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Surgeon Reliability in Rating Physical Deformity in Adolescent Idiopathic Scoliosis.
外科医师在对青少年特发性脊柱侧凸畸形的分级上的可靠性研究
Deformity
畸形
Abstract:
Study Design. Cross sectional survey.
摘要：
研究设计：截面调查
Objectives： To compare pediatric spine surgeons' relative rankings of the importance of surgical considerations, and their reliability of ratings of the physical deformity of patients with adolescent idiopathic scoliosis (AIS).
目的：比较小儿脊柱外科医师对青少年特发性脊柱侧凸畸形的患者分级的可靠性，以及其对外科干预指征重要性的相对分级。
Summary of Background Data：Adolescents' appearance is a factor in surgical decision-making. Although the reliability of the Cobb angle has been extensively studied, less attention has been directed toward the reliability of surgeons' assessment of physical appearance.
背景资料总结：青少年的外观是决定外科治疗的一个因素。尽管Cobb角的可靠性已被深入研究，但少有对外科医生评估身体外观的可靠性的研究。
Methods：Five surgeons ranked the relative importance of 13 surgical considerations. While viewing clinical photographs of 40 patients, surgeons rated the following: shoulder blades, shoulders, waist asymmetry, and the "overall appearance" of the back.
方法：五位外科医师对13种外科治疗指征的相对重要性给予排序。观察了40例临床病例的照片资料后，外科医师们对如下方面作出排序：肩胛骨、肩、腰部不对称以及背部整体的外观。
Results： "Severity of deformity" was consistently ranked the most important surgical consideration. Surgeons, however, varied widely in their reliability of their ratings of physical appearance: shoulder blades ([kappa] = 0.34), shoulders ([kappa] = 0.22), waist ([kappa] = 0.24), and overall appearance ([kappa] = 0.40).
结果：畸形的严重性被一致列为最重要的外科治疗指征。然而医师们在对身体外观的分级上却大相径庭：肩胛骨（kappa=0.34），肩（kappa=0.22），腰部（kappa=0.24），整体外观（kappa=0.40）
Conclusion：Because patients' physical appearance is an important element of surgical decision-making, differences among surgeons could be contributing to inconsistent recommendations.
结论：因为病人的身体外观是一个重要的决定外科干预的因素，外科医师之间的差异将会导致不一致的治疗建议。
Comparison of Animals Used in Disc Research to Human Lumbar Disc Geometry.
用来做椎间盘研究的动物与人腰椎间盘形态的比较
Abstract:
摘要
Study Design. Measurement and normalization of disc geometry parameters for several animal models used in disc research.
研究设计.对在椎间盘研究中使用的动物模型的椎间盘形态学参数的测量和标准化。
Objectives. To compare normalized values of disc geometry to the human disc geometry to aid in the selection and interpretation of animal model studies.
目的.将（动物）椎间盘形态学的标准化参数与人的椎间盘形态学比较，以利于在研究中动物模型的选择与解释。
Summary of Background Data. Animal models are widely used to study intervertebral disc degeneration and to evaluate disc treatment methods because of the availability of the tissue, the decreased variability between subjects compared with humans, and the feasibility to perform in vivo experiments. There is a general lack of comparative data with respect to the human disc analog for animal models.
背景概述：，由于动物模型组织的有效性、模型与人之间越来越小的变异性以及开展体内试验的可行性，它常在椎间盘退变的研究及椎间盘处理方式的评估中广泛应用。对于动物模型来说，其与模拟人椎间盘的比较方面的数据目前还是很缺乏的。
Methods. The disc height, lateral width, AP width, area, and the nucleus pulposus lateral width, AP width, area, and centroid offset were all measured and normalized by 2 scaling factors, lateral width and disc area, for comparison to human.
方法.我们对椎间盘的高度、外侧宽度、附件宽度、面积和髓核外侧宽度、附件宽度、面积以及重心分支都进行了测定，并在2个标准单位范围内进行了标准话。而外侧宽度和椎间盘面积则作为其与人椎间盘比较的参数。
Results. The species studied were ranked according to the average percent deviation of the normalized disc height, AP width and nucleus pulposus area from human geometry as: mouse lumbar (12%), rat lumbar (15%), mouse tail (18%), baboon (19%), bovine tail (22%), rabbit (26%), sheep (31%), and rat tail (46%).
