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Spontaneous Regression of Symptomatic Lumbar Epidural Varix: A Case Report.
症状性腰硬膜外静脉瘤的自然消退：个案报告
Case Report
病例报告
Abstract:
摘要
Study Design. A case report of spontaneous regression of symptomatic lumbar epidural varix.
研究设计：1例症状性腰硬膜外静脉瘤自然消退的病例报告
Objectives. To present a case of spontaneous regression of lumbar epidural varix itself and to briefly review the literature.
目的：报告1例自然消退的症状性腰硬膜外静脉瘤，并文献。
Summary of Background Data. It has previously been reported that some cases of lumbar epidural varix exhibit complete resolution of symptoms without surgery. However, the natural history of lumbar epidural varix is still unclear. To our knowledge, spontaneous regression of lumbar epidural varix itself has not been previously reported in the literature.
背景资料：以前有几例报告腰硬膜外静脉瘤未经手术治疗症状完全缓解。
Methods. A 57-year-old woman experienced a sudden episode of low back pain radiating to the right lower extremity during physical exercise. Magnetic resonance imaging revealed a mass lesion in the ventral right epidural space, extending from the L2-L3 intervertebral disc space inferiorly, along the posterior aspect of the L3 vertebral body, to the L3-L4 intervertebral disc space, which was isointense on T1-weighted images and hyperintense on T2-weighted images compared with the L2-L3 disc.
方法：一位57岁女性在体育锻炼时突发向右下肢放射的下腰痛。MRI显示硬膜外间隙的右腹侧大的损害（从L2,3椎间隙下缘，经L3椎体后缘，一直延续到到L4椎间隙），相对于L2,3椎间盘，其T1相为中等信号，T2相为高信号。
Results. Repeat magnetic resonance imaging every 2 weeks revealed that the patient's lumbar epidural varix spontaneously regressed with corresponding changes in clinical symptoms, that it extended from the epidural venous plexus, consistent with epidural varix, and that it exhibited a gradual decrease in size.
结果：随后每2周一次MRI显示：伴随临床症状的变化，腰硬膜外静脉瘤自发消退，显示尺寸逐步缩小。Conclusion. Although surgical treatment is often performed for symptomatic lumbar epidural varices, the findings of the present case suggest the usefulness of conservative treatment of these lesions in selected patients without major neurologic deficits.
结果：尽管对腰硬膜外静脉瘤经常手术治疗，我们的病例显示在没有主要神经障碍的病例进行保守治疗是由价值的。
Coronal and Sagittal Plane Correction in Adolescent Idiopathic Scoliosis: A Comparison Between All Pedicle Screw Versus Hybrid Thoracic Hook Lumbar Screw Constructs.
青少年特发性侧凸病人中全椎弓根螺钉构型与螺钉和钩混和应用构型在冠状面和矢状面矫正程度的比较
Deformity
Spine. 32(4):448-452, February 15, 2007.
Lowenstein, Jason E. MD *; Matsumoto, Hiroko MA *+++; Vitale, Michael G. MD, MPH *+++; Weidenbaum, Mark MD *; Gomez, Jaime A. MD +; Lee, Francis Young-In MD, PhD *+; Hyman, Joshua E. MD *+; Roye, David P. Jr MD *+
Abstract:
摘要
Study Design. This was a retrospective cohort study using a previously matched convenience sample of 34 patients.
研究设计：这是一组回顾性研究，应用于配对的34个病人
Objective. This study sought to determine the relative corrective benefits of these 2 types of constructs in the correction of coronal and sagittal curves in patients with adolescent idiopathic scoliosis (AIS). In addition, the 2 constructs were compared for coronal and sagittal balance.
目的：该研究试图确定青少年特发性侧凸病人中这两种类型的构型在冠状面和矢状面的矫正中的相对矫形益处。另外，两种构型在冠状面和矢状面的平衡进行了比较。
Summary of Background Information. Recent clinical research suggests that thoracic pedicle screw constructs (all-screw constructs) are more effective than hybrid lumbar screw thoracic hook constructs (hybrid constructs) in correcting spine deformity.
背景信息简介，最近临床研究提示（全椎弓螺钉）胸椎螺钉构型在脊椎畸形的矫正方面比腰椎螺钉和胸椎钩混和应用（混合构型）有效。
Methods. The sample consisted of patients with AIS who underwent isolated posterior spinal fusion and instrumentation. Seventeen patients underwent fusion using all-screw constructs, and 17 underwent fusion with hybrid constructs; preoperative and postoperative radiographs and measurements were compared.
方法：样本包括经历孤立的后路脊椎融合和器械固定的青少年特发性侧凸病人。17个病人应用全椎弓螺钉构型融合，17个病人应用混合构型融合，术前和术后X线片和测量进行了比较。
Results. There was no significant difference observed when comparing the 2 groups, although there was a trend toward better correction of the main thoracic curve in the all-screw construct group (P = 0.089). In the all-screw group, mean thoracic kyphosis decreased from 29.6[degrees] to 19.4[degrees] (P = 0.012). Sagittal balance changed in the hybrid group from -21.2 mm to 8.2 mm, and in the all-screw group changed from -28.8 mm to 1.5 mm. The major curve in the hybrid group improved from 54.06[degrees] to 20.25[degrees] and improved from 54.88[degrees] to 15.06[degrees] in the all-screw group.
结果：尽管全椎弓螺钉组在主胸弯有一个更好的矫形趋势（P=0.089），但是两组病人没有显著差异。在全椎弓螺钉组，平均胸椎后突从29.6度下降到19.4度（P=0.012）。混合构型组矢状面平衡改变从-21.2mm到8.2mm，在全椎弓螺钉组从-28.8mm到5mm。主侧弯在混合构型组从54.06 改进到20.25度，在全椎弓螺钉组从54.88改进到15.06度。
Conclusions. There was no statistically significant difference comparing the 2 groups, although a trend was observed toward better correction of the main thoracic curve in the all-screw construct group. The all-screw group demonstrated a significant decrease in kyphosis, which was not seen in the hybrid group. Hybrid constructs were comparable to all-screw constructs in the correction of coronal plane deformity and sagittal balance.
结论：尽管在全椎弓螺钉组主胸弯被观察到得到更好的矫形，但是两组病人没有统计学显著差异。全椎弓螺钉组显示明显踬脊柱的后突畸形，这点在混合构型组未被看到。混合构型组和全椎弓螺钉组在冠状面畸形和矢状面的平衡的矫形方面相似?
The most recent instrumentation innovation for the treatment of adolescent idiopathic scoliosis (AIS) is pedicle screw. Pedicle screws have been combined with hooks in hybrid constructs or used alone in all-screw constructs.Exactly what combination of fixation techniques is most efficacious remains controversial.治疗青少年特发性侧凸，最近的器械革新是椎弓根螺钉。椎弓根螺钉联合钩应用于混合构型或者单独被应用于全椎弓根螺钉构型。确切的，什么联合固定技术是最有效的仍然是有争议的。
For some years, hook instrumentation was the “gold standard” treatment for AIS. The concept of pedicle screw fixation in the thoracic spine was first introduced in the late 1970s as a treatment for trauma and tumors.1很多年以来，钩固定构型是治疗青少年特发性侧凸（AIS）的金标准。在胸椎中应用椎弓根螺钉固定的概念的是19世纪70年代末期作为治疗创伤和肿瘤首次提出的1。Thoracic pedicle screws were described by Suk et al in 1995 as a fixation option in the correction and treatment of AIS.2 They evaluated and compared the magnitude of curve correction for their all-hook constructs to all-screw constructs. They found significantly better coronal correction for all-screw constructs.2 胸椎弓根螺钉在1995年被suk等作为矫正和治疗AIS的固定选择2 。他们评价和比较了全钩构型和全螺钉构型弯曲矫形的程度。他们发现全螺钉构型的冠状面的矫形明显好于全钩构型。Sagittal deformities have also been studied in patients with idiopathic scoliosis treated with either hooks or screws, and better correction of hypokyphosis has been reported with the use of all-screw constructs.3 Kim et al reported outcomes in 52 AIS patients who had been treated with either allhook or all-screw constructs.4 They found immediate postoperative coronal major curve correction of 49.9% in the all-hook group and 75.6% in the all-screw group; that difference was significant. They concluded that all screw constructs offered a significantly better curve correction with improved pulmonary function values.4 Other studies have found that lumbar pedicle screws offer greater lumbar curve correction and better maintenance of correction than hook constructs.5 AIS病人被钩或螺钉治疗后矢状面畸形也被研究，发现应用全螺钉构型能较好的矫形轻度后突畸形3。Kim等报告52个AIS病人采用全钩构型或者全螺钉构型的治疗结果4。他们发现术后即刻冠状面主弯的矫形全钩构型为49.9%，全螺钉构型为75.6%,区别是显著的。他们的结论是全螺钉构型提供一个显著的好的侧弯矫形和改进的肺功能值。其它研究显示腰椎弓螺钉比钩构型提供较好的腰椎侧弯矫形和较好的保持矫形效果5。
In 1996, Hamill et al5a studied the hybrid construct using distal screws and thoracic hooks. They reviewed coronal, sagittal, and axial correction using transpedicular
fixation in addition to the Cotrel-Dubousset hook instrumentation and compared it with Cotrel-Dubousset (hook) instrumentation alone. The technique was used in patients with double major curves. They reported a statistically significant improvement of Cobb angle correction in the hybrid group. Lowest instrumented vertebral tilt and translation was also better in the hybrid group. The authors concluded that the hybrid construct that used pedicle screws on the convexity of the lumbar curve improved coronal alignment more than the all-hook construct. More recent studies have dealt with the same
question and obtained different results. 在1996年，Hamill等研究应用远端螺钉和胸椎钩的混合构型。他们回顾比较CD和椎弓根螺钉联合应用、单独应用CD钩在冠状面、矢状面、轴位上矫形程度。这项技术被用于双主弯的病人。他们报告在混合构型组Cobb角的矫形得到统计学上的显著提高。最低器械固定的椎体倾斜和移位也是混合组较好。作者的结论是在腰椎侧弯凸点应用椎弓根螺钉的混合构型比全钩钩型更能改进冠状面的序列。对该同样的问题，已有更多新近研究，但得到不同的结果。
Liljenqvist et al6 in 2002 and Storer et al7 in 2005 found no significant difference in immediate postoperative coronal correction, although long-term follow-up (2–12 years) showed that primary coronal curve correction was better maintained in the hybrid constructs group compared with the all-hook group. No difference was found between the 2 groups when comparing sagittal correction, with both showing no significant change between preoperative and postoperative kyphosis. Operative time and quality of life showed no significant differences between groups. For these reasons, those authors believe that both constructs provided comparable corrections.6,7 Lijenqvist等在2002年，store等在2005年发现尽管长期随访（2-12年）显示混合组比全钩组在原发冠状面矫形的维持上要好，但是在术后即刻冠状面矫形上没有显著差别。两组在冠状面的矫形上没有发现区别，两者均显示术前和术后的后突角没有显著改变。手术时间和生活质量在两组也没有显著区别，这些作者认为两种构型提供相似的矫形效果6，7。
