Scoliocorrector Fatma-UI for correction of adolescent idiopathic scoliosis: Development, effectivity, safety and functional outcome

BACKGROUND Adolescent idiopathic scoliosis remains a major problem due to its high incidence,high risk,and high cost.One of the aims of the management in scoliosis is to correct the deformity.Many techniques are available to correct scoliosis deformity;however,they are all far from ideal to achieve three-dimensional correction in scoliosis.AIM To develop a set of tools named Scoliocorrector Fatma-UI(SCFUI)to aid threedimensional correction and to evaluate the efficacy,safety,and functional outcome.METHODS This study consists of two stages.In the first stage,we developed the SCFUI and tested it in finite element and biomechanical tests.The second stage was a single-blinded randomized clinical trial to evaluate the SCFUI compared to direct vertebral rotation(DVR).Forty-four subjects with adolescent idiopathic scoliosis were randomly allocated into the DVR group(n=23)and SCFUI group(n=21).Radiological,neurological,and functional outcome was compared between the groups.RESULTS Finite element revealed the maximum stress of the SCFUI components to be between 31.2-252 MPa.Biomechanical analysis revealed the modulus elasticity of SCFUI was 9561324±633277 MPa.Both groups showed improvement in Cobb angle and sagittal profile,however the rotation angle was lower in the SCFUI group(11.59±7.46 vs 18.23±6.39,P=0.001).Neurological and functional outcome were comparable in both groups.CONCLUSION We concluded that SCFUI developed in this study resulted in similar coronal and sagittal but better rotational correction compared to DVR.The safety and functional outcomes were also similar to DVR.

The Outcome of Posterior Spinal Fusion and Instrumentation of Adolescent Idiopathic Scoliosis without Wound Suction Drainage

Background: In spine surgery postoperative closed suction drainage is used to decrease the potential risks of wound hematoma formation, and reduces the risk of infection, cord compression and neurologic deficit. However, the efficacy of drains used for this purpose in adolescent idiopathic scoliosis is controversial. The purpose of this study is to evaluate outcomes of patients after posterior spinal fusion with instrumentation for adolescent idiopathic scoliosis without wound suction drainage. Methods: A total of 66 Patients who underwent posterior spinal fusion and instrumentation for the correction of Adolescent idiopathic scoliosis without the use of drain from January 2012 to January 2021 were included. Wound dehiscence, wound hematoma, infection, preoperative and postoperative hemoglobin levels and need for transfusion were described as frequency and mean values. Results: The average age was 15.06 years. Hospital stay was 2.2 days. Patients were followed-up over 50.21 months. There was no deep infection, wound hematoma. The difference between just postoperative and three days after operation hemoglobin levels was not significant and no need for transfusion. Only 3 (4.5%) cases with superficial skin infection and 4 (6%) cases with skin and Wound dehiscence were treated with dressing and antibiotics with full recovery. Conclusion: Without using drain for patients with idiopathic scoliosis who underwent posterior spinal fusion and instrumentation, no increase in blood loss, transfusion requirements, wound infection, skin dehiscence, and wound hematoma was observed.

Research progress on the safety of nail placement in adolescent idiopathic scoliosis surgery

Adolescent idiopathic scoliosis is a spinal deformity with unknown etiology and high incidence,especially in adolescent females.If scoliosis patients do not get effective treatment in the early stage,the degree of scoliosis will continue to worsen with the growth of age or the rapid development of scoliosis in a short time,and the appearance deformities such as high and low shoulders and razor back will gradually appear,which can affect the cardiopulmonary function and even shorten life expectancy.It has a great impact on the physical and mental health of the patients.Mild scoliosis is often well controlled by bracing,and moderate to severe scoliosis deformity often requires scoliosis corrective surgery.In adolescent idiopathic scoliosis correction,pedicle screws offer better stability and firmness,stronger orthopedic force,and lower incidence of related complications caused by instruments than traditional hook and conical internal fixation instruments.At the same time,scoliosis patients have uneven development of the left and right sides of the vertebral body,narrow diameter of concave pedicle and varying degrees of rotation of parietal vertebra,resulting in changes in the position of important anatomical structures such as spinal cord and thoracic aorta in the spinal canal.It makes it difficult to place pedicle screws,resulting in a high misplacement rate.How to improve the safety of screw placement,reduce the misplacement rate and the risk of spinal cord,nerve root,blood vessels,viscera and so on,has always been the focus of spinal surgeons.This paper summarizes the related literature on the effects of new techniques such as pedicle anatomy,complications of nail placement and computer navigation,and 3D guided template on the accuracy of screw placement in adolescent idiopathic scoliosis patients,and the safety of nail placement.In order to provide reference for clinical practice.