结果.不同种属动物研究所得的标准化椎间盘高度、附件宽度和髓核面积与人形态学参数相比的平均变异程度为：小鼠腰椎（12％），大鼠腰椎（15％），小鼠尾椎（18％），狒狒(19%),牛尾椎（22％），兔（26％），羊（31%）和大鼠尾椎（46％）。
Conclusions. This paper provides a reference to compare disc geometries of experimental animal models to the human lumbar disc, to aid both in interpretation of and in planning for experimental disc research, and to provide normalized disc geometry parameters for computational models.
结论.本篇文章提供了关于实验动物模型与人腰椎椎间盘形态学比较的参考，有助于实验性椎间盘研究的释义与计划，并为电脑模拟模型提供了标准化的形态学参数。
Senescence in Cells of the Aging and Degenerating Intervertebral Disc: Immunolocalization of Senescence-Associated [beta]-Galactosidase in Human and Sand Rat Discs.
老化退变椎间盘的细胞衰老：人和沙鼠椎间盘衰老相关β－牛乳糖的免疫定位研究
Abstract:
摘要：
Study Design. Human intervertebral disc anulus tissue was obtained in a prospective study of cell senescence. Localization of the senescence biomarker [beta]-galactosidase (senescence associated [beta]-galactosidase, SA-[beta]-gal) was used for quantitative determination of the % senescent cells. Discs were obtained from surgical specimens or control donors. Discs were also studied from the lumbar spine of the sand rat. Experimental studies were approved by the authors' Human Subjects Institutional Review Board and animal use committee.
研究设计：我们在一个关于细胞衰老的前瞻性研究中获得了人的椎间盘髓核组织，并且用衰老细胞的生物学标记β－牛乳糖（衰老相关β－牛乳糖，SA－β－gal）来作为衰老细胞的定量标度。研究所用的椎间盘是通过手术样本及可靠的捐献者得到的。同时，我们还研究了来自沙鼠的腰椎椎间盘。所有的实验研究都得到了作者所在人类项目制度检查小组和动物使用委员会的批准。
Objectives. To determine the incidence of cell senescence in human discs with Thompson Grades I through V using immunocytochemistry to quantify the percentage of cells positive for the senescence biomarker SA-[beta]-gal.
目标：为了确定人椎间盘Thompson分级I 到V级的细胞衰老率，我们使用了免疫细胞化学的方法来定量作为衰老生物学标记的SA－β－gal阳性的细胞比例。
Summary of Background Data. Cell senescence has been recognized as a potential factor playing a role age-related disc degeneration. Senescent cells are viable but have lost the ability to divide. Senescence cells, however, are metabolically active.
背景概述：细胞衰老被认为是在年龄相关椎间盘退变中起作用的一个潜在因子。衰老的细胞多种多样，但是它们都失去了继续分裂的能力。但是，衰老的细胞同时都表现出代谢旺盛。
Methods. Fifty-seven discs specimens from 54 subjects were examined with immunocytochemistry for anti-SA-[beta]-gal immunocytochemical localization to identify senescent cells. The fraction of positive cells was determined with quantitative histomorphometry.
方法：我们将来自54个实体的57个椎间盘样本用细胞免疫化学的方法通过抗SA－β－gal细胞免疫组织化学定位标志了衰老细胞。而阳性细胞的比例则由组织形态学方法来定量。
Results. Quantitative histomorphometry of human discs show an overall incidence of SA-[beta]-gal-positive cells of 29.9% (+/-24.8, SD), with a range from 0 to 92.01%. Analysis by ANOVA of the % senescent cells grouped by Thompson grade showed significant increases in senescence with increasing disc degeneration (P < 0.0001). Further analysis with Tukey's test showed significant differences between the % senescent cells in Grades I/II versus IV, and versus V. SA-[beta]-gal-positive cells were also present in discs of the aging sand rat spine.