The potential advantage of the power of screw fixation needs to be balanced with a consideration of complications of screw placement. These risks include possible neurologic injury, major vascular injury, violation of the pleura, and increased radiation exposure during screw placement. However, multiple reports confirm that pedicle screw placement in the thoracic spine can be performed with both accuracy and safety.8–11 椎弓根螺钉力量的潜在好处需要和椎弓根植入的并发症综合考虑。这些危险包括可能的神经损伤，主要血管损伤，损伤胸膜，增加螺钉植入过程中射线的暴露。然而，多项报道证实胸椎椎弓根螺钉植入是可以精确和安全实施的。8-11
A number of authors have shown improved curve correction with screw-only and hybrid constructs over hook constructs. To the best of our knowledge, only one other study has compared all-screw constructs with hybrid constructs. 12 Kim et al reported significantly better major curve correction and pulmonary function in the all-screw group over the hybrid group.2 They also found that lowest instrumented vertebra, surgical time, and SRS-24 scores had no significant differences between the 2 groups. The technique using hybrid construct is associated with a low risk of complications; we felt that this may be a better control and possibly the “gold standard” to which segmental pedicle screw constructs should be compared. The purpose of this retrospective study is to compare coronal and sagittal correction and balance in 2 groups of patients with AIS, one treated with a hybrid construct composed of hooks in the thoracic spine and screws at the distal end of the construct and another treated by an all-screw construct.许多作者已经显示全螺钉构型或混合构型比全钩构型侧弯矫形效果好。就我们所知，仅一个研究比较了全螺钉构型和混合构型。12。Kim等报告全螺钉构型比混合构型显著改善了主弯矫形和肺功能2。他们也发现最低固定椎体，手术时间，SRS-24评分在两组没有显著区别。应用混合构型的技术有低的危险并发症，我们认为它可以作为较好对照和可能的节段性螺钉固定构型比较的金标准。我们的回顾性研究的目的是比较两组AIS病人中冠状面和矢状面矫形与冠状面和矢状面平衡，一组为胸椎用钩远端用螺钉的混合构型，另组为全螺钉构型。
Methods方法
Demographic Data. 资料Following institutional review board approval, 34 patients with adolescent idiopathic scoliosis were included in this study. These patients underwent isolated posterior spinal fusion and instrumentation at Morgan Stanley Children’s Hospital of New York-Presbyterian between 1998 and 2004. Seventeen patients underwent fusion using all-screw constructs, and 17 patients underwent fusion using hybrid constructs.34个AIS病人，1998-2004年在New York-Preterian 的Morgan Stanley儿童医院 实施后路融合和固定术。17个病人实施全螺钉构型，17个病人实施混合构型。
The patients were matched according to age at surgery, operative method, curve location, number of fusion levels, and degree of curves. The all-screw group had 15 female and 2 male patients. Average age at surgery was 14.1 years (range, 10–18 years). The hybrid group had 14 female and 3 male patients. Average age at surgery was 13.5 years (range, 10–16 years).病人根据手术时年龄，手术方法，侧弯定位，融合阶段的数目，侧弯角度配对。全螺钉构型组15个女2个男，手术平均年龄为14.1岁（范围，10-18岁）。混合组构型组14个女3个男，手术平均年龄为13.5岁（范围，10-16岁）。
Curve Location and Radiographic Analysis. Three-foot standing preoperative radiographs were compared with postoperative radiographic measurements. The mean interval between surgery and postoperative radiographic measurement was 75.73 days (range, 4–457 days). 侧弯定位和放射学分析 对三个站立位术前放射片和术后片进行测量比较。手术和术后拍片测量平均间隔75.73天(范围4-457天)。冠状面侧弯有近胸弯7个，主胸弯35个，胸腰/腰弯32个。The coronal curves were identified as proximal thoracic curve (n = 7), main thoracic curve (n= 35), and thoracolumbar/lumbar curve (n = 32). Although the proximal thoracic curve was measured it was excluded from the analysis due to small number of patients (all-screw, n = 2; hybrid, n =5). 冠状面侧弯有近胸弯7个，主胸弯35个，胸腰/腰弯32个。尽管近胸弯被进行测量但是从分析中除去了，因为病人数少（全螺钉构型2个，混合构型5个）。Coronal balance was measured using a plumb line from the center of the C7 endplate. 冠状面平衡应用颈7终板中心的铅垂线进行测量。The largest preoperative curve for each individual was identi- fied as the major curve and compared with the postoperative curve at the same location. Additionally, the second largest preoperative curve was noted as a secondary curve and compared with the postoperative curve at the same location. 最大术前侧弯被认为是主侧弯，进行了该弯术前术后比较，第二大弯被认为继发性弯，进行了该弯术前术后比较。Thoracic sagittal kyphosis was measured from the superior endplate of T4 to the inferior endplate of T12, lumbar lordosis was measured from L1– L5, and the thoracolumbar junction sagittal measurement was taken from T10-L2. 胸椎矢状面后突畸形从T4-T12进行测量，腰椎前凸畸形从L1-L5进行测量，胸腰联合处矢状面测量从T10-L2，Sagittal balance was measured by dropping a plumb line from the posterior inferior endplate of C7, and the distance from the line was measured to the posterior superior endplate of S1. 矢状面平衡以颈7后下终板铅垂线作一垂线，该线和S1后上终板垂线的距离进行测量。All measurements were made by a single observer. We expected the Cobb angle measurement to have 2° to 3.2° margin of error.13 There were no significant differences between the all-screw group and the hybrid group in preoperative assessments (P > 0.15). 所有测量由一个观察者实施。我们推测Cobb角有2-3.2度的错误范围13。全螺钉组和混合组在术前评价中无统计学差异（p>0.15）。
Operative Procedures. 手术过程All patients in both groups underwent isolated posterior spinal fusion and instrumentation. In the all-screw constructs, every level was instrumented on at least one side. The all-screw correction was performed with rod insertion, rod rotation, translation of the rod, appropriate dis-traction/compression in order to level the proximal and distal end vertebra, and at the end of the series direct vertebral rotation was used. The all-screw constructs were placed using intraoperative fluoroscopic assistance (Figure 1). In the hybrid constructs, thoracic hook placement followed classic Cotrel- Dubousset instrumentation techniques. Screws were placed under fluoroscopic control in the lumbar vertebra. The correction was obtained with rod insertion followed by rod rotation. Apical distraction in the concavity was performed and appropriated distraction and compression were done to level distal and proximal end vertebra (Figure 2). 所有病人进行后路脊柱融合和固定，在全椎弓螺钉组，每个椎体进行固定或至少一侧进行每个椎体固定。全螺钉矫形通过棒的插入、旋转、移位、和近端和远端椎体合适的加压或撑开实现和直接椎体旋转技术。全螺钉构型在透视支持下实施（图1）。在混合构型组，胸椎钩安放技术为CD技术，腰椎螺钉在透视下植入。矫形通过棒的插入和旋转，凹侧顶点撑开，远端和近端椎体的合适的加压和撑开来实现（图2）。
Statistical Analysis.统计分析 Paired-samples t tests were conducted to analyze possible differences between preoperative curves and postoperative curves within groups. Independent-samples t tests were performed to compare changes in degree of curves between patients with all-screw constructs, and patients with the hybrid constructs. All statistical tests were 2-tailed, and a P value of <0.05 was considered to be significant. All statistical analyses were conducted using SPSS version 12.0. 配对的t检验被用来分析各组中术前和术后弯曲的可能区别。独立样本t检验被用来比较（全螺钉构型组和混合构型组）两组之间术前术后侧弯角度变化程度。所有统计保留2位，p<0.05被认为有意义。所有统计分析采用SPSS12.0版本。
Results 结果
Comparison Between Preoperative and Postoperative Assessment Within the All-Screw Group Table 1 illustrates the differences between preoperative and postoperative assessments within all-screw groups. There was a statistically significant mean difference between preoperative and postoperative measurement in thoracic sagittal kyphosis (mean =10.29°; P =0.012). The lumbar lordosis decreased 7.76° in average, which was also statistically significant (P = 0.009). The change in sagittal balance (mean, 30.35 mm) in was also found to be statistically significant (P = 0.042). The average decrease of 38.12° in the main thoracic curve was statistically significant (P<0.001).Amean change of 29.50° in thoracolumbar/lumbar curve was significant (P < 0.001). The major curve decreased 39.82° in average, which was statistically signifi-cant (P< 0.001). The average change of 22.82° in secondary curve was also significant (P< 0.001).
全螺钉构型组术前术后比较分析
表1显示全螺钉构型组术前和术后值的比较。平均胸椎矢状面后突在术前和术后有统计学差异（均数=10.29度，p=0.012）。腰椎前突平均减少7.76度，也有统计学意义（p=0.009）。矢状面平衡改变（均数，30.35）也发现有统计学差异（p=0.042）。主胸弯平均下降38.12度也有统计学差异（p〈0.001）。胸腰/胸侧弯平均改变29.50度，有统计学差异（p〈0.001）。主侧弯下降平均39.82度，有统计学差异（p〈0.001），继发侧弯平均改变22.82度也有统计学差异（p〈0.001）。
表1 螺钉组术前术后均数比较
测量结果 N 术前值 术后值 P
（mean±SD） （mean±SD）
胸椎矢状后突（T4-T12） 17 29.65±13.79 19.35±8.45 0.012
腰椎前突（L1-L5） 17 45.53±12.76 35.76±5.96 0.009
胸腰联合(T10-L2) 17 8.35±5.41 8.94±5.53 0.767
矢状面平衡 17 -28.82±52.22 1.53±19.82 0.042
主胸弯 17 53.18±13.09 15.06±9.15 <0.000
胸腰/腰弯 14 41.71±15.15 12.21±10.02 <0.000
冠状面平衡 16 10.00±14.11 6.06±14.79 0.416
主弯 17 54.88±12.48 15.06±9.04 <0.000
继发弯 17 34.65±17.42 11.82±9.84 <0.000
Comparison Between Preoperative and Postoperative Assessment Within the Hybrid Group Table 2 shows the differences between preoperative and postoperative assessments within hybrid groups. There was no significant change after surgery in thoracic sagittal kyphosis (mean 3.82°; P 0.248). The mean difference of 6.29° in lumbar lordosis was found to be statistically significant (P 0.037). The average change of 29.41 mm in sagittal balance was also significant (P 0.017). The main thoracic curve demonstrated a mean decrease of 29.19°, which was significant (P 0.001). Also, there was statistically significant mean difference in the thoracolumbar/lumbar curve before surgery and after surgery (26.56°; P 0.001). The average decrease of 33.81° in the major curve was statistically significant (P 0.001). The change in secondary curve (mean, 30.35°) was found to be also statistically significant (P 0.001).