Accuracy of screw placement in the apical region of Lenke 1 adolescent idiopathic scoliosis surgery using a calibration technique for the intraoperative navigation error

Objective:To study the position and the grade of screw perforation in the apical region of adolescent idiopathic scoliosis(AIS)surgery using a calibration technique for the intraoperative navigation error,and to analyze the related factors of navigation deviation and the clinical significance of the calibration technique.Methods:From 2017 to 2020,a total of 60 Lenke 1 AIS surgical cases were enrolled in this research.The 30 cases received surgery using the intraoperative navigation system(Navigation group)and another 30 cases were assisted with intraoperative navigation system with calibration technique(Calibration group)for the intraoperative navigation error.The basic information and radiological data of the both groups were all recorded.According to the Fu Chang-feng’s pedicle channel classification system,the pedicle on the apical region of the two groups was classified.And then the accuracy of screw placement of the two groups was evaluated according to the Rao’s classification.Results:A total of 600 screws were placed in the two groups.The 297 and 303 pedicle screws were implanted in the navigation group and the calibration group,respectively.In the apical region of the calibration group,the rates of the grade 0 screw placement in type A,B and C pedicle were 95.7%,86.7%and 68.9%respectively.It was a statistically significant difference from the 73.9%,66.9%and 30.0%in the navigation group respectively(P<0.05).In the calibration group,the rates of the medial cortical perforation in the type A,B,C and D pedicle were 0%,1.6%,1.6%and 0%,respectively.The corresponding rates were 16.3%,16.9%,30.0%and 47.6%in the navigation group,respectively.Moreover,in the concave side of the apical region of the calibration group,the rates of the medial cortical perforation in the type A,B,C and D pedicle were 0%,3.6%,2.6%and 0%,respectively.Compared with the calibration group,the corresponding rates were higher in the navigation group(34.4%,25.9%,37.2%and 60.0%,respectively).No serious complications such as spinal cord or neurovascular injury occurred for the two groups.Conclusion:Compared with the intraoperative navigation system,the calibration technique for the intraoperative navigation error could provide the higher accuracy of pedicle screw placement in the apical region of the major curve,the lower medial cortical perforation rate,the less screws misplacement rate on the concave side and the less complication rate of the severe Lenke 1 AIS patients.

Posterior Selective Thoracic Fusion in Adolescent Idiopathic Scoliosis Patients:a Comparison of All Pedicle Screws versus Hybrid Instrumentation

Objective To analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion. Methods By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients who underwent selective thoracic fusion from February 2000 to January 2007 in our hospital, the patients were divided into 2 groups according to different instrumentation fashions： Group A was hook-screw-rod （hybrid） internal fixation type, Group B was screw-rod （all pedicle screws） internal fixation type, and the screws were used in every segment on the concave side of the thoracic curve. The parameters of the scoliosis were measured and the correction results were analyzed. Results Totally, 48 patients （7 males, 41 females） were included, with an average age of 14.4 years old and a mean follow-up time of 12.3 months. Thirty and 18 patients were assigned to group A and group B, respectively. The mean preoperative coronal Cobb angles of the thoracic curve were 48.8° and 47.4°, respectively. After surgery, they were corrected to 13.7° and 6.8°, respectively. At final follow-up, they were 17.0° and 9.5°, with an average correction rate of 64.6% and 79.0%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The mean preoperative coronal Cobb angles of the lumbar curve were 32.6° and 35.2°, respectively. After surgery, they were corrected to 8.6° and 8.3°, respectively. At final follow-up, they were 10.3° and 11.1°, with an average correction rate of 66.8% and 69.9%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The correction loss of the thoracic curve and lumbar curve in the 2 groups were 3.1° and 1.8°, 2.4° and 2.4°, respectively. No significant difference was noted （both P〉0.05）. The decompensation rate at final follow-up in these 2 groups were 4% （1/25） and 7.1% （1/14） respectively, with no significant difference （P〉0.05）.