结果：对人椎间盘的组织形态学定量显示：整体的SA－β－gal细胞阳性率为29.9%，范围在0 到92.01%之间。对于Thompson分级的衰老细胞ANOVA分析显示：随着椎间盘退变的加深，衰老细胞明显增多。而进一步的对Tukey试验的分析显示，I/II级和IV/ V级的衰老细胞有显著的差异。同时，我们在高龄沙鼠椎间盘中也发现了SA－β－gal阳性的细胞。
Conclusions. Quantitative analysis of immunohistochemical localization of SA-[beta]-gal identified a sizeable population of senescent cells in the aging/degenerating disc. It is important to discover more about the senescent disc cell population because these cells persist and accumulate over time within the disc. Since senescent cells cannot divide, senescence may reduce the disc's ability to generate new cells to replace existing ones lost to necrosis or apoptosis.
结论：对SA－β－gal的免疫组织化学定位的定量分析，可以在老年或退变椎间盘中识别大量的衰老细胞。对于衰老椎间盘细胞数量的进一步深入了解是非常必要的，因为这些细胞会在椎间盘中随着时间推移持续存在并且进一步累计。衰老细胞是不会分裂的，这就使得椎间盘产生新的细胞来替代因坏死和调亡所致细胞丢失的能力减弱。
Multidisciplinary Rehabilitation for Subacute Low Back Pain: Graded Activity or Workplace Intervention or Both?: A Randomized Controlled Trial.
Randomized Trial
Spine. 32(3):291-298, February 1, 2007.
Anema, Johannes R. MD, PhD *+++[S]; Steenstra, Ivan A. PhD *+++[S]; Bongers, Paulien M. PhD *++; de Vet, Henrica C. W. PhD [S]; Knol, Dirk L. PhD [S][//]; Loisel, Patrick MD, FRCSC [P]; van Mechelen, Willem MD, PhD *+[S]
Abstract:
Study design. Population-based randomized controlled trial.
Objective. To assess the effectiveness of workplace intervention and graded activity, separately and combined, for multidisciplinary rehabilitation of low back pain (LBP).
Summary of Background Data. Effective components for multidisciplinary rehabilitation of LBP are not yet established.
Methods. Participants sick-listed 2 to 6 weeks due to nonspecific LBP were randomized to workplace intervention (n = 96) or usual care (n = 100). Workplace intervention consisted of workplace assessment, work modifications, and case management involving all stakeholders. Participants still sick-listed at 8 weeks were randomized for graded activity (n = 55) or usual care (n = 57). Graded activity comprised biweekly 1-hour exercise sessions based on operant-conditioning principles. Outcomes were lasting return to work, pain intensity and functional status, assessed at baseline, and at 12, 26, and 52 weeks after the start of sick leave.
Results. Time until return to work for workers with workplace intervention was 77 versus 104 days (median) for workers without this intervention (P = 0.02). Workplace intervention was effective on return to work (hazard ratio = 1.7; 95% CI, 1.2-2.3; P = 0.002). Graded activity had a negative effect on return to work (hazard ratio = 0.4; 95% CI, 0.3-0.6; P < 0.001) and functional status. Combined intervention had no effect.
Conclusion. Workplace intervention is advised for multidisciplinary rehabilitation of subacute LBP. Graded activity or combined intervention is not advised.
(C) 2007 Lippincott Williams & Wilkins, Inc.
亚急性下腰痛的多学科康复：分级活动还是工作场所干预或二者结合？一项随机对照实验。
摘要：
研究设计：基于人群的随机对照实验。
研究目标：评价工作场所干预和分级活动二者分开或结合对于下腰痛的多学科康复的作用。
背景资料分析：下腰痛的多学科康复作用的有效因素尚未建立。
研究方法：因非特异性下腰痛而纳入的患者，2到6周的随机分为2组。工作场所干预组96人，常规护理组100人。工作场所干预包括工作场所评估，工作变更以及包括所有参与者的病例管理。到第8周仍然有症状的患者，随机分为分级活动组55人，常规护理组57人。分级活动包含按照操作条件制约的每2周一次的锻炼活动。在患者请病假的第12周、26周和第52周测试结果。结果以基线评定，为持续返回工作、疼痛的强度以及功能状态。
研究结果：工作场所干预组的职工返回工作的时间是77天，而没有干预的是104天（平均值），P＝0.02。工作场所干预对于返回工作是有效的。（危害比＝1.7，95％可信区间，1.2－2.3；P=0.002）。分级活动对返回工作以及功能状态没有作用（危害比＝0.4；95％可信区间，0.3－0.6；P<0.001）。二者结合的干预没有效果。
研究结论：对于亚急性下腰痛，建议采用工作场所干预进行多学科的康复。不建议采用分级活动或二者结合的干预。
A Study of the Cutaneous Nerves Encountered During Thoracoplasty.