混合构型组术前术后比较分析
表2显示混合构型组术前和术后值的比较。平均胸椎矢状面后突在术前和术后没有统计学差异（均数=3.82度，p=0.248）。腰椎前突平均减少6.29度，有统计学意义（p=0.037）。矢状面平衡改变（均数，29.41）也发现有统计学差异（p=0.017）。主胸弯平均下降29.19度有统计学差异（p〈0.001）。胸腰/胸侧弯平均改变26.56度，有统计学差异（p〈0.001）。主侧弯下降平均33.81度，有统计学差异p〈0.001），继发侧弯平均改变30.35度也有统计学差异（p〈0.001）。
表2 混合构型组术前术后均数比较
测量结果 N 术前值 术后值 P
（mean±SD） （mean±SD）
胸椎矢状后突（T4-T12） 17 26.24±11.22 22.42±10.47 0.248
腰椎前突（L1-L5） 17 41.29±14.29 35.00±9.57 0.037
胸腰联合(T10-L2) 17 10.94±9.20 9.71±6.76 0.595
矢状面平衡 17 -21.24±36.82 8.17±23.82 0.017
主胸弯 17 48.81±12.63 17.63±10.35 <0.001
胸腰/腰弯 16 42.25±16.32 15.69±9.55 <0.001
冠状面平衡 16 11.00±13.93 6.69±10.85 0.238
主弯 16 54.06±9. 85 20.25±8.56 <0.001
继发弯 16 37.81±10.32 16.44±9.12 <0.001
Comparison Between Changes After Surgery in the All-Screw Group and Changes in the Hybrid Group Next, the changes after surgery between patients with all-screw constructs and patients with the hybrid constructs were compared (Table 3). There was no signifi-cant difference between the all-screw constructs and thehybrid constructs. Although there was no statistical significance,a trend was observed (P0.089) toward morecorrection of the main thoracic curve in the all-screwconstruct group (38.12°) than in the hybrid constructgroup (29.19°).
全螺钉构型术后变化值和混合构型术后变化值之间的比较
表3全螺钉构型术后变化值和混合构型术后变化值之间的比较。全螺钉构型和混合构型没有统计学差异。尽管没有统计学差异（p=0.089），但是观察到全螺钉构型组（38.12度）比混合构型组（29.19度）有有较好的矫形主胸弯的趋势。
表3全螺钉构型术后变化值和混合构型术后变化值之间的比较
测量结果 螺钉 混合 P
N （mean±SD） N （mean±SD）
胸椎矢状后突（T4-T12） 17 10.29±14.91 17 3.82±13.15 0.189
腰椎前突（L1-L5） 17 7.76±10.72 17 6.29±11.44 0.701
胸腰联合(T10-L2) 17 0.59±8.03 17 1.24±9.38 0.547
矢状面平衡 17 30.35±13.73 17 29.41±45.77 0.958
主胸弯 17 38.12±14.23 16 17.63±10.35 0.089
胸腰/腰弯 14 42.25±16.32 16 29.19±15.01 0.479
冠状面平衡 17 3.94±19.48 16 4.31±14.04 0.951
主弯 17 39.82±13.02 16 33.81±11.40 0.169
继发弯 17 22.82±15.43 16 21.38±11.02 0.760
Discussion
The goal of our study was to retrospectively compare 2different techniques of posterior idiopathic scoliosis correction.There was no significant difference between the all-screw constructs and the hybrid constructs in thecoronal and sagittal correction in patients with adolescent idiopathic scoliosis in this series.Both constructs achieved success in coronal correction in patients with adolescent idiopathic scoliosis. The main thoracic curve decreased 38.12° by all-screw constructs and 29.19° by hybrid constructs. Although not statistically significant,there was a trend toward better correction of the main thoracic curve in the all-screw construct group compared with hybrid construct group (P0.089). Therefore,it seems likely that in a larger series, and as we gain more experience with all-screw constructs, curve correction and control will prove to be significantly better with that technique In this series, the thoracolumbar/lumbar curves, the major curves, and the secondary curves decreased more on average in the all-screw constructs, but the difference between groups was not significant.我们研究的目的是回顾比较后路特发性侧弯的两种不同技术的区别。在我们这个系列病人中全螺钉构型和混合构型在冠状面和矢状面的矫形没有显著差异。
两种构型在AIS病人的冠状面的矫形中均获得成功。主胸弯和混合构型分别下降38.12度和29.19度。尽管没有统计学差异，但是观察到全螺钉构型有较好的矫形主胸弯的趋势（p=0.089）。因此，看来可能在较大的一组病例和我们获得更多的全螺钉构型的经验时侧弯矫形和控制会比混合型较好。本系列病人，胸腰/腰弯，主弯，继发侧弯平均下降全螺钉构型组比混合构型组多，但没有统计差异。
Both constructs were also successful in achieving sagittal balance in this patient population. Sagittal balance improved from 28.82 mm to 1.53 mm on average in theall-screw group and from 21.24 mm to 8.18 mm in the hybrid group. However, the all-screw group demonstrated a significant decrease in kyphosis from 29.65° to 19.35° (P 0.012), which was not seen in the hybrid group (26.23° to 22.42°, P 0.248). As our experience with the all-screw constructs has increased, we have begun to use larger diameter rods, and it appears that sagittal control is improved and we are able to achieve thoracic kyphosis. 两种构型在矢状面的平衡上也都获得成功。矢状面平衡平均下降全螺钉构型和混合构型分别从-28.82到1.53，-21.24到8.18。然而，全螺钉组后突由29.65度下降到19.35有统计学差异（P=0.012）。混合构型组由26.23度下降到22.42度，没有统计差异（P=0.248）。随着我们全螺钉构型经验的增加，我们已经开始用较大直径的棒，看来矢状面控制可以得到改进，我们可以获得胸椎后突。
The majority of patients were treated by our senior author, who began using thoracic pedicle screw fixation for idiopathic scoliosis correction in 2001. Therefore, the results demonstrated in this study compare 20 years of hook experience with the initial 3 years of thoracic pedicle screw use for scoliosis correction. While previously cited studies showed significant improvement with allscrew construct fixation over hybrid construct fixation in both coronal and sagittal correction and balance, our results were not as conclusive. The use of screws in the thoracic spine has a steep learning curve.6 The all-screw constructs studied here were performed early in our experience. The hybrid constructs were performed with a significant past experience. It is possible that as equal familiarity is obtained using both of these techniques; a more significant difference between the 2 may be observed.大多数病人被我们的年长的作者所作，他开始应用胸椎弓螺钉治疗AIS病人开始于2001年，因此，我们这项研究结果显示的为有20年的钩经验和有3年应用胸椎弓螺钉初步经验的矫正脊柱侧弯的比较。然而过去引用的研究显示全螺钉构型比混合构型固定在冠状面和矢状面矫正和平衡方面获得显著改进。胸椎弓螺钉的应用有一个陡峭的学习曲线6。我们这全螺钉构型的研究是建立在我们的早期经验的基础上的。混合构型我们有非常丰富的经验。随着两项技术得到同样的熟练程度，两组之间更加显著的区别是可能观察到的。
Also, it is possible that different techniques of correction using the same segmental screw construct may result in difference in magnitude of curve improvement. In 2004,Lee et al described their concept of “direct vertebral rotation,” a technique using direct rotation of the thoracic pedicle screws in conjunction with rod derotation.14 They found a significant improvement in coronal and rotational correction with their direct vertebral rotation technique over simple rod derotation alone. In our patients, a similar reduction maneuver was used in both the hybrid group and the all-screw groups. It is possible that simply replacing thoracic hooks with screws may not significantly alter the correction obtained with the same reduction technique.同样节段的椎弓根螺钉构型应用不同的矫正技术也可能得到侧弯改进程度的不同。在2004年，Lee等描述了他们的“直接椎体旋转”概念，此技术为应用直接旋转胸椎椎弓根螺钉和棒反旋转14。他们发现应用直接椎体旋转技术比简单的单独棒反旋转技术能使冠状面和旋转的矫正方面得到显著提高。我们全螺钉构型组和混合构型组均运用相似的技术，简单的放置钩和螺钉可能不能获得同样的矫形效果。
Conclusion
In this study, all-screw constructs and hybrid constructs produced similar results in terms of coronal and sagittal curve correction and balance. In this study, thoracic screws
significantly decreased thoracic kyphosis; an affect was not demonstrable when thoracic hooks were used. Others have demonstrated that all-screw constructs provide better coro-nal and sagittal curve correction and better overall sagittal and coronal balance when compared with all-hook constructs. Further investigation comparing hybrid constructs (thoracic hooks/lumbar pedicle screws) with all-screw constructs is needed to demonstrate whether or not the techniques are equivalent.本研究中，全螺钉构型和混合构型组在在冠状面和矢状面矫正和平衡方面获得类似的结果。本研究中，胸椎弓螺钉显著减低胸椎后突，胸椎钩没有发现同样效果。其他人证明全螺钉构型比混合构型可以获得更好的冠状面和矢状面矫正和冠状面和矢状面平衡。进一步调查比较混合构型（胸椎钩/腰椎螺钉）和全螺钉构型是否为同样的技术是必需的。