Predictors of spine deformity progression in adolescent idiopathic scoliosis: A systematic review with meta-analysis

AIM: To evaluate published data on the predictors of progressive adolescent idiopathic scoliosis(AIS) in order to evaluate their efficacy and level of evidence. METHODS: Selection criteria:(1) study design: randomized controlled clinical trials, prospective cohort studies and case series, retrospective comparative and none comparative studies;(2) participants: adolescents with AIS aged from 10 to 20 years; and(3) treatment: observation, bracing, and other. Search method: Ovid MEDLINE, Embase, the Cochrane Library, Pub Medand patent data bases. All years through August 2014 were included. Data were collected that showed an association between the studied characteristics and the progression of AIS or the severity of the spine deformity. Odds ratio(OR), sensitivity, specificity, positive and negative predictive values were also collected. A metaanalysis was performed to evaluate the pooled OR and predictive values, if more than 1 study presented a result. The GRADE approach was applied to evaluate the level of evidence.RESULTS: The review included 25 studies. All studies showed statistically significant or borderline association between severity or progression of AIS with the following characteristics:(1) An increase of the Cobb angle or axial rotation during brace treatment;(2) decrease of the rib-vertebral angle at the apical level of the convex side during brace treatment;(3) initial Cobb angle severity(> 25o);(4) osteopenia;(5) patient age < 13 years at diagnosis;(6) premenarche status;(7) skeletal immaturity;(8) thoracic deformity;(9) brain stem vestibular dysfunction; and(10) multiple indices combining radiographic, demographic, and physiologic characteristics. Single nucleotide polymorphisms of the following genes:(1) calmodulin 1;(2) estrogen receptor 1;(3) tryptophan hydroxylase 1;(3) insulin-like growth factor 1;(5) neurotrophin 3;(6) interleukin-17 receptor C;(7) melatonin receptor 1B, and(8) Scoli Score test. Other predictors included:(1) impairment of melatonin signaling in osteoblasts and peripheral blood mononuclear cells(PBMC);(2) G-protein signaling dysfunction in PBMC; and(3) the level of platelet calmodulin. However, predictive values of all these findings were limited, and the levels of evidence were low. The pooled result of brace treatment outcomes demonstrated that around 27% of patents with AIS experienced exacerbation of the spine deformity during or after brace treatment, and 15% required surgical correction. However, the level of evidence is also low due to the limitations of the included studies.CONCLUSION: This review did not reveal any methods for the prediction of progression in AIS that could be recommended for clinical use as diagnostic criteria.

Increased Expression of Receptor Activator of Nuclear Factor-κB Ligand in Osteoblasts from Adolescent Idiopathic Scoliosis Patients with Low Bone Mineral Density

Persistent generalized low bone mineral density (BMD) has been reported in patients with adolescent idiopathic scoliosis (AIS).However,the exact mechanisms and causes of the low BMD in AIS patients are largely unknown.The purpose of this study was to examine the relationship between the receptor activator of NF-κB ligand (RANKL)/osteoprotegerin (OPG) levels in osteoblasts (OBs) from AIS patients with low BMD and with comparison made between the patients and controls.Twenty AIS patients and eight age-matched controls were included in the present study.The BMD of lumbar spine and proximal femur was measured in all subjects.OBs from the cancellous bone of each subject was harvested and primarily cultured.The mRNA and protein expression of RANKL and OPG in OBs was detected by RT-PCR and Western blotting.The results showed BMD was lower in AIS patients than in controls.A significantly higher mRNA and protein expression of RANKL was observed in OBs from AIS patients,while no significant difference was found in the expression of OPG between AIS patients and controls.As a result,RANKL/OPG ratio in patients with AIS was remarkably higher than controls.Our study preliminarily demonstrated expression of RANKL was higher in OBs from AIS patients with low BMD as compared with controls,suggesting the unbalanced RANKL/OPG ratio caused by an over-expression of RANKL in OBs may be responsible for the low BMD in AIS patients.