Anatomy
Spine. 32(3):301-305, February 1, 2007.
Hoernschemeyer, Dan MD *; Farjoodi, Payam MS +; Cheng, Jen MD ++; Sponseller, Paul MD +
Abstract:
Study Design. Ten cadavers were dissected to describe the cutaneous branches of the dorsal rami nerves that should be identified and protected throughout the thoracoplasty procedure.
Objective. To identify the anatomic distribution of the cutaneous branches of the dorsal rami in the thoracic spine.
Summary of Background Data. The last anatomic description of cutaneous branches of the dorsal rami nerves dates back to the early 1900s.
Methods. Ten cadavers were dissected. Each of the branches was followed deeper into the musculature of the back. The Steel 2-incision approach, the Geissele subcutaneous approach, and the subfascial/subtrapezial approach were then carried out on each cadaver.
Results. We determined the course traveled by each of these cutaneous branches of the dorsal rami. Medial branches traverse the paraspinal muscles running dorsally within a few millimeters of the midline before exiting beneath the trapezius. Lateral branches cross the top border of the inferior rib at an average of 6.8 mm from the tip of the transverse process and the lower border of the rib 27 mm from the tip of the transverse process.
Conclusions. Both branches of the dorsal rami nerves are encountered during the posterior approaches used. Medial branches have the best chance for identification and preservation with the subtrapezial approach. Lateral branches can be identified and protected in each of the 3 posterior exposures.
(C) 2007 Lippincott Williams & Wilkins, Inc.
对在胸廓成形术中遇到的皮神经的研究
摘要
研究设计：通过解剖10具尸体，描述胸神经后支的皮支，以便在胸廓成形术中辨别并保护它们。
研究目标：在胸脊柱区辨明胸神经后支皮支的解剖分布。
背景资料分析：最近的有关胸神经后支皮支的描述是在20世纪初期。
研究方法：解剖10具尸体。每一个分支都追踪到深入背部肌肉的位置。在每一具尸体上都采用Steel 2 切口，Geissele 皮下入路和筋膜下或斜方肌下的入路。
研究结果：我们确定了胸神经后支皮支的走行路径。内侧分支横过脊柱旁肌肉，在斜方肌下走出之前，走在离中线几毫米的背侧。外侧分支在距离横突尖平均6.8毫米处越过下位肋骨的上界，在距离横突尖2.7毫米处越过下界。
研究结论：在采用后入路时，会遇到胸神经后支的两个分支。采用斜方肌下入路，可以很好的辨别和保护内侧支，采用3种后方暴露方法，外侧支都可以得到很好的显露和保护。
Cement Augmentation of Vertebral Screws Enhances the Interface Strength Between Interbody Device and Vertebral Body.
Abstract:
Study Design. An in vitro cadaveric study comparing cage-vertebra interface strengths for 3 different screw-cement configurations.
Objectives. To determine the effects of cement augmentation of pedicle screws on cage-vertebra interface failure properties for 2 interbody device shapes (elliptical or cloverleaf); and to compare between pedicle and anterior vertebral body screws with cement augmentation.
Summary of Background Data. Pedicle or anterior screw fixation is commonly used with interbody device fixation. Cement has recently been shown to augment screw fixation in the osteoporotic spine by improving the screw-bone interface strength. The effect of cement augmentation of pedicle or anterior screws on cage-vertebra interface properties has not been previously studied or compared.
Methods. An elliptical or a cloverleaf-shaped indentor covering 40% of the endplate was axially compressed against the superior endplate of 48 thoracolumbar vertebrae. Each vertebra had polymethylmethacrylate cement augmentation of 1) anterior screws, 2) pedicle screws, or 3) pedicle screws without cement. Compressive load was applied through a mechanism that allowed unconstrained rotation of the indentors.
Results. Cement augmentation of pedicle screws resulted in significantly higher failure loads (54%) and failure strength (69%) for both shaped indentors when compared with uncemented pedicle screws. There was no significant difference in failure load and failure strength between pedicle and anterior screws with cement augmentation. Indentor shape was not a significant factor on failure load or failure strength.
