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11 Three-Dimensional Analysis of Formation Failure in
Congenital Scoliosis
先天性脊柱侧突椎体形成障碍的三维分析

Study Design. Morphologic analysis was performed
by 3-dimensional (3D) CT in 75 patients with congenital
scoliosis exhibiting formation failure.
研究设计.使用三维CT重建技术对75例先天性脊柱侧突患者的椎体进行形态学分析判断是否存在形成障碍。

Objectives. The objectives of this study were to conduct
3D analysis of the morphology of spinal malformation
and to elucidate the association between malformed
vertebrae and adjacent vertebrae.
目的. 此研究的目的是对脊柱畸形的形成进行三维分析,进一步区别畸形椎体和邻近正常椎体。

Summary of Background Data. The morphology of
spinal malformation has conventionally been evaluated
by plain radiograph radiography. Although the usefulness
of 3D CT has recently been reported, these reports
have only demonstrated that this technique allows more
detailed evaluation than plain radiography.
背景.以往使用普通X线平片对脊柱分节不良进行评估。尽管目前已经发现使用三维CT重建技术 具有很多的好处,但是大家都还局限于此技术可以比平片进行更加细节的评估。

Methods. We examined the morphology of the posterior
components in spinal malformation of formation failure
and evaluated the association between the anterior
and posterior components by 3D CT. We clarified the
morphologic variations of the posterior components in
spinal malformation by dividing 75 cases of formation
failure into solitary and multiple numbers of malformed
vertebrae and into simple and complex modes of malformation
between anterior and posterior components.
方法.我们使用三维CT重建技术分别对脊柱形成障碍的后方结构进行评估,同时分析前方组织和后方组织之间的关系。我们将脊柱畸形后方组织结构的不同将75例患者从单个节段到多个节段的畸形椎体,并且比较他们分别在前方和后方组织结构之间的存在的差异。

Results. Thirty-three patients exhibited a single malformed
vertebra in the entire spine (solitary malformation
group), while the other 42 had multiple malformed vertebrae
(total, 102 malformed vertebrae: multiple malformation
group). The multiple malformation group consisted
of 26 patients (57 malformed vertebrae) in whom the
cause of scoliosis could be explained separately for each
of the malformed vertebrae and 16 patients (45 malformed
vertebrae) in whom the structure was complicated
and the cause of scoliosis could not be explained
for each of the malformed vertebra.
结果.33例患者整个脊柱中出现了单个畸形椎体(单畸形椎体组);其他的42例患者具有多个节段的畸形椎体(共计102个节段的椎体;多畸形椎体组)。多畸形椎体组又分为组一,26例患者(57个畸形椎体)脊柱侧凸的病因可以单纯通过畸形椎体解释;组二,16例患者(45个畸形椎体)这些患者的组织结构比较复杂,脊柱侧凸不能不能单纯使用畸形椎体解释。

Conclusion. There were morphologic variations of the
posterior components of malformed vertebrae. A completely
new complex malformation in which the mechanism
of formation failure may differ from the conventionally
proposed mechanisms was also found.
结论.畸形椎体可以导致后方的组织结构的形态学变异。畸形椎体的观点与传统的观点不同,该观点认为椎体的形成障碍也可以解释部分先天性脊柱侧突的成因。

Key words: congenital scoliosis, failure of formation,
3-dimensional analysis, computed tomography. Spine
2007;32:562–567
关键词:先天性脊柱侧突;形成障碍;三维分析;计算机辅助断层扫描。
12 Reliability of 3D Reconstruction of the Spine of Mild
Scoliotic Patients
轻度脊柱侧突患者三维重建模型的可靠性研究
deformity
畸形

Study Design. A reliability study was conducted in
quantitative 3-dimensional (3D) measurements for mild
scoliosis.
研究设计.使用定量的三维测量方法对轻度脊柱侧突患者的三维模型的精确性进行评估

Objective. To evaluate the intrarater and interrater reliability
of a computer tool used for 3D reconstruction of
the spine.
目的.评估使用三维重建技术重建轻度脊柱侧凸患者的技术在评估者之间和评估者内部的精确性。

Summary of Background Data. No reliability study of
spinal in vivo 3D medical imaging measurements has
been performed in the literature.
背景. 目前文献上未见对体内三维脊柱侧凸模型进行评估的文献报导。

