.39)mm、(17.11±3.24)mm、(51.28±11.20)°]和末次随访[(64.21±14.86)°、(12.69±3.26)mm、(45.17±11.65)mm、(6.51±1.77)°、(9.53±2.36)mm、(17.50±3.07)mm、(51.82±12.20)°],差异有统计学意义(P<0.01)。牵引前,患者FVC、FVC%、FEV1、FEV1%为(1.13±0.19)L、(31.61±4.64)%、(1.08±0.22)L、(29.68±11.56)%,低于牵引末次复查[(1.36±0.28)L、(36.19±4.95)%、(1.17±0.19)L、(33.45±5.97)%]、内固定术后[(1.49±0.28)L、(38.08±7.46)%、(1.26±0.22)L、(35.91±7.81)%]和末次随访[(1.53±0.26)L、(38.61±6.91)%、(1.28±0.24)L、(36.88±7.85)%],差异有统计学意义(P<0.01)。结论改良HPT牵引能有效矫正重度脊柱畸形伴呼吸功能障碍患脊柱畸形,改善呼吸功能,是一种安全、有效地辅助治疗措施。