Conclusions. Cage-vertebra interface properties were improved when cement was used to augment vertebral and pedicle screws. Cement augmentation of pedicle or anterior screws may reduce interbody device subsidence.
骨水泥加固的椎体螺钉可以增强椎体与椎体中器械表面之间的强度
生物力学研究
研究设计：为在尸体骨上做的体外实验，比较3种不同水泥螺钉模型的椎体－器械表面的强度。
目的：来测定骨水泥加固的椎弓根螺钉在2种形状（椭圆形或者四叶形）压力的椎体－器械中的表面失败率特性，并比较椎弓根螺钉和前路螺钉骨水泥增强效果的差异。
研究背景：经椎弓根和前路椎体螺钉常用于椎体间内固定。骨水泥近来被用于伴有骨质疏松的患者中，来加强螺钉与椎体接触的强度。有关骨水泥在经椎弓根和前路椎体间螺钉的效果尚未被研究。
方法：在48块胸腰椎椎体中，选用椭圆形或者四叶状的锯齿边缘的压力器，接触椎体的面积约为40％的终板面积，作轴向压迫。每个椎体都采用不同方法的聚甲基丙烯酸甲酯骨水泥增强：1)前路螺钉，2）椎弓根螺钉，或者是3）椎弓根螺钉无骨水泥。压力负荷为使凹陷的椎体不旋转。
结果：经骨水泥增强的椎弓根螺钉组比无骨水泥组在负荷失败率和强度失败率方面两种形状的压配中均有显著差异。在前路与后路椎弓根骨水泥两组中无显著差异。压物的形状在负荷失败率和强度失败率中不是主要因素。
结论:骨水泥增强椎弓根螺钉与椎体的强度，因此可以改善椎体与内固定器械表面强度。使用骨水泥的前路或者椎弓根螺钉可以减轻椎体高度的丢失。
Pedicle Screw Placement Accuracy: A Meta-analysis
椎弓根螺钉置钉的准确性：一项Meta分析
Study Design. A meta-analysis of the published literature was conducted specifically looking at accuracy and the postoperative methods used for the assessment of pedicle screw placement in the human spine.
研究设计：针对已发表的文献进行Meta分析，逐一地检查其在人体脊柱中椎弓根螺钉置钉的准确性和手术后所采用的评估方法。
Objectives. This study specifically aimed to identify postoperative methods used for pedicle screw placement assessment, including the most common method, and to report cumulative pedicle screw placement study statistics from synthesis of the published literature.
目的：这一研究确切的目的在于找出手术后评估椎弓根螺钉置钉的方法，包括最常用的方法；并综合已发表的文献，从而对越来越多的椎弓根螺钉置钉的研究作一统计报道。
Summary of Background Data. Safety concerns have driven specific interests in the accuracy and precision of pedicle screw placement. A large variation in reported accuracy may exist partly due to the lack of a standardized evaluation method and/or the lack of consensus to what, or in which range, is pedicle screw placement accuracy considered satisfactory.
背景资料概述：由于安全性的关系，使得人们对椎弓根螺钉置钉的准确性和精确度有着特殊的兴趣。据已有的报道，准确性存在很大的差异，一部分原因可能是由于缺乏一个标准化的评价方法，和/或对椎弓根螺钉的置钉在什么范围或在那个范围内可认为其准确性是满意的，还存在异议。
Methods. A MEDLINE search was executed covering the span from 1966 until 2006, and references from identified papers were reviewed. An extensive database was constructed for synthesis of the identified studies. Subgroups and descriptive statistics were determined based on the type of population, in vivo or cadaveric, and separated based on whether the assistance of navigation was employed.
方法：对MEDLINE数据库进行检索，涵括的时间跨度自1966年至2006年，以及包括找出的论文的参考文献都进行了复习。构建一个大范围的数据库以综合分析已找出的研究资料。按照人群类型，活体内或尸体来决定其亚组和描述统计，并按照是否应用导航辅助进行分类。
Results. In total, we report on 130 studies resulting in 37,337 total pedicle screws implanted, of which 34,107 (91.3%) were identified as accurately placed for the combined in vivo and cadaveric populations. The most common assessment method identified pedicle screw violations simply as either present or absent. Overall, the median placement accuracy for the in vivo assisted navigation subgroup (95.2%) was higher than that of the subgroup without the use of navigation (90.3%).