Key Points
● This study examined 34 patients with adolescent idiopathic scoliosis who underwent posterior idiopathic scoliosis correction with all pedicle screw constructs versus hybrid thoracic hook lumbar screw constructs.本研究检查了34个AIS病人，他们采用了全钩构型或混合构型矫正及脊柱侧弯。
● There was no significant difference observed when comparing the 2 groups.2组未发现明显区别。
● Although there was no statistical significance, a trend was observed toward better correction of the main thoracic curve in the all-screw construct group.尽管没有统计学差异，胸椎主弯在全螺钉构型可以获得较好矫形。
● The all-screw group demonstrated a significant decrease in kyphosis, which was not seen in the hybrid group.全螺钉构型显著减少后突，在混合构型组未发现此点。
● Hybrid constructs were comparable to all-screw constructs in the correction of coronal plane deformity and sagittal balance.混合构型和全螺钉构型在冠状面畸形和矢状面平衡方面是相似的。
治疗青少年特发性侧凸，最近的器械革新是椎弓根螺钉。椎弓根螺钉联合钩应用于混合构型或者单独被应用于全椎弓根螺钉构型。确切的，什么联合固定技术是最有效的仍然是有争议的。
很多年以来，钩固定构型是治疗青少年特发性侧凸（AIS）的金标准。在胸椎中应用椎弓根螺钉固定的概念的是19世纪70年代末期作为治疗创伤和肿瘤首次提出的1。胸椎弓根螺钉在1995年被suk等作为矫正和治疗AIS的固定选择2 。他们评价和比较了全钩构型和全螺钉构型弯曲矫形的程度。他们发现全螺钉构型的冠状面的矫形明显好于全钩构型。AIS病人被钩或螺钉治疗后矢状面畸形也被研究，发现应用全螺钉构型能较好的矫形轻度后突畸形3。Kim等报告52个AIS病人采用全钩构型或者全螺钉构型的治疗结果4。他们发现术后即刻冠状面主弯的矫形全钩构型为49.9%，全螺钉构型为75.6%,区别是显著的。他们的结论是全螺钉构型提供一个显著的好的侧弯矫形和改进的肺功能值。其它研究显示腰椎弓螺钉比钩构型提供较好的腰椎侧弯矫形和较好的保持矫形效果5。
在1996年，Hamill等研究应用远端螺钉和胸椎钩的混合构型。他们回顾比较CD和椎弓根螺钉联合应用、单独应用CD钩在冠状面、矢状面、轴位上矫形程度。这项技术被用于双主弯的病人。他们报告在混合构型组Cobb角的矫形得到统计学上的显著提高。最低器械固定的椎体倾斜和移位也是混合组较好。作者的结论是在腰椎侧弯凸点应用椎弓根螺钉的混合构型比全钩钩型更能改进冠状面的序列。对该同样的问题，已有更多新近研究，但得到不同的结果。
Lijenqvist等在2002年，store等在2005年发现尽管长期随访（2-12年）显示混合组比全钩组在原发冠状面矫形的维持上要好，但是在术后即刻冠状面矫形上没有显著差别。两组在冠状面的矫形上没有发现区别，两者均显示术前和术后的后突角没有显著改变。手术时间和生活质量在两组也没有显著区别，这些作者认为两种构型提供相似的矫形效果6，7。
椎弓根螺钉力量的潜在好处需要和椎弓根植入的并发症综合考虑。这些危险包括可能的神经损伤，主要血管损伤，损伤胸膜，增加螺钉植入过程中射线的暴露。然而，多项报道证实胸椎椎弓根螺钉植入是可以精确和安全实施的。8-11
许多作者已经显示全螺钉构型或混合构型比全钩构型侧弯矫形效果好。就我们所知，仅一个研究比较了全螺钉构型和混合构型。12。Kim等报告全螺钉构型比混合构型显著改善了主弯矫形和肺功能2。他们也发现最低固定椎体，手术时间，SRS-24评分在两组没有显著区别。应用混合构型的技术有低的危险并发症，我们认为它可以作为较好对照和可能的节段性螺钉固定构型比较的金标准。我们的回顾性研究的目的是比较两组AIS病人中冠状面和矢状面矫形与冠状面和矢状面平衡，一组为胸椎用钩远端用螺钉的混合构型，另组为全螺钉构型。
方法
资料 34个AIS病人，1998-2004年在New York-Preterian 的Morgan Stanley儿童医院 实施后路融合和固定术。17个病人实施全螺钉构型，17个病人实施混合构型。病人根据手术时年龄，手术方法，侧弯定位，融合阶段的数目，侧弯角度配对。全螺钉构型组15个女2个男，手术平均年龄为14.1岁（范围，10-18岁）。混合组构型组14个女3个男，手术平均年龄为13.5岁（范围，10-16岁）。
侧弯定位和放射学分析 对三个站立位术前放射片和术后片进行测量比较。手术和术后拍片测量平均间隔75.73天(范围4-457天)。冠状面侧弯有近胸弯7个，主胸弯35个，胸腰/腰弯32个。尽管近胸弯被进行测量但是从分析中除去了，因为病人数少（全螺钉构型2个，混合构型5个）。冠状面平衡应用颈7终板中心的铅垂线进行测量。最大术前侧弯被认为是主侧弯，进行了该弯术前术后比较，第二大弯被认为继发性弯，进行了该弯术前术后比较。胸椎矢状面后突畸形从T4-T12进行测量，腰椎前凸畸形从L1-L5进行测量，胸腰联合处矢状面测量从T10-L2，矢状面平衡以颈7后下终板铅垂线作一垂线，该线和S1后上终板垂线的距离进行测量。所有测量由一个观察者实施。我们推测Cobb角有2-3.2度的错误范围13。全螺钉组和混合组在术前评价中无统计学差异（p>0.15）。
手术过程 所有病人进行后路脊柱融合和固定，在全椎弓螺钉组，每个椎体进行固定或至少一侧进行每个椎体固定。全螺钉矫形通过棒的插入、旋转、移位、和近端和远端椎体合适的加压或撑开实现和直接椎体旋转技术。全螺钉构型在透视支持下实施（图1）。在混合构型组，胸椎钩安放技术为CD技术，腰椎螺钉在透视下植入。矫形通过棒的插入和旋转，凹侧顶点撑开，远端和近端椎体的合适的加压和撑开来实现（图2）。
统计分析 配对的t检验被用来分析各组中术前和术后弯曲的可能区别。独立样本t检验被用来比较（全螺钉构型组和混合构型组）两组之间术前术后侧弯角度变化程度。所有统计保留2位，p〈0.05被认为有意义。所有统计分析采用SPSS12.0版本。
结果
全螺钉构型组术前术后比较分析
表1显示全螺钉构型组术前和术后值的比较。平均胸椎矢状面后突在术前和术后有统计学差异（均数=10.29度，p=0.012）。腰椎前突平均减少7.76度，也有统计学意义（p=0.009）。矢状面平衡改变（均数，30.35）也发现有统计学差异（p=0.042）。主胸弯平均下降38.12度也有统计学差异（p〈0.001）。胸腰/胸侧弯平均改变29.50度，有统计学差异（p〈0.001）。主侧弯下降平均39.82度，有统计学差异（p〈0.001），继发侧弯平均改变22.82度也有统计学差异（p〈0.001）。
表1 螺钉组术前术后均数比较
测量结果 N 术前值 术后值 P
（mean±SD） （mean±SD）
胸椎矢状后突（T4-T12） 17 29.65±13.79 19.35±8.45 0.012
腰椎前突（L1-L5） 17 45.53±12.76 35.76±5.96 0.009
胸腰联合(T10-L2) 17 8.35±5.41 8.94±5.53 0.767
矢状面平衡 17 -28.82±52.22 1.53±19.82 0.042
主胸弯 17 53.18±13.09 15.06±9.15 <0.000
胸腰/腰弯 14 41.71±15.15 12.21±10.02 <0.000
冠状面平衡 16 10.00±14.11 6.06±14.79 0.416
主弯 17 54.88±12.48 15.06±9.04 <0.000
继发弯 17 34.65±17.42 11.82±9.84 <0.000
混合构型组术前术后比较分析
表2显示混合构型组术前和术后值的比较。平均胸椎矢状面后突在术前和术后没有统计学差异（均数=3.82度，p=0.248）。腰椎前突平均减少6.29度，有统计学意义（p=0.037）。矢状面平衡改变（均数，29.41）也发现有统计学差异（p=0.017）。主胸弯平均下降29.19度有统计学差异（p〈0.001）。胸腰/胸侧弯平均改变26.56度，有统计学差异（p〈0.001）。主侧弯下降平均33.81度，有统计学差异p〈0.001），继发侧弯平均改变30.35度也有统计学差异（p〈0.001）。
表2 混合构型组术前术后均数比较
测量结果 N 术前值 术后值 P
（mean±SD） （mean±SD）
胸椎矢状后突（T4-T12） 17 26.24±11.22 22.42±10.47 0.248
腰椎前突（L1-L5） 17 41.29±14.29 35.00±9.57 0.037
胸腰联合(T10-L2) 17 10.94±9.20 9.71±6.76 0.595
矢状面平衡 17 -21.24±36.82 8.17±23.82 0.017
主胸弯 17 48.81±12.63 17.63±10.35 <0.001
胸腰/腰弯 16 42.25±16.32 15.69±9.55 <0.001
冠状面平衡 16 11.00±13.93 6.69±10.85 0.238
主弯 16 54.06±9. 85 20.25±8.56 <0.001
继发弯 16 37.81±10.32 16.44±9.12 <0.001
全螺钉构型术后变化值和混合构型术后变化值之间的比较
表3全螺钉构型术后变化值和混合构型术后变化值之间的比较。全螺钉构型和混合构型没有统计学差异。尽管没有统计学差异（p=0.089），但是观察到全螺钉构型组（38.12度）比混合构型组（29.19度）有有较好的矫形主胸弯的趋势。
表3全螺钉构型术后变化值和混合构型术后变化值之间的比较
测量结果 螺钉 混合 P
N （mean±SD） N （mean±SD）
胸椎矢状后突（T4-T12） 17 10.29±14.91 17 3.82±13.15 0.189
腰椎前突（L1-L5） 17 7.76±10.72 17 6.29±11.44 0.701
胸腰联合(T10-L2) 17 0.59±8.03 17 1.24±9.38 0.547
矢状面平衡 17 30.35±13.73 17 29.41±45.77 0.958
主胸弯 17 38.12±14.23 16 17.63±10.35 0.089
胸腰/腰弯 14 42.25±16.32 16 29.19±15.01 0.479
冠状面平衡 17 3.94±19.48 16 4.31±14.04 0.951
主弯 17 39.82±13.02 16 33.81±11.40 0.169
继发弯 17 22.82±15.43 16 21.38±11.02 0.760
讨论
我们研究的目的是回顾比较后路特发性侧弯的两种不同技术的区别。在我们这个系列病人中全螺钉构型和混合构型在冠状面和矢状面的矫形没有显著差异。
两种构型在AIS病人的冠状面的矫形中均获得成功。主胸弯和混合构型分别下降38.12度和29.19度。尽管没有统计学差异，但是观察到全螺钉构型有较好的矫形主胸弯的趋势（p=0.089）。因此，看来可能在较大的一组病例和我们获得更多的全螺钉构型的经验时侧弯矫形和控制会比混合型较好。本系列病人，胸腰/腰弯，主弯，继发侧弯平均下降全螺钉构型组比混合构型组多，但没有统计差异。
两种构型在矢状面的平衡上也都获得成功。矢状面平衡平均下降全螺钉构型和混合构型分别从-28.82到1.53，-21.24到8.18。然而，全螺钉组后突由29.65度下降到19.35有统计学差异（P=0.012）。混合构型组由26.23度下降到22.42度，没有统计差异（P=0.248）。随着我们全螺钉构型经验的增加，我们已经开始用较大直径的棒，看来矢状面控制可以得到改进，我们可以获得胸椎后突。
大多数病人被我们的年长的作者所作，他开始应用胸椎弓螺钉治疗AIS病人开始于2001年，因此，我们这项研究结果显示的为有20年的钩经验和有3年应用胸椎弓螺钉初步经验的矫正脊柱侧弯的比较。然而过去引用的研究显示全螺钉构型比混合构型固定在冠状面和矢状面矫正和平衡方面获得显著改进。胸椎弓螺钉的应用有一个陡峭的学习曲线6。我们这全螺钉构型的研究是建立在我们的早期经验的基础上的。混合构型我们有非常丰富的经验。随着两项技术得到同样的熟练程度，两组之间更加显著的区别是可能观察到的。
同样节段的椎弓根螺钉构型应用不同的矫正技术也可能得到侧弯改进程度的不同。在2004年，Lee等描述了他们的“直接椎体旋转”概念，此技术为应用直接旋转胸椎椎弓根螺钉和棒反旋转14。他们发现应用直接椎体旋转技术比简单的单独棒反旋转技术能使冠状面和旋转的矫正方面得到显著提高。我们全螺钉构型组和混合构型组均运用相似的技术，简单的放置钩和螺钉可能不能获得同样的矫形效果。
结论
本研究中，全螺钉构型和混合构型组在在冠状面和矢状面矫正和平衡方面获得类似的结果。本研究中，胸椎弓螺钉显著减低胸椎后突，胸椎钩没有发现同样效果。其他人证明全螺钉构型比混合构型可以获得更好的冠状面和矢状面矫正和冠状面和矢状面平衡。进一步调查比较混合构型（胸椎钩/腰椎螺钉）和全螺钉构型是否为同样的技术是必需的。
关键点
本研究检查了34个AIS病人，他们采用了全钩构型或混合构型矫正及脊柱侧弯。
2组未发现明显区别。
尽管没有统计学差异，胸椎主弯在全螺钉构型可以获得较好矫形。
全螺钉构型显著减少后突，在混合构型组未发现此点。
混合构型和全螺钉构型在冠状面畸形和矢状面平衡方面是相似的。
12. Posterior Spinal Fusion for Scoliosis in Duchenne Muscular Dystrophy Diminishes the Rate of Respiratory Decline.
Duchenne 肌营养不良性脊柱侧突后路融合可以降低呼吸功能降低的发生率
Deformity
畸形
Abstract:
摘要：
Study Design. To assess the rate of decline in pulmonary function in Duchenne muscular dystrophy (DMD) before and after posterior spinal fusion for scoliosis.