Altered physiology of mesenchymal stem cells in the pathogenesis of adolescent idiopathic scoliosis

Adolescent idiopathic scoliosis is the most common spinal deformity during puberty,especially in females.It is characterized by aberrant skeletal growth and generalized reduced bone density,which is associated with impaired bone mineral metabolism.Despite recent progress in multidisciplinary research to support various hypotheses,the pathogenesis of Adolescent idiopathic scoliosis is still not clearly understood.One of the hypothesis is to study the role of mesenchymal stem cells due to its involvement in the above-mentioned bone metabolic abnormalities.In this review,we will summarize reported literatures on the role of mesenchymal stem cells,particularly in the pathogenesis of Adolescent idiopathic scoliosis.In addition,we will describe the research on mesenchymal stem cells of Adolescent idiopathic scoliosis performed using bioinformatics tools.

POSTERIOR SELECTIVE THORACIC FUSION IN ADOLESCENT IDIOPATHIC SCOLIOSIS

To define the criteria of posterior selective thoracic fusion in patients with adolescent idiopathic scoliosis. Methods By reviewing the medical records and roentgenograms of 17 patients with adolescent idiopathic scoliosis who un-derwent posterior selective thoracic fusion, the curve type, Cobb angle, apical vertebral rotation and translation, trunk shift, and thoracolumbar kyphosis were measured and analyzed. Results There were 17 King type Ⅱ patients (PUMC type: Ⅱb1 13, Ⅱc3 4). The coronal Cobb angle of thoracic curve be-fore and after operation were 56.9°and 21.6° respectively, the mean correction rate was 60.1%. The coronal Cobb angle of lumbar curve before and after operation were 34.8° and 12.1° respectively, and the mean spontaneous correction rate was 64.8%. At final follow-up, the coronal Cobb angle of thoracic and lumbar curve were 23.5° and 15.2° respectively, there were no significant changes in the coronal Cobb angle, apical vertebral translation and rotation compared with that after operation. One patient had 12° of thoracolumbar kyphosis after operation, no progression was noted at final follow-up. There was no trunk decompensation or deterioration of the lumbar curve. In this group, 3.9 levels were saved compared with fusing both the th-oracic and lumbar curves. Conclusion Posterior selective thoracic fusion can be safely and effectively performed in King type Ⅱ patients with a mo-derate and flexible lumbar curve, which can save more mobile segments and at the same time can maintain a good coronal and sagittal balance.

Postoperative Disc Wedging in Adolescent Idiopathic Thoracolumbar/Lumbar Scoliosis:a Comparison of Anterior and Posterior Approaches

Objective To evaluate the different influences of anterior and posterior correction and fusion approaches upon disc wedging in adolescent idiopathic thoracolumbar/lumbar scoliosis.Methods The retrospective study was conducted with the medical records and radiographs of adolescent idiopathic thoracolumbar/lumbar scoliosis patients that underwent anterior(group A) or posterior(group B) correction and fusion surgery from December 1998 to May 2008.The correction of the main curve and changes of the disc wedging were analyzed.Results Fifty-three patients were included,26 in group A and 27 in group B.The mean coronal Cobb angles of the main curve in group A and group B were significantly corrected after surgery(P<0.05),with an average correction rate of 75.2% and 88.2%,respectively.Upon final follow-up,the coronal Cobb angles of the two groups were 18.9°±11.1° and 7.7°±5.6°,respectively,with an average correction loss of 6.8°±6.5° and 2.7°±3.3°,respectively.The coronal Cobb angle after operation and at final follow-up,and the correction rate were significantly better in group B than those in group A(P<0.05),while the coronal Cobb angle loss in group A was greater than that in group B(P<0.05).The disc wedging before operation,after operation,and at final follow-up were 3.2°±3.0°,5.7°±3.0°,and 8.6°±4.4° in group A,and 2.4°±3.2°,3.3°±3.4°,and 3.7°±3.6° in group B,respectively.Postoperative disc wedging was significantly larger compared with preoperative measurements in group A(P<0.05),but not in group B(P>0.05).The difference between disc wedging at final follow-up and that after surgery was significant in group A(P<0.05),but not in group B(P>0.05).Between the two groups,group A had larger disc angles after operation and at final follow-up(P<0.05),and a greater loss of disc angle(P<0.05).Conclusion For adolescent idiopathic thoracolumbar/lumbar scoliosis,posterior approach using all pedicle screws might produce a better result in terms of disc wedging compared with anterior approach.