Methods. This study included 30 patients (mean age
13 years) with mild idiopathic scoliosis. Spinal 3D reconstruction
was performed using a new technique called
semiautomatic 3D reconstruction, which requires only the
location of the corners of each vertebral body on 2 orthogonal
views. Three raters performed the 3D reconstruction
procedure on the 30 pairs of radiographs in
random order. One of the raters repeated the procedure
for the 30 patients 15 days later. Inter-reliability and intrareliability
were estimated for different parameters: thoracic
kyphosis, lumbar lordosis, Cobb’s angle, pelvic morphologic
and positional parameters, and axial rotation.
方法:此研究包括30例轻度脊柱侧凸的患者(平均13岁)。使用一种被称为半自动三维重建的技术进行患者的脊柱三维重建,此技术仅需要提供两个正交的角度的每个椎体的角度定位。3个评估者对30对的放射线结果按照随机的原则进行重建。其中一个评估者对所有的30例患者的资料在15天后重建。评估者内的精确性和评估者之间的精确性使用不同的参数进行评估:胸椎后凸,腰椎前凸,Cobb's角,骨盆形态和位置参数,轴向旋转。

Results. Intraclass correlation coefficient showed good
or very good agreement for most of the measurements.
The 95% prediction limits are approximately 4° for the
measurements of spinal curves, 2° for pelvic parameters,
and axial vertebral rotation.
结果. 其中的许多测量结果显示组间的相似性很高。在测量脊柱弯曲的时候95%的预计误差在4°之内,骨盆参数的误差在2°以内,轴向旋转的误差也是2°之内。

Conclusions. The reliability of 3D reconstruction of the
spine is acceptable, and this technique can be used for
clinical studies.
结论. 三维重建技术的精确性是可以接受的,此技术可以被用于临床研究。

Key words: 3-dimensional reconstruction, scoliosis,
vertebra. Spine 2007;32:568–573
关键词: 三维重建,脊柱侧突,椎体
第4篇
Radiographic Assessment and Quantitative Motion Analysis of the Cervical Spine After Serial Sectioning of the Anterior Ligamentous Structures.
颈椎前侧韧带结构连续切片后对于颈椎棘突的放射学评估和定量的运动分析研究
Cervical Spine
颈椎棘突
Spine. 32(5):518-526, March 1, 2007.
Subramanian, Navin MD; Reitman, Charles A. MD; Nguyen, Lyndon MS; Hipp, John A. PhD
Abstract:
Study Design. Cadaveric study of a diagnostic test for cervical spine instability.
摘要:
研究设计:对尸体颈椎棘突标本的不稳定性进行诊断性试验。

Objective. Determine if flexion-extension (FE) radiographs can be used to detect incremental damage to anterior cervical structures.
研究目的:检测颈椎过伸过屈位片(FE)能否作为测定颈椎前侧结构渐进性损伤的标准。
Summary of Background Data. Prior studies have shown that damage to cervical structures can alter motion between vertebrae, and FE radiographs are sometimes used to detect this damage. However, no study has determined if FE radiographs are sensitive and specific for acute injury.
背景资料概括:先前的研究表明颈椎结构的损伤能够影响到椎间的活动度,而且颈椎过伸过屈位片一些情况下可以作为测定这种损伤的标准。然而,还没有任何研究证实颈椎过伸过屈位片反映急性损伤的灵敏度和特异性。
Methods. FE radiographs were taken of the intact neck and after each incremental increase in damage to the anterior structures. Intervertebral motion was quantified using previously validated methods. The sensitivity and specificity of intervertebral motion measurements were assessed.
方法:拍摄的颈椎过伸过屈位片分为两组,一组为正常未受损的,一组为不同程度的前侧结构损伤后的。椎间活动度的量化采用经证实可行的方法来处理。我们主要评估这种颈椎FE位片反映椎间活动度测量结果的灵敏度和特异性。
Results. Motion within the intact spines was within normal ranges. Although intervertebral rotation changed significantly after certain anterior structures were damaged, rotation frequently remained within normal ranges, even after extensive damage. A center of rotation that was posterior to the 95% confidence interval for normal motion was 100% sensitive and specific for damage to the anterior structures of the spine.
结果:正常颈椎棘突的活动度都在正常范围。尽管在某个前侧结构损伤后椎间旋转度有显著的改变,但往往还在正常范围内,甚至在大范围损伤后也依然如此。旋转中心如果在正常活动度的95%的可信区间之后,对棘突前侧结构的损伤则具有100%的灵敏度和特异性。
Conclusions. The results suggest that extensive damage to the anterior cervical spine could be missed if instability assessment was based on intervertebral rotation or displacements measured from FE radiographs. In contrast, a center of rotation that was located posterior to normal was both sensitive and specific for damage to anterior structures.
结论:结果表明颈椎棘突前侧的大面积损伤,如果所用的是从FE片上所测量的椎间旋转和移位的不稳定性评估所得的结果,可能会有遗漏。相反,在正常活动范围之后的旋转中心对测定前侧结构损伤具有一定的灵敏度和特异性。
Dr. Ahmet Munir Sarpyener: Pioneer in Definition of Congenital Spinal Stenosis.
Dr. Sarpyener 先天性椎管狭窄定义的先驱
全文