研究设计.评估Duchenne肌营养不良性脊柱侧突（DMD)患者在脊柱侧突后路脊柱融合治疗前后的肺功能情况。
Objective. To compare the rate of respiratory decline using percent normal forced vital capacity (%FVC) measurements before and after posterior spinal fusion.
目的.使用目前常用的用力肺活量（FVC）指标来判断脊柱后路融合手术后呼吸功能的降低情况。
Summary of Background Data. Posterior spinal fusion for scoliosis is used widely in DMD, although the long-term pulmonary effects have not been well established.
背景资料.DMD患者的治疗中后路的脊柱融合情况使用很多，尽管长期的对肺组织功能的影响还未十分明了。
Methods. Fifty-six patients were assessed. Percent forced vital capacity was the outcome parameter with data analysis using a mixed-model repeated-measures ANOVA and paired t tests. Group 1: Inclusion criteria were a diagnosis of DMD, 2 or more pulmonary function tests presurgery, and 2 or more postsurgery. Group 2: The rates of respiratory decline before and after spinal fusion for the whole study population were determined by within- subjects mixed-model regression analysis to account for the varying number of FVC studies between patients and unequal spacing between tests.
方法.评估了56例患者。用力肺活量作为分析的参数使用混合的模型反复使用ANOVA和配对t检验进行统计学比较。组I：诊断为DMD，术前进行2次或者更多的肺功能测试在手术前后。组II：使用线性回归分析比较患者和不对称的总体间术前和术后呼吸功能的降低率，来比较用力肺活量的变异数目。
Results. Group 1: 20 patients. Mean length of time of respiratory value determination was 2.5 +/- 1.0 years presurgery and 5.6 +/- 2.8 years postsurgery. Mean rate of decline presurgery was 8.0% +/- 4.1% per year, which decreased to 3.9% +/- 1.9% per year postsurgery (paired t test = 4.58, P < 0.0001). Group 2: 56 patients. The respiratory value determinations ranged from 4 years presurgery to 8 years postsurgery. The rates of respiratory decline based on the whole study population were 4% per year presurgery, which decreased to 1.75% per year postsurgery (F-test comparison of slopes = 19.71, P < 0.0001).
结果. 组I：20例患者。术前平均测定的时间是 2.5 +/- 1.0年，术后是5.6 +/- 2.8 年。术前平均降低率是 每年8.0% +/- 4.1%，术后为每年3.9% +/- 1.9%（配对t检验，t＝ 4.58, P < 0.0001)。组II：56例，术前平均测定的时间是4年，术后是8年。呼吸功能术前降低率是4%，术后为1.75%(F = 19.71, P < 0.0001)
Conclusions. Posterior spinal fusion for scoliosis in DMD is associated with a significant decrease in the rate of respiratory decline postsurgery compared with presurgery rates.
结论.与术前相比，DMD患者行后路脊柱融合手术后可以明显降低呼吸功能。
11. Thoracoscopic Scoliosis Surgery Affects Pulmonary Function Less Than Thoracotomy at 2 Years Postsurgery.
术后2年的随访研究发现胸腔镜脊柱侧突矫正手术较开胸手术对肺功能的影响较小
Abstract:
摘要：
Study Design. Prospective evaluation of pulmonary function before and 2 years after surgery following anterior scoliosis instrumentation.
研究设计.前瞻性的分别在术前和术后2年的时间内评价脊柱侧突前方内固定对肺功能的影响。
Objectives. To determine if thoracoscopic anterior scoliosis correction with instrumentation affected pulmonary function less than open thoracotomy approaches at 2 years follow-up.
目的.研究是否前方的胸腔镜脊柱侧突矫正手术影响肺组织的功能较传统的开胸手术较小。
Summary of Background Data. The thoracoscopic approach has been shown to have a smaller reduction in pulmonary function tests (PFTs) compared with an open thoracotomy approach following anterior thoracic instrumentation for adolescent idiopathic scoliosis in the immediate postoperative period; however, it is unclear if a difference remains 2 years following the procedure.
研究背景.与传统的开胸手术相比，胸腔镜手术在治疗青少年特发性脊柱侧突前路内固定时在术后即刻可以较少的减少肺功能测试的结果；然而是否在术后2年的时间内依然存在这个优势还没有研究结果支持。
Methods. A total of 107 patients in a multicenter adolescent idiopathic scoliosis database underwent an anterior instrumented fusion for thoracic scoliosis. PFTs assessing forced vital capacity (FVC), forced expiratory volume (FEV1), and total lung capacity (TLC) were obtained prospectively before and 2 years after surgery. The patients were grouped as follows: Group I, thoracoscopic instrumented fusion (n = 36); Group II, open (thoracotomy) instrumented fusion without thoracoplasty (n = 28); and Group III, open instrumented fusion with thoracoplasty (n = 43).
方法. 多中心的107例青少年特发性脊柱侧突患者由于接受前方器械内固定畸形手术的资料包括在本研究中。包括最大通气量（FVC),用力呼气容量(FEV1)和肺总量（TLC)等在内的肺功能测试分别在术前和术后2年测试。患者按照如下进行分类：第一组，胸腔镜手术，36例；第二组，开胸手术器械固定未行胸廓成形术，28例；第三组，开胸手术加胸廓成形术，43例。
Results. Thoracoscopic instrumentation affected pulmonary function 2 years after surgery minimally, and on an average showed improvements in all parameters except the percent-predicted FVC, which decreased by 1% +/- 11%, and percent predicted FEV, which decreased by 2% +/- 9%. Improvements were noted in absolute FVC, FEV1, TLC, and percent-predicted TLC. This is in contrast to the patients treated with a thoracotomy, who had a greater persistent reduction in PFTs at follow-up. An added thoracoplasty to the thoracotomy approach, however, resulted in even greater residual reduction in PFTs at follow-up, with declines in percent-predicted FVC of 15%, percent-predicted FEV1 of 14%, and percent-predicted TLC of 8%.
结果.术后2年胸腔镜手术对肺功能的影响较小，除了预期最大通气量FVC和FEV1以外的所有参数都明显提高。降低了1%+/- 11%，预期用力呼气量FEV1降低了 2% +/- 9%。绝对FVC,FEV1.TLC和预期TLC增加了。相比之下，开胸手术的患者在随访期内所有的肺功能测试的指标都没有明显的改善。然而，在开胸手术基础上增加的胸廓成形术反而导致术后肺功能的恢复减慢，预期最大通气量降低了15%，预期用力呼气量降低了14%，肺总量降低了8%。
Conclusions. This study shows a clear advantage to the minimally invasive thoracoscopic approach with regards to pulmonary function when compared with the open thoracotomy approaches.
结论.此研究显示微创胸腔镜手术在治疗脊柱侧突上较传统的开胸手术具有很大的优势。
A Prospective Randomized Study of Unilateral Versus Bilateral Instrumented Posterolateral Lumbar Fusion in Degenerative Spondylolisthesis.
Randomized Trial
Abstract:
Study Design. Prospective randomized study on 82 patients with degenerative lumbar spondylolisthesis, having undergone posterolateral fusion with bilateral or unilateral instrumentation.
Objective. To determine the effectiveness of unilateral pedicle instrumentation in clinical outcome and rate of union in comparison with the classic bilateral system.
Summary of Background Data. Instrumentation has proved to have advantages and disadvantages related to its rigidity. The use of less rigid systems applied to posterior lumbar fusions proved promising according to the results achieved in both experimental and clinical field.
Methods. Eighty-two patients were randomized into 2 groups: Group 1 (n = 42) had had bilateral instrumentation, and Group 2 (n = 40) had only had unilateral instrumentation. One case from Group 1, L3-S1 dropped out; only fusions of 1 or 2 levels remained in the study. Length of time spent on operating, blood loss, blood transfusion, hospital stay, complications, clinical results measured by SF-36v2, and radiologic assessment of union and of loss of height of adjacent discs were analyzed and compared by means of [chi]2 test, t test, and Fisher exact test.
Results. Statistically, there was no significant difference between the 2 groups in relation to demographics, blood loss, need of transfusion, hospital stay, complications, clinical results, rate of union, and effect on adjacent discs. The operating time needed for Group 2 was significantly shorter in than the time needed for Group 1 (P < 0.001). In Group 1, 3 of 186 screws violated the pedicle cortex requiring reoperation because root irritation versus no complication on a total of 90 screws in Group 2.
Conclusion. Unilateral instrumentation used for the treatment of degenerative lumbar spondylolisthesis is as effective as bilateral instrumentation when performed in addition to 1- or 2-level posterolateral fusion. The cost of this method is lower, saves time, and reduces possible risk inserting screws in only one side.
(C) 2007 Lippincott Williams & Wilkins, Inc.
一项对退变性脊柱滑脱后外侧腰椎融合术采用单侧于双侧器械对比的前瞻性随机研究
随机研究
摘要
研究设计：82例退变性腰椎滑脱的患者，采用双侧或单侧器械进行了后外侧的融合，对其进行前瞻性的随机研究。
研究目标：与经典的双侧器械系统对比，从临床效果以及融合率上判定单侧椎弓根器械的作用。
背景资料总结：因为固定强度的关系，器械有其优点也有其不利的一面。从临床与实验所得到的结果来看，使用不太坚强的固定系统进行后路腰椎的融合是有良好前景的。
研究方法：将82例患者随机分为两组：第一组42例采用双侧器械，第二组40例只是采用单侧器械。在第一组中有一例患者，腰3-骶1内固定脱出，在研究中只有1到2个水平的融合得以保留。手术时间，失血量，输血量，住院时间，并发症以及临床结果等采用SF-36v2进行评价；对于融合率的放射学诊断和邻近椎间盘的高度丢失采用卡方检验，t检验以及Fisher exact 检验进行对比分析。
研究结果：在统计学上，两组在基本外形、失血量、是否需要输血、住院时间、并发症、临床结果、融合率以及对邻近椎间盘的作用上并无显著性差异。第二组所需的手术时间比第一组明显缩短（P<0.001）。在第一组中，186枚螺钉中有3枚穿破了椎弓根皮质，因为神经根激惹而需要再次手术；第二组的共90枚螺钉中没有并发症。
研究结论：在治疗退变性腰椎滑脱而进行1到2个节段的后外侧融合时，单侧器械和双侧一样有效。单侧的器械花费少，节省时间，而且减低了植入螺钉时的可能风险。
Anti-TNF-[alpha] Antibody Reduces Pain-Behavioral Changes Induced by Epidural Application of Nucleus Pulposus in a Rat Model Depending on the Timing of Administration.