结果：总共，我们的报道包括130项研究，总共置入37337例椎弓根螺钉，其中结合体内和尸体组群有34107例（91.3%）被认为置钉位置是准确的。或者存在，或者不存在最常用的能简便地识别椎弓根螺钉侵犯的评估方法。总的说来，置钉准确性的中位数，活体内导航辅助组（95.2%）要高于不用导航的研究组（90.3%）。
Conclusions. Navigation does indeed provide a higher accuracy in the placement of pedicle screws for most of the subgroups presented. However, an exception is found at the thoracic levels for both the in vivo and cadaveric populations, where no advantage in the use of navigation was found.
结论：在以上提到的大部分组群中，导航对于椎弓根螺钉置钉确实能提供一个较高的准确性。然而，在活体内和尸体组群都发现一个例外：胸椎水平用导航并没有发现什么优势。
Key words: pedicle screw; image-guided surgery; navigation; evaluation; measurement; safety; position; accuracy
关键词：椎弓根螺钉；影像导航外科手术；导航；评估；测量；安全性；位置；准确性
Complications and Mortality Associated With Cervical Spine Surgery for Degenerative Disease in the United States
美国颈椎退变性疾病手术相关的并发症和死亡率
Abstract
Study Design. Retrospective cohort.
研究设计：回顾性组群研究。
Objectives. To describe the incidence of complications and mortality associated with surgery for degenerative disease of the cervical spine using population-based data. To evaluate the associations between complications and mortality and age, primary diagnosis and type of surgical procedure.
目的：以（人口）总体资料为基础，对颈椎退变性疾病手术相关的并发症发生率和死亡率进行描述。评价并发症和死亡率与年龄、初始诊断和手术类型等的相关性。
Summary of Background Data. Recent studies have shown an increase in the number of cervical spine surgeries performed for degenerative disease in the United States. However, the associations between complications and mortality and age, primary diagnosis and type of surgical procedure are not well described using population-based data.
背景资料概述：近期的研究显示，在美国颈椎退变性疾病行手术治疗的数量有所增加。然而，并发症和死亡率与年龄、初始诊断和手术类型之间的相关性尚没有基于总体资料的较好的描述。
Methods. We created an algorithm defining degenerative cervical spine disease and associated complications using the International Classification of Diseases-ninth revision Clinical Modification codes. Using the Nationwide Inpatient Sample, we determined the primary diagnoses, surgical procedures, and associated in-hospital complications and mortality from 1992 to 2001.
方法：我们用国际疾病分类法-第9 次修订-临床修订版建立了一种算法，确定颈椎退变性疾病和相关的并发症。我们用1992年至2001年全国性的患者作为样本，确定其初始诊断、手术方法和相关的院内并发症和死亡率。
Results. From 1992 to 2001, the Nationwide Inpatient Sample included an estimated 932,009 (0.3%) hospital discharges associated with cervical spine surgery for degenerative disease. The majority of admissions were for herniated disc (56%) and cervical spondylosis with myelopathy (19%). Complications and mortality were more common in the elderly, and after posterior fusions or surgical procedures associated with a primary diagnosis of cervical spondylosis with myelopathy.
结果：从1992年至2001年，全国性的患者样本包括大约932009例（0.3%）在医院进行的有关颈椎退变性疾病手术。大多数的纳入者都是因为椎间盘突出（56%）和脊髓型颈椎病（19%）。并发症和死亡率更常见于老年人，在后路融合之后，或手术相关的初始诊断是脊髓型颈椎病者。
Conclusions. There are significant differences in outcome associated with age, primary diagnosis, and type of surgical procedure. Administrative databases may underestimate the incidence of complications, but these population-based studies may provide information for comparison with surgical case series and help evaluate rare or severe complications.
结论：与年龄、初始诊断和手术类型相关的结果存在显著的差异性。官方的数据可能低估了并发症的发生率，但这一基于总体的研究与手术病例组的研究相比，可能能提供一些信息，并且对评价少见的或严重的并发症也有帮助。
Key words: cervical spine surgery; degenerative disease; epidemiology; complications; mortality; outcomes; elderly
关键词：颈椎手术；退变性疾病；流行病学；并发症；死亡率；疗效；老年人
谢谢众位老师