The first applications of modern spine surgery started in the late 19th century.1–3 The developments in anesthesia techniques, the discovery of radiograph and its application, and occurrence of wars contributed to the development of this discipline. Although the most important applications of reconstructive spine surgery were performed in the second half of the 20th century, the definition and understanding of spine disorders and their treatment were performed in the late 19th century and first half of this century.
现代脊柱外科手术开始于19世纪晚期。麻醉技术的进步、影像学技术的发展及应用以及两次世界大战的爆发都促进了这一领域的发展。尽管重建性脊柱外科最重要的应用发生在20世纪后半叶,然而脊柱疾病的定义、理解及治疗却早在19世纪晚期和本世纪前半叶[color=red](原文如此,估计应指20世纪前半叶)。[/color]

One of the most important spinal disorders defined in the first half of the 20th century was lumbar spinal stenosis.4,5 The definition of this disorder has been commonly attributed to Dr. Verbiest.1–3 However, a review of the literature reveals some examples of degenerative 6–8 and congenital spine stenosis.9,10 There are many case reports describing the clinical aspects of lumbar spinal stenosis.11,12 In the absence of any tumoral lesion in surgery, Kennedy et al7 attributed the cauda equina syndrome to the toxic or inflammatory process, whereas Towne and Rechardt 13 attributed it to ligamentum flavum hypertrophy
腰椎管狭窄症是20世纪前半叶定义的最重要的脊柱疾病之一。对此疾病的定义普遍认为应归功于Dr.Verbiest。然而,文献复习却揭示了一些退行性和先天性椎管狭窄的病例。有很多病例报告描述了腰椎管狭窄症的临床表现。在手术中没有发现任何肿瘤性病变的情况下,Kennedy等将马尾综合征归因于毒性或炎症性过程,而Towne和Rechardt将此归因于黄韧带肥厚。

The aim of this report is to highlight the history of congenital spinal stenosis reported by Dr. Sarpyener, and review his scientific studies and spine surgery applications.
本文的目的在于强调Dr. Sarpyener报告的先天性椎管狭窄的历史,综述他的科研及外科临床应用结果

Biography
Dr. Münir Ahmet Sarpyener (Figure 1) was born in Musul in 1902. He moved to Istanbul when he was 13 years old. After elementary and college educations, he started medical school at the School of Medicine of Darulfunun University in Istanbul in 1918. He graduated from this school in 1923 and completed his internship in 1924 in Gülhane Military Academy Hospital. He completed his general surgery training in 1925–1926 in Haydarpasa Military Hospital, and worked as a general surgeon in Erzincan between 1928 and 1932. Thereafter, he worked in pediatric surgery and orthopedics in Lyon, France, for 1 year, and returned to Turkey and worked in Tekirdag in 1933–1934. He was appointed Associate Professor of Pediatric Surgery and Orthopaedics in 1934 in Sisli Child Hospital, an affiliated Hospital to Istanbul University School of Medicine directed by Professor Akif Sakir Sakar. Dr. Sarpyener became professor of Pediatric Surgery and Orthopaedics in 1940, and chair of this department in 1958. He retired in 1971 and died in 1982.
生平
Dr. Munir Ahmet Sarpyener生于1902年的Musul。13岁时来到Istanbul。经过基础教育及大学教育,于1918年开始了在Darulfunun大学医学院的医学生涯。1923年毕业于该校,1924年在Gulhane Military Academy医院度过实习医师阶段。1925-1926年在Haydarpasa Military医院完成了普通外科训练,并于1928-1932年之间在Erzincan做普通外科医生。之后,赴法国里昂做一年的小儿外科和骨科医师后返回土耳其,1933-1934年间在Tekirdag工作。1934年在Sisli儿童医院被聘为小儿外科及骨科学副教授,该医院是由Akif Sakir Sakar教授主持工作并作为Istanbul大学医学院的附属医院。Dr.Sarpyener在1940年晋升为小儿外科及骨科学教授,1958年任该系主任。1971年退休,1982年逝世。