Accuracy of pedicle screw placement in Lenke 1 adolescent idiopathic scoliosis surgery using intraoperative navigation with a simple calibration technique

Objective:To compare the position and the grade of screw perforation in Lenke 1 adolescent idiopathic scoliosis(AIS)surgery using intraoperative navigation system with and without calibration technique,and to explore the related factors of navigation deviation and the clinical significance of calibration technique.Methods:From 2014 to 2017,a total of 45 Lenke 1 AIS surgical cases were enrolled in this study.The 23 surgical cases were assisted with intraoperative navigation system(Navigation group)and another 22 cases received surgery using intraoperative navigation system with calibration technique(Calibration group).In two groups,the basic information and radiological data were all recorded.Postoperative CT scan with 3D reconstruction was used to analyze the accuracy of pedicle screw placement,as well as the length and position of cortical perforation.Results:There was no statistical difference between two groups in gender,age,Risser sign,both preoperative Cobb angles and flexibility of the major curve,as well as numbers of pedicle screws.477 and 469 pedicle screws were implanted in the navigation group and the calibration group respectively.The rate for major pedicle perforations 2 mm(grades 2,3)was 7.8%in navigation group.It was statistically significant difference from the 4.3%screw misplacement in calibration group(P=0.014).In navigation group,the rates of major pedicle perforations 2 mm were medial:3.4%,lateral:3.6%and anterior:0.6%respectively.The corresponding rates were 1.1%,2.6%and 0.4%in calibration group respectively.The rates of the medial cortical perforation 2 mm showed statistical difference between two groups(P=0.016).No serious complications,such as nerve or vascular injury,were found in all patients.Conclusion:Intraoperative navigation system with calibration technique provides the real-time monitoring of navigation deviation,the higher accuracy of pedicle screw insertion,the lower medial cortical perforation rate and the less complication rate,as well as a simple calibration technique with higher accuracy of screw placement in comparison to intraoperative navigation system for Lenke 1AIS surgery.

The Differential Effects of Exercise, Brace and Combined Rehabilitation Treatment in Patients with Adolescent Idiopathic Scoliosis

Objective:To compare the effects of different conservative managements on patients with adolescent idiopathic scoliosis (AIS). Method:One hundred and four AIS patients were recruited for this study. The patients were divided into 3 groups:exercise (E group), brace (B group) and combined rehabilitation treatment (brace treatment combined with exercise, CR group). Radiological parameter were used to assess AIS patients before and after treatment. The Chinese version of scoliosis research society-22(SRS-22) patient questionnaires were filled out by patients after treatment. The SRS-22 scores were compared among management groups. Result:The maximal Cobb angles were smaller in E group than in B group or CR group both before and af- ter treatment. The maximal Cobb angles were significantly smaller after treatment than before treatment in B group and CR group. Function/activity was better in E group than in B group or CR group. Self-image/appear- ance and satisfaction with management were better in E group and CR group than in B group. There was no significant difference among treatment groups in pain and mental health. Conclusion:Both brace and combined rehabilitation treatment can reduce the spinal curve of AIS patients. Both exercise and combined rehabilitation treatment have positive influence on self-image/appearance and satis- faction with management. We support preference of combined rehabilitation treatment above brace treatment.