Basic Science
Spine. 32(4):413-416, February 15, 2007.
Sasaki, Nobuhisa MD, PhD; Kikuchi, Shin-ichi MD, PhD; Konno, Shin-ichi MD, PhD; Sekiguchi, Miho MD, PhD; Watanabe, Kazuyuki MD
Abstract:
Study Design. An experimental animal study.
Objective. To study if antitumor necrosis factor-alpha (TNF-[alpha]) antibody, which is administered at different times, reduces the pain behavior induced by application of nucleus pulposus (NP) to the nerve root.
Summary of Background Data. Treatment with TNF-[alpha] inhibitor reduces the pain-related behavior induced by epidural application of NP in rats.
Methods. Left L5 partial laminectomy was performed and NP was applied to the L5 nerve root in 24 rats. The rats were divided into 4 groups. In 3 groups, anti-rat TNF-[alpha] antibody was intravenously administered immediately after, or 6 or 20 days after NP application. The fourth group was not treated with anti-rat TNF-[alpha] antibody (untreated rats). The withdrawal threshold of the plantar surface was determined 1 day before up through 28 days after NP application.
Results. The withdrawal threshold of rats that had been treated with anti-rat TNF-[alpha] antibody immediately after or 6 days after, but not 20 days after, NP application, was significantly higher than that of the untreated rats.
Conclusions. Anti-TNF-[alpha] antibody reduced allodynia only when it was administered soon after the onset of allodynia. Late administration of anti-TNF-[alpha] antibody did not have an antiallodynic effect.
(C) 2007 Lippincott Williams & Wilkins, Inc.
依据给药时间不同抗TNF-α抗体可以降低鼠模型中髓核刺激硬膜囊所致的疼痛行为改变
摘要
研究设计：动物实验研究。
研究目标：研究是否抗肿瘤坏死因子α抗体在不同的给药时间会减低因为髓核作用于神经根而导致的疼痛行为。
背景资料总结：在鼠中采用TNF-α抑制剂治疗可以降低因髓核压迫硬膜囊所致的疼痛相关行为。
研究方法：共24鼠，切除腰5左侧部分椎板，用髓核压迫L5神经根。将鼠分为4组，在3组中，在髓核压迫后立即、6天后、20天后静脉给以抗鼠的TNF-α抗体。第四组不给与抗体（非治疗组）。在髓核压迫后的28天之前一天测定鼠足平面的收缩高度。
研究结果：在髓核压迫之后立即给药和6天后给药组，而不是20天之后给药组鼠的收缩高度显著高于未治疗组。
研究结论：只有在allodynia发作之后不久给药，抗TNF-α抗体才能降低allodynia。抗TNF-α抗体的晚期给药没有抗allodynia的效果。
Outcome and Management of Spinal Tuberculosis According to the Severity of Disease: A Retrospective Study of 137 Adult Patients at Korean Teaching Hospitals
脊柱结核与病变严重程度相关的治疗和疗效：韩国教学医院对137例成人患者的一项回顾性研究
Abstract
Study Design. A retrospective study examining the clinical features, management, and treatment outcome of patients with spinal tuberculosis (T.
研究设计：一项对脊柱结核患者临床特征、治疗、疗效进行检测的回顾性研究
Objective. To determine the influence of disease severity and treatment modality on outcome of patients with spinal TB.
目的：检测病变严重程度和治疗方式对脊柱结核患者治疗结果的影响。
Summary of Background Data. Although anti-TB chemotherapy is now the mainstay treatment for spinal TB, it may not be applicable to all situations, especially in patients with risk of deformity, instability, and progression of neurologic deficit.
背景资料概述：虽然抗结核化疗是目前脊柱结核的主要治疗方法，但这并不一定适合于所有状况，尤其是对于那些有畸形、不稳和进展性神经损害风险的患者。
Methods. In this retrospective study (1994–2003), medical records and radiographic findings of patients with spinal TB were reviewed at 7 teaching hospitals in South Korea. The duration of triple chemotherapy with isoniazid, rifampin, and ethambutol, disease severity, operative procedures, and outcome were analyzed. The outcome was assessed as both favorable and unfavorable according to predefined criteria.
方法：在这一回顾性研究中（1994-2003），我们复习了韩国7所教学医院中脊柱结核患者的病历和X线资料。对用异烟肼、利福平、乙胺丁醇进行三联化疗的持续时间，病变的严重程度，手术方式和治疗结果进行分析。按照预先的标准，对有利于和不利于结果都进行评价。
Results. A total of 137 patients were diagnosed with spinal TB during the study period. Twenty-one patients were lost to follow-up and excluded from analysis. The mean age was 44.07 ± 16.57 years. The most common vertebral area involved was the lumbar (44.8%). The mean number of vertebra involved was 2.25. The mean angle of kyphosis was 21.58°. Forty-seven patients (35.1%) had severe symptoms. Radical surgery was carried out in 84 (62.2%) patients. Twenty patients were treated with short-term chemotherapy, while 96 under long-term. At the end of chemotherapy, 94 patients had achieved a favorable status and 22 an unfavorable one. Statistically, there was no significant difference between the 2 groups in terms of gender, chemotherapy duration, or the severity of spinal TB; however, age (P = 0.025; odds ratio = 0.963; 95% confidence interval 0.932–0.995) and radical surgery (P = 0.043; odds ratio = 3.047; 95% confidence interval 1.038–8.942) were significantly related to a favorable outcome by logistic analysis.
结果：在研究期间，总共137例患者被诊断为脊柱结核。其中21例患者由于失访而没有进行分析。平均年龄44.07 ± 16.57岁，最常见的受累的椎体区域是腰椎(44.8%)。平均受累椎体数为2.25，平均后突角为21.58°。47例患者(35.1%)有严重的症状。84例患者 (62.2%)进行了根治手术。20例患者进行了短期的化疗，而96例患者进行了长期的化疗。化疗结束时，94例患者达到了一个良好的状况，22例患者的状况较差。从统计学上来看，对于性别、化疗持续的时间或者脊柱结核的严重程度，两者之间没有显著性差异。然而，经Logistic分析，年龄(P = 0.025; odds ratio = 0.963; 95% CI 0.932–0.995) 和根治性手术 (P = 0.043; odds ratio = 3.047; 95% CI 1.038–8.942)均有良好的结果显著相关。
Conclusions. Our results showed that a younger age and radical surgery in conjunction with anti-TB chemotherapy were significant favorable prognostic factors.
结论：我们的结果显示叫年轻的年龄和根治性手术结合抗结核化疗是重要的良好的预后因素。
Key words: tuberculosis; spine; outcome; treatment
关键词：结核；脊柱；疗效；治疗
Factors Predicting Cervical Collar-Related Decubitus Ulceration in Major Trauma Patients.
因素预测在成年创伤患者中颈托所致的压疮
Study Design. Retrospective medical record and electronic database audit to ascertain the incidence and predictors of cervical collar-related decubitus ulceration (CRU).
研究设计:回顾医学记录和电子数据库确定颈托所致压疮的发生率及预测因素.
Objective. To determine the incidence and risk factors associated with the development of CRU in major trauma patients immobilized in Philadelphia cervical collars.
目的:确定使用费城颈托的成年创伤患者CRU的发生率及相关危险因素.
Summary of Background Data. Cervical spine immobilization requires the utilization of a cervical collar before spinal clearance, which may be complicated by CRU and increased morbidity.
背景资料:在脊柱愈合之前颈椎固定需要使用一种颈托固定,它可能并发CRU和增加发病.
Methods. From a trauma registry database at a level 1 trauma center, 299 major trauma patients admitted over a 6-month period were identified. Predictors of CRU were retrospectively examined and assessed for relative importance using medical records and prospective infection control and radiology databases.
方法:在一等创伤中心从创伤登记数据库中选出299名被确定具有6 个月以上病史的成年创伤患者.,通过使用医疗文件,预期感染控制及放射学数据对CRU 的预测因素进行回顾性分析和相关重要性评价.
Results. Clinically significant predictors of CRU were ICU admission (P = 0.007), mechanical ventilation (P = 0.005), the necessity for cervical MRI (P <= 0.001), and time to cervical spine clearance (P <= 0.001). Time to cervical spine clearance was the major indicator, such that the risk of CRU increased by 66% for every 1 day increase in cervical collar time.
结果:临床上有显著性意义的CRU预测因素是CU监护使用(P = 0.007),机械通气(P = 0.005),颈椎核磁的重要性(P <= 0.001),以及颈椎痊愈的时间(P <= 0.001).后者是主要因素,所以CRU的风险随着颈托佩戴时间每增加一天便增加66%.
Conclusion. In major trauma patients at a level 1 trauma center, the risk of CRU development increased significantly for every day of Philadelphia cervical collar time. Associated increased morbidity may be reduced by measures aimed at earlier cervical spine clearance.
结论:在一级创伤中心的成年创伤患者中, CRU的发生风险随着费城颈托固定时间增加显著增加.相应发病的增加可以通过针对颈椎早期痊愈采取措施而降低.
Residual Sagittal Motion After Lumbar Fusion: A Finite Element Analysis With Implications on Radiographic Flexion-Extension Criteria.
腰椎融合后残存矢状面运动：与过伸过屈位片评判标准有关的多元化分析
Biomechanics
生物力学
Spine. 32(4):417-422, February 15, 2007.
脊柱学杂志 32(4):417-422,2007年2月15日
Bono, Christopher M. MD *; Khandha, Ashutosh MS +; Vadapalli, S MS +; Holekamp, Scott MS +; Goel, Vijay K. PhD +; Garfin, Steven R. MD ++
Bono, Christopher M. 医学博士；Khandha, Ashutosh 理学硕士；Vadapalli, S 理学硕士；Holekamp, Scott 理学硕士；Goel, Vijay K. 博士；Garfin, Steven R. 医学博士
Abstract:
Study Design. Finite element analysis of a lumbar fusion model.
摘要：
研究设计：对腰椎融合模型进行多元化分析。
Objectives. To quantify residual sagittal angular motion following various types and levels of completeness of lumbar fusion in order to understand better the validity of current recommendations for interpreting flexion- extension radiographs to assess fusion.
研究目的：在不同方式的融合术后腰椎已不同程度达到融合目的后，将腰部残留的角转运动功能加以量化，以更深入地理解目前所采取的手术方式对实现腰椎融合的有效性，其中主要通过腰椎过伸过屈位片来对融合效果进行评估。
Summary of Background Data. Recommended threshold criteria for solid fusion using flexion-extension radiographs have varied from 0[degrees] to 5[degrees] of angular motion between vertebrae. Notwithstanding this wide variation and lack of uniform consensus, the validity of these criteria has not been previously biomechanically assessed to the authors' knowledge. To investigate this issue, the authors sought to test various types of simulated healed, noninstrumented lumbar fusions using finite element modeling to determine the amount of residual angular motion under physiologic stresses.