Spine Surgery Applications
Dr. Sarpyener performed many operative procedures in children with spina bifida occulta and lumbar spinal stenosis. He also performed decompressive laminectomies in cases of spinal tuberculosis and applied bone grafts on paravertebral muscles for spine fusion. To increase the fusion rate, he used a custom-made demineralized bone matrix that he obtained after boiling the bovine tibia 5 times. He also performed inverse laminoplasty in cases of scoliosis; however, he discontinued this procedure due to unsatisfactory results (K. Sarpyener, written communication, 2006).
脊柱外科应用
Dr.Sarpyener完成了很多儿童隐性脊柱裂及腰椎管狭窄症的手术。他也为一些脊柱结核的病例做过椎板切除减压及椎旁肌处骨移植脊柱融合术。为提高融合率,他使用过一种自制的脱矿化骨基质,这种脱矿化骨基质通过反复煮沸牛胫骨达5次而获得。他还做过逆向椎板成形术治疗脊柱侧弯,然而因结果欠满意未能继续下去。


Scientific Studies
Dr. Sarpyener published 6 books and more than 200 papers, including 25 papers in English and French. He summarized the results of his observations on spina bifida since the 1920s.9,10,12,14–23
In 1 of his papers, “Spina Bifida Occulta und Steine in den Harnwegen,”18 he cited his own monograph “Vertebra Bifida,”14 published in 1926 in Turkish. He reported his clinical observations on 10 cases of spinal bifida.
His papers published in 1945 and 1947, in the Journal of Bone and Joint Surgery, were the first comprehensive papers in the field of congenital spinal stenosis.
In his first paper,9 Dr. Sarpyener reported 13 cases of congenital lumbar spinal stenosis (Figure 2). He diagnosed spinal stenosis using suboccipital Pantopaque myelography, and reported that such a stenosis was characterized with enuresis, clubfoot, spastic and flaccid paralysis, leading to gait abnormalities, and contractures. He classified congenital spinal canal stenosis into 4 groups, including segmental, extensive, localized, and atypical. He reported that a laminectomy procedure was indicated in cases with gait and enuresis abnormalities
Two years after this report in 1947, he reported 2 cases with congenital spine stenosis (Figure 3).10 He concluded that in patients with congenital spinal stenosis, the occurrence of some abnormalities such as coxa plana, coxa vara congenita, subluxation of the hip, malum coxa juvenilis, malum coxae senilis, and Osgood-Schlatter, as he stated, were more common
科学研究
Dr.Sarpyener发表过6本著作及大于200篇论文,包括25篇英语及法语论文。他总结了自1920年起自己对隐性脊柱裂的观察结果。
在一篇名为“Spina Bifida Occulta und Steine in den Harnwegen”文章中他引用了自己用土耳其语发表的专著“Vertebra bifida”。他报告了10例脊柱裂病例的临床观察。
他发表在1945和1947年JBJS上的文章首次对先天性椎管狭窄做了详尽的阐述。
在他第一篇文章中,Dr.Sarpyener报告了13例先天性腰椎管狭窄症的患者。他使用枕骨下碘苯酯脊髓造影术来诊断椎管狭窄,报告了此种狭窄的临床特点包括遗尿、畸形足、痉挛性或弛缓性瘫痪(导致步态异常)及肌挛缩。他将先天性椎管狭窄分为4型,包括节段型、广泛型、局限型和非典型。并指出有步态和遗尿异常的病例具备行椎板切除术的指征。
此文章发表2年后即1947年,他报告了2例先天性椎管狭窄病例,并得出结论:先天性椎管狭窄患者某些畸形如扁平髋、先天性髋内翻、髋关节半脱位、青年性髋关节病、老年性髋关节病及Osgood-Schlatter病的发生率更高。


Discussion
The history of modern spine surgery in Turkey can be dated to the late 19th century after the report of the laminectomy procedure in spine trauma cases by Professor Cemil Topuzlu.24 There were many applications of spine surgery by general surgeons and neurosurgeons in the early 20th century in the Ottoman empire (before 1923) and young Republic of Turkey (after 1923).25–29
General surgeons (1914) performed the first laminectomies (1894), first spine fusion applications (1925), and first spine surgery for spasticity, whereas neurosurgeons performed the first applications for spine tumors (1924) and intervertebral discs (1948).24–29
Dr. Sarpyener was a