Pedicle Screw Insertion for Concave Side of Proximal Thoracic Curve in Adolescent Idiopathic Scoliosis

Background: Insertion of the pedicle screws (PS) into the proximal thoracic spine is occasionally challenging owing to the small size of the pedicles and the proximity to the spinal cord. An appropriate anchor placement method for the concave side of the proximal thoracic curve has not been established yet. This study aimed to evaluate the pedicle size and position of PS on the concave side of the proximal thoracic curve in patients with adolescent idiopathic scoliosis (AIS). Methods: Forty consecutive patients with AIS who underwent correction and fusion with all PS constructs, including the proximal thoracic curve in the fusion area, were included. After identifying the screws inserted on the concave side of the proximal thoracic curve, the pre-operative morphology and postoperative position of the inserted PS, including the end vertebrae, were analyzed using computed tomography (CT). Screw perforations were categorized into four grades depending on the degree of perforation from the pedicle wall on postoperative CT and were classified using an outcome-based classification. Results: A total of 109 screws were inserted on the concave side of the proximal thoracic curve. The average width of all pedicles was 3.5 ± 1.1 mm. The width of 90 pedicles (83%) was Conclusion: Perforations were found in 84% of the PS on the concave side of the proximal thoracic curve;however, 93% of the PS were considered acceptable in the outcome-based classification. Thus, we conclude that the in-out-in technique may be both feasible and effective.

Research progress of the relationship between abnormal vestibular reflexes and adolescent idiopathic scoliosis

Adolescent idiopathic scoliosis (AIS) is an agnogenic structural scoliosis occurring in adolescence, and the main diagnostic criteria is coronal Cobb angle >10°in total spine X-ray. Studies have shown that AIS may be associated with abnormal postural reflexes, vestibular system is an important component of postural reflexes and its mechanism in the occurrence and development of scoliosis has received wide attention in recent years. In the study, the research progress on the role of abnormal vestibular reflexes in the pathogenesis of AIS was mainly introduced to help the clinicians better understand the pathogenesis of AIS and provide new ideas for AIS study.

Impaired autophagy activity-induced abnormal differentiation of bone marrow stem cells is related to adolescent idiopathic scoliosis osteopenia

Background:Osteopenia has been well documented in adolescent idiopathic scoliosis(AIS).Bone marrow stem cells(BMSCs)are a crucial regulator of bone homeostasis.Our previous study revealed a decreased osteogenic ability of BMSCs in AIS-related osteopenia,but the underlying mechanism of this phenomenon remains unclear.Methods:A total of 22 AIS patients and 18 age-matched controls were recruited for this study.Anthropometry and bone mass were measured in all participants.Bone marrow blood was collected for BMSC isolation and culture.Osteogenic and adipogenic induction were performed to observe the differences in the differentiation of BMSCs between the AIS-related osteopenia group and the control group.Furthermore,a total RNA was extracted from isolated BMSCs to perform RNA sequencing and subsequent analysis.Results:A lower osteogenic capacity and increased adipogenic capacity of BMSCs in AIS-related osteopenia were revealed.Differences in mRNA expression levels between the AIS-related osteopenia group and the control group were identified,including differences in the expression of LRRC17,DCLK1,PCDH7,TSPAN5,NHSL2,and CPT1B.Kyoto Encyclopedia of Genes and Genomes enrichment analyses revealed several biological processes involved in the regulation of autophagy and mitophagy.The Western blotting results of autophagy markers in BMSCs suggested impaired autophagic activity in BMSCs in the AIS-related osteopenia group.Conclusion:Our study revealed that BMSCs from AIS-related osteopenia patients have lower autophagic activity,which may be related to the lower osteogenic capacity and higher adipogenic capacity of BMSCs and consequently lead to the lower bone mass in AIS patients.