概括背景资料：我们推荐评判融合是否稳定的标准是：在腰椎过伸过屈位片上，椎间的矢状面活动角度不超过5度。这个范围较宽泛，也没有被较多人认可，而据作者所知，目前这个标准的有效性还没有在生物力学上得到评估。为了探究这一课题，我们运用多元化的方法来建立和测验各种类型的已被治愈的腰椎融合模型，然后得出在生理性压力下残存矢状面活动角度的有关数值。
Methods. A validated 3-dimensional, nonlinear finite element model of an intact adult human L3-L4 motion segment was developed. Four fusion types were simulated using this model, including anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), intertransverse process fusion, and interspinous process fusion. Variations of completeness of fusion were also represented. For ALIF and PLIF, this included tests of solid bridging bone within the posterior or anterior 75%, 50%, or 25% disc space. In addition, PLIF was also tested with either a unilateral or bilateral facetectomy to simulate commonly used surgical techniques. Variations of intertransverse process fusion included unilateral or bilateral bridging bone with or without medial fusion to the pars interarticularis. Only 1 scenario of a healed, solid interspinous process fusion was tested. The intact model and all fusion models were stressed with 10.6-Nm flexion and extension moments. The angular deflections were recorded in degrees.
方法：制作一个完整的成人腰3-4节段三维立体多元化模型，再用这个模型来制成4种融合方式的模型，包括腰椎前路椎间融合(ALIF)、腰椎后路椎间融合(PLIF)、腰椎横突间植骨融合、椎板棘突间植骨融合；而且达到融合的程度也不尽相同。对腰椎前路椎间融合与后路椎间融合来说，包括对起稳定连接作用的植骨骨质的测验，这些骨质在前路或后路手术中分别占椎间隙的75%, 50%或者25%。此外，后路椎间融合模型还要通过在外科手术中很常用的单侧或双侧椎骨关节面切除来测试。对横突间植骨融合而言，主要包括对单侧或双侧植骨骨质的测试，可以同时伴有或不伴有峡部近内侧融合。椎板棘突间植骨融合中，只测试了1个已达到融合目的的案例。这个多元化模型和所有被测试的腰椎融合模型都被施加10.6Nm大小的伸屈力矩，所偏转的角度以度为单位记录。
Results. A wide range of sagittal angular motion was recorded. For ALIF, this ranged from 0.8[degrees] (complete, 100% fusion) to 3.3[degrees] (solid fusion of the posterior 25% disc space). For PLIF, the numbers were more varied, ranging from 0.7[degrees] (complete, 100% fusion) to 6.9[degrees] (solid fusion of posterior 25% disc space with bilateral facetectomy). For intertransverse process fusion, the least motion was with a solid bilateral fusion, with medial healing to the pars (2.0[degrees]); the greatest motion was found with a solid unilateral fusion without medial healing (6.0[degrees]). Interspinous process fusion allowed only 1.9[degrees] of motion.
结果：所记录的矢状面活动角度范围较大。前路椎间融合，范围是0.8度（完全、100%融合）到3.3度（后方椎间隙25% 的稳定融合）；后路椎间融合范围较大，是0.7度（完全、100% 融合）到6.9度（伴有双侧峡部近内侧融合的后方椎间隙25% 的稳定融合）；横突间植骨融合，最小值2.0度是双侧偏内侧稳定融合，最大值6.0度是单侧且不偏向内侧融合；椎板棘突间植骨融合只出现1.9度的活动度。
Conclusions. The amount of residual flexion-extension motion with simulated lumbar fusions (presumably allowed by the bone's inherent elasticity) under physiologically comparable moments varies with fusion type and, more substantially, with varying amounts of completeness. The current study documents a range of sagittal angular motion after several types of simulated lumbar fusion that appear to have considerable overlap with previously purported radiographic criteria for solid fusion using flexion-extension radiographs. However, it also suggests the possibility that some scenarios of solid, yet incomplete, fusion may allow motion that is substantially greater than 5[degrees], which is beyond the most liberal of previously published threshold criteria.
结论：经过对大量腰椎融合模型研究所得出腰椎融合后残留屈伸功能（这种残留功能推测是由骨质自身存在的弹性所致）的有关数据进行分析，并有生理性数据作为对照，认为残留活动度与融合方式有关，与融合程度的关系也甚为密切。本研究证实了腰椎以不同方式融合后矢状面上活动角度的允许范围，似乎印证了以前用过伸过屈位片评判融合后腰椎残留运动功能的影像学中未经证实的标准。尽管如此，它还是说明稳定的融合后腰椎矢状面活动也许要大于5度的可能性。尽管这种假想还未经完善，可它对现有文献报道过的诸多范围和标准还是造成一定冲击力的。
A Novel Mathematical Model of the Sagittal Spine
一个新的矢状椎体的数学模型
Abstract:
摘要：
Study Design. Development of a mathematical model with application to a cohort of healthy volunteers.
研究设计.找出一种可以应用于健康志愿者的数学模型。
Objectives. To derive a smooth mathematical function representing the sagittal spinal curve from individual vertebral elements. To generate normative data using this model.
目的.从独立的椎体的矢状椎体曲线数据中获得一种能彻底表现其功能的数学模型，并且通过这种模型，我们可以模拟它的最基本的特征。
Summary of Background Data. Current concepts of spinal sagittal balance center on the C7 plumb line. While elegant in its ease of use, this method oversimplifies the true complexity of the spine. If the spinal curve could be expressed as a smooth mathematical function, the ability to analyze sagittal balance would be greatly enhanced.
背景概要：当前的研究表明，椎体矢状平衡中心存在于C7垂直线上。但是在使用这种简化方式的同时，这种过度方法又过度简化了椎体的真正的复杂性。如果，椎体的曲线可以通过数学方法流 畅地表达出来，我们分析矢状方向上的平衡的能力将会得到极大的强化。
Methods. Lateral full-length radiographs of 18 normal volunteers were examined. The posterosuperior aspect of each vertebral body was chosen as a representative point for the spinal sagittal curve. A cubic spline function was derived from these points. From this function, the area under the curve (AUC) and average sagittal positions of the thoracic, lumbar, and thoracolumbar segments were calculated.
方法.我们对18个正常志愿者进行了椎体的外侧全长影像学检查。每个最体的上后方的面都被作为代表矢状曲线的一个点。通过这些点，我们得到了其垂直方向的立体图象。通过这些图象，这些曲线下的面积(AUC)以及胸椎、腰椎、胸腰椎段的平均矢状位置都被计算出来。
Results. Assuming an average vertebral column height of 60 cm with anterior being positive, the average position of the posterosuperior aspect of C7 relative to S1 was -2.8 cm (+/-3.0). The average thoracolumbar AUC was -161 cm2 (+/-83). The average lumbar and thoracic AUCs were 0 cm2 (+/-17) and -157 cm2 (+/-68), respectively. The average sagittal position over the thoracolumbar curve was -3.3 cm (+/-1.7). The average sagittal positions of the lumbar and thoracic subcurves were 0.1 cm (+/-1.1) and -5.1 cm (+/-2.2), respectively. Intraobserver and interobserver reliabilities were excellent.
结果：以前方为正，假设椎体的平均高度为60cm，C7的靠近S1的后上方平均位置为-2.8 cm (+/-3.0)。胸腰椎的平均AUC为－161cm2(+/-83)。腰椎和胸椎的平均AUC为0 cm2 (+/-17)和-157 cm2 (+/-68)。相对地，在胸腰椎曲线上方的平均矢状位置为-3.3 cm (+/-1.7)。腰椎和胸椎的副曲线的平均矢状位置为0.1 cm (+/-1.1)和-5.1 cm (+/-2.2)。观察者和观察者间变异是显著的。
Conclusions. A mathematical model of the sagittal spine that retains the spine's segmental nuances was derived using cubic spline interpolation. The average sagittal position of the thoracolumbar spine, a calculation based on the AUC, is a less variable measure of sagittal balance than the C7 plumb line. The model and normative data generated from it will allow more insightful investigations of spinal deformity and more quantitative evaluations of corrective outcomes.
结论. 通过立方垂直插入的方式，我们获得了保留有椎体节段特点的矢状椎体的数学模型。通过基于计算AUC的方式，我们得出通过胸腰椎体的平均矢状位置来衡量C7的垂直线是一个更加稳定可靠的方法。这种模型和它产生的常规数据，使得我们能够对椎体的形态有更深入的了解，并且能够得到大量的正确的评估结果。
Postural Changes of the Dural Sac in the Lumbar Spines of Asymptomatic Individuals Using Positional Stand-Up Magnetic Resonance Imaging.
运用站立位MRI观察无症状个体腰部脊柱硬脊膜囊位置改变的研究
Abstract:
Study Design. Positional magnetic resonance imaging (MRI) study of control subjects.
研究设计：对控制受试者的定位MRI研究。
Objectives. To determine dimensional changes in the lumbar dural sac as a function of posture, and to establish changes between the supine, erect and seated positions.
［color=blue]研究目的：测量腰部硬脊膜囊在不同体位下的改变以及确定分别在仰卧位，直立位，坐位下的不同变化.[/color]
Summary of Background Data. Studies using computerized tomography and MRI were done to determine the mechanical effects on the lumbar spinal canal in the different positions. There has been no consecutive study, however, in which normal individuals were investigated for positional changes of the dural sac, including true standing position.
背景数据概要：本研究运用CT和MRI确定不同体位对腰部椎管的影响机制，而且目前还没有对正常个体在不同体位下硬脊膜囊改变包括真正的站立位下改变的连续性研究。
Methods. Thirty-two male asymptomatic volunteers were recruited. The examination was performed using a new MRI system. All subjects were examined with sagittal T2 and axial T1-weighted spin-echo images. The subjects were studied in the supine, standing, and sitting positions. The measurements were made using OSIRIS software (Digital Imaging Unit University Hospital of Geneva, Geneva, Switzerland). On axial images, dural sac cross-sectional area and anteroposterior (AP) dural sac diameter were measured at the level of the L3/4, L4/5, and L5/S1 discs. On midsagittal images, AP dural sac diameter and the upper-endplate angles of L1 and S1 were measured.
研究方法：共召集32名男性无症状志愿者并运用一台新MRI系统进行测量。所有受试者都运用矢状T2和轴向T1加权自旋回波图像进行测量。受试者分别接受仰卧位，站立位和坐位的研究。运用OSIRIS软件（瑞士日内瓦大学医院数字影像装置）进行测量。在轴位图像上，硬脊膜囊的横截面面积和前后径分别在L3/4,L4/5和L5/S1椎间盘高度进行测量。在正中矢状位图像上测量了L1和S1水平的硬脊膜囊的前后径和上终板角。
Results. We found a disc degeneration or disc protrusion in 41% (12/29) of the subjects, but there was no obvious compression of the dural sac. Depending on the postures, the mean dural sac cross-sectional area and AP dural sac diameter changed. At all levels, mean dural sac cross-sectional area in the supine position was significantly smaller than in other postures. The dural area decreased most at the L5/S1 level due to positional change from standing to supine. The largest dural area at the L5/S1 level was in sitting extended. AP dural sac diameter on axial and midsagittal images showed a similar tendency.