单纯凸侧去旋转与凸凹双侧同时去旋转对Lenke 5型AIS的矫形效果比较

目的比较单纯凸侧去旋转与凸凹双侧同时去旋转对Lenke 5型青少年特发性脊柱侧凸(AIS)的矫形效果。方法选择Lenke 5型AIS患者52例,其中采取单纯凸侧去旋转矫形固定融合术28例(单侧组)、采取凸凹双侧同时去旋转矫形固定融合术24例(双侧组),比较两组手术相关指标(手术时间、术中出血量、融合节段数量),影像学测量指标(冠状位、矢状位、轴位影像学指标和融合节段邻近椎间盘角度及腰骶影像学指标),脊柱侧凸学会-22r(SRS-22r)评分(包括疼痛、功能状况、自我形象、心理状况、对治疗的满意度五个维度)及手术相关并发症。结果两组手术时间、术中出血量、融合节段数量比较差异均无统计学意义(P均>0.05)。在影像学测量指标中,两组术前及术后矢状位、冠状位、轴位相关影像学指标及上下固定椎邻近椎间盘角度比较差异均无统计学意义(P均>0.05)。双侧组术前与末次随访时矢状位、冠状位上固定椎近端椎间盘角度变化值较大。两组治疗前后SRS-22r各维度评分比较差异均无统计学意义(P均>0.05)。两组术中均无电生理监测异常及手术相关并发症发生。结论单纯凸侧去旋转与凸凹双侧同时去旋转对Lenke 5型AIS的矫形效果相当,顶椎去旋转效果相似。单纯凸侧去旋转可避免凹侧螺钉切割等并发症发生,若行凸凹双侧同时去旋转术后随访时需密切观察融合节段近端椎间盘退变情况。

Surgical treatment for scoliosis extending to main thoracic spine by key-vertebral-screws technique (KVST)

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%.

支具在青少年特发性脊柱侧弯(AIS)治疗中的应用

目的:探讨支具治疗青少年特发性脊柱侧弯(AIS)的疗效。方法:对本院2008年1月—2011年2月收治的青少年特发性脊柱侧弯症(AIS)36例患者采用支具治疗,其中29例获得随访。结果 :26例特发性脊柱侧弯患者均有明显的改善,平均矫正11°,26例AIS患儿中无明显肢体神经受压、肌力减退、呼吸系统、消化系统症状等支具并发症出现,均完成了支具穿戴要求。

选择性与完全性置钉内固定术矫治AIS的比较

目的初步探讨选择性与完全性置钉内固定术治疗青少年特发性脊柱侧凸（adolescentidiopathicscoliosis，AIS）的临床疗效。方法回顾性分析2008年1月至2012年7月我科收治的48例青少年特发性脊柱侧弯两种不同置钉方法的临床资料，治疗组24例和对照组24例分别经过选择性与完全性椎弓根钉棒内固定术，进行侧弯矫形及预弯、后凸旋转矫形，并行结构性节段丰富植骨融合。随访时间18～32个月，平均24个月，对比手术前后Cobb角和主弯畸形矫正率，并进行统计学分析。结果术前胸主弯Cobb角分别为（39．5±1．2）°和（40．8±1．7）°，胸腰弯／腰弯Cobb角分别为（22．3±1．6）°和（19．8±2．2）°。术后矫正角度分别为（11．4±0．8）°和（12．2±0．3）°。矫正率分别为（72．3±0．2）％和（71．4±0．4）％（P〉0．05），至随访末两者无明显差异。结论应用选择性置钉的方法可以有效地减少置入的椎弓根螺钉数量，有效矫正AIS畸形，减少手术创伤和费用，是一种可行的手术方式。

选择性前路或后路手术治疗Lenke5型AIS胸弯自发矫正比较及策略分析

[目的]比较选择性前路或后路手术治疗Lenke5型青少年特发性脊柱侧凸未融合胸弯术后自发矫正情况。[方法]1997年5月～2005年10月，共72例接受手术的Lenke5型青少年特发性脊柱侧凸患者，其中40例采用选择性前路手术（A组），32例采用选择性后路手术（B组），随访时间最少2年。[结果]末次随访发现，两组患者无1例发生术后相关并发症，A组术前胸弯平均30°，术后平均16°；B组术前33°，术后18°。两组患者术后未融合胸弯大多得到了明显改善，且两组患改善率没有差别，但末次随访发现，72例患者中，4例患者（C组）术后胸弯加重，躯干发生了失平衡，A组、B组各2例。该4例患者（TL／L：T）Cobb’s比率均值为1．09，其余68例（D组）比率均值为1．59。C、D组患者胸弯柔韧性也有差别，C组较D组僵硬（分别34．2％和57．3％）．[结论]选择性前路或后路手术治疗Lenke5型青少年特发性脊柱侧凸，未融合胸弯自发矫正效果相当，但术前对患者（TL／L：T）Cobb’s比率和胸弯柔韧性进行评估非常重要。