研究结果：我们发现41%（12/29）的受试者存在椎间盘的突变或者突出，但都未明显压迫硬脊膜囊。硬脊膜囊的平均横截面积和前后径随体位的不同而发生变化。在不同脊椎高度，硬脊膜囊的平均横截面积在仰卧位是显著小于其他体位时。从站立位改为仰卧位时硬脊膜区域的减小以L5/1水平最为显著。L5/S1水平最大的硬脊膜区域出现在长时间坐位时。前后径在轴位和正中矢状位上呈现相似的变化趋势。
Conclusions. A significant posture-dependent difference of the dural sac cross-sectional area at the level of intervertebral disc in asymptomatic volunteers has been demonstrated. When the posture changed from supine to standing position, lumbar dural sac volume expanded by the increased pressure of cerebrospinal fluid, and the dural sac cross-sectional area increased. The smallest values were found in the supine position
研究结论：无症状志愿受试者在椎间盘水平上出现了明显的依赖于姿势的硬脊膜囊横截面积的改变，当姿势由仰卧位改为站立位时由于脑脊液流体压力的增加导致腰部硬脊膜囊容积的扩大和和解面积的增大。在仰卧位时所有测量值都达到最小。
Can a New Behaviorally Oriented Training Process to Improve Lifting Technique Prevent Occupationally Related Back Injuries Due to Lifting?
一个新的行为训练程序可以改进因职业性抬举运动所致腰背损伤者的抬举技巧吗？
Abstract:
摘要：
Study Design. A prospective randomized control trial.
研究设计：一个前瞻性随机试验。
Objective. To determine the degree to which a new behavior-based lift training program (LiftTrainer[TM]; Ascension Technology, Burlington, VT) could reduce the incidence of low back disorder in distribution center jobs that require repetitive lifting.
目的：为了确定一个基于行为活动的抬举训练系统(LiftTrainer[TM]; Ascension Technology, Burlington, VT)降低分配中心里面从事重复性抬举活动的工人的腰背痛疾病的发生率的程度。
Summary of Background Data. Most studies show programs aimed at training lifting techniques to be ineffective in preventing low back disorders, which may be due to their conceptual rather than behavioral learning approach.
背景概述：许多研究显示，对于腰背痛的患者来说，改进抬举技巧的训练系统效果并不是很好。这可能应该归因于他们对其的理解，而不是由于行为学习的途径造成的。
Methods. A total of 2144 employees in 19 distribution centers were randomized into either the LiftTrainer[TM] program or a video control group. In the LiftTrainer[TM] program, participants were individually trained in up to 5, 30-minute sessions while instrumented with motion capture sensors to quantify the L5/S1 moments. Twelve months following the initial training, injury data were obtained from company records.
方法：总共有在19哥分发中心的2144名工人被随机分到了抬举训练组[TM]或者是影像监控对照组。在抬举训练组[TM]中，参加者在装备对L5/S1活动的运动感知器时，都独自训练了5，30分钟。在初次训练后的第12个月，我们从公司的记录中得到了工人们的劳损数据。
Results. Survival analyses (Kaplan-Meier) indicated that there was no difference in injury rates between the 2 training groups. Likewise, there was no difference in the turnover rates. However, those with a low (<30 Nm) average twisting moment at the end of the first session experienced a significantly (P < 0.005) lower rate of low back disorder than controls.
结果：Kaplan-Meier生存分析显示，在两个训练组中，并没有发现显著的差异。同样的，在转归率上也没有显著的差异。但是，在第一期结束时，那些小于30Nm的旋转运动显示了训练组比对照组有显著低的腰背疾患率。
Conclusions. While overall the LiftTrainer[TM] program was not effective, those with twisting moments below 30 Nm reported fewer injuries, suggesting a shift in focus for "safe" lifting programs.
结论：虽然总的来说抬举训练系统[TM]不是非常的有效，但对于带有小于30Nm力的旋转的活动却可以减少损伤率。这表明，这是安全抬举系统应该关注的焦点。
Is It Safer to Place Pedicle Screws in the Lower
Thoracic Spine Than in the Upper Lumbar Spine?
放置上腰椎椎弓根螺钉比下胸椎椎弓根螺钉更安全吗？
Study Design. An anatomic study of 100 patients comparing
the pedicle isthmic width of the lower thoracic
spine and the upper lumbar spine using magnetic resonance
imaging.
实验设计：采用MRI对100例患者的下胸椎和上腰椎椎弓峡部的解剖宽度进行对比研究。
Objectives. To compare the lower thoracic pedicles
and upper lumbar pedicles in nondeformity patients as a
surrogate measure of safety of pedicle screw use.
目的：通过对下胸椎和上腰椎椎弓根的解剖测量，对比椎弓根螺钉使用的安全性。
Summary of Background Data. Pedicle isthmic width
is the significant limiting factor in the safety and proper placement of transpedicular screws. The presumption in the past has been that the lumbar pedicles are larger than the thoracic pedicles. Few publications in the English language literature specifically evaluate the association between the pedicle isthmic widths of the lower thoracic and upper lumbar.
研究背景：椎弓根峡部的宽度是椎弓根螺钉安全、正确的放置的重要影响因素。但英文文献中几乎没有关于下胸椎和上腰椎椎弓根峡部宽度之间关系的报道。
Methods. The study evaluates 100 patients, without
coronal spinal deformities. MRIs were obtained of the
pedicles from T10 to L2 and subsequently measured using
the axial T2-weighted views. Lower thoracic and upper lumbar pedicle isthmus, the narrowest section of
pedicle, was investigated and compared. The “medial
pedicle to medial rib corridor” at T10–T12 was defined
and measured as part of the methodology of the study. Statistical analysis included one-way analysis of variance
with post hoc least significant difference pairwise comparisons.
方法：本研究对100例无脊柱畸形的患者进行研究。对T10 － L2段脊柱椎弓根进行MRI扫描，随后采用T2加权图像进行测量。并对比下胸椎和上腰椎（此两处椎弓根最狭窄）的椎弓根宽度。在T10–T12段取椎弓根内侧缘到肋骨颈内侧缘进行测量。统计分析采用post hoc least significant difference pairwise comparisons的单向方差分析法。
Results. The smallest pedicle isthmic width was at (mean± SD, 6.0± 1.6 mm), while T12 (mean ± SD, 7.6 ±1.5 mm) had the largest pedicle width. Although smaller in diameter than T12, both T10 (mean ±SD, 6.2 ± 1.2mm) and T11 (mean ±SD, 7.5 ±1.6 mm) had larger pedicle width than L1 (P < 0.01). Pedicle widths were larger in males compared with females (P <0.05).
结果
结果显示L1椎弓根峡部宽度最小(mean± SD, 6.0± 1.6 mm)，而T12 椎弓根峡部宽度值最大(mean ± SD, 7.6 ±1.5 mm)。 尽管T10 (mean ±SD, 6.2 ± 1.2mm) 和 T11 (mean ±SD, 7.5 ±1.6 mm) 椎弓根宽度值较T12小，但均大于L1(P < 0.01)。同时，结果显示，同一锥体男性椎弓根宽度比女性大。
Conclusions. The results show that the lower thoracic pedicles are larger than the upper lumbar pedicles. This may make it safer to place screws in the lower thoracic spine than in the upper lumbar spine. Upper lumbar may be so small (_5 mm) to preclude safe conventional screw placement.
结论
研究显示下胸椎椎弓根比上腰椎更为宽大。或许我们可因此认为下胸椎椎弓根螺钉的放置比下腰椎安全性更高。而在上腰椎放置椎弓根螺钉反而显得不够安全。
Key words: isthmic pedicle width, MRI, thoracic,
lumbar.
关键词：椎弓峡部宽度值、MRI、胸部的、腰椎
Assessment of Forearm Pronation Strength in C6 and C7 Radiculopathies
C6 、C7神经根型颈椎病中旋前圆肌肌力的评估
Study Design. Consecutive case series of patients with C6 and C7 radiculopathies.
实验设计：连续收集C6 、C7神经根型颈椎病患者进行研究。
Objectives. To explore the clinical utility and reliability of manual muscle testing of forearm pronation strength in C6 and C7 radiculopathies.
目的：探索手工检查C6 、C7神经根型颈椎病患者旋前圆肌肌力的临床应用及可靠性。
Summary of Background Data. evidence of denervation of the pronator teres was the most common finding in C6 radiculopathies, and frequently present in C7 radiculopathies. Clinical evaluation of the pronator teres through manual muscle testing of forearm pronation has never been explored; therefore, its clinical utility is unknown as compared with the muscle groups that are traditionally evaluated.
研究背景：临床中经常发现C6 、C7神经根型颈椎病患者EMG(肌电图)显示旋前圆肌呈失神经支配表现。然而，尚未有研究报道对手工检查旋前圆肌肌力的临床意义及可靠性作出评估。与其它传统应用于临床疾病诊断和评价的一组肌肉相比，旋前圆肌肌力的临床意义仍有待探索。
Methods. Fifty-five subjects with diagnostic imaging evidence of either C6 (n = 25) or C7 (n = 30) cervical root compression and clinical symptoms consistent with cervical radiculopathy were recruited for this study. These subjects underwent manual muscle testing of forearm pronation, wrist extension, elbow flexion, and elbow extension. The frequency of impaired strength was recorded and compared for C6 and C7 radiculopathies. A second examiner evaluated each subject, with his or her findings compared with the first examiner only for the determination of interrater reliability.
方法：本研究对共55例经影像学证实有神经根压迫（C6 25例， C7 30例），并与临床症状相符的神经根型颈椎病患者，采用手工检查前臂旋前、伸腕、屈肘、伸肘功能。记录每种功能的受损情况并进行对比。另一检查者对每位患者进行独立体检，并将结果与第一位检查者进行对比，以确定其可靠性。
Results. In C6 radiculopathy subjects, forearm pronation weakness was present in 72%, was twice as common as wrist extension weakness, was present in all case where elbow flexion or wrist extension weakness was noted, and was found in all but 2 subjects where elbow extension weakness was present. In C7 radiculopathy subjects, forearm pronation weakness accompanies elbow extension weakness in 23% of subjects and was the only weakness in 10% of subjects. Manual muscle testing demonstrated adequate interrater reliability.
结果：在C6神经根型颈椎病患者中，72%出现前臂旋前功能减弱，是腕伸肌力减弱患者的2倍，并且在所有屈肘肌力和伸腕肌力减弱患者中均发现旋前圆肌肌力减弱，而所有伸肘肌力减弱患者中只有2例未发现旋前圆肌肌力减弱。在C7神经根型颈椎病患者中，23%同时合并前臂旋前功能和伸肘功能减弱，另外，有10%患者只发现前臂旋前功能减弱。因此，手工检查已足以说明旋前圆肌功能临床应用的可靠性。
Conclusions. Forearm pronation weakness is the most frequent motor finding in C6 radiculopathies and may be noted in some cases of C7 nerve root compression.
结论：旋前圆肌肌力减弱是C6神经根性颈椎病最常见的运动障碍，并且在有些C7神经根受压患者也会出现。
Key words: cervical, radiculopathy, physical examination, clinical examination, diagnostic accuracy, reliability.
关键词：颈（神经）的， 神经根病， 体格检查， 临床检查， 诊断的准确性， 可靠性
谢谢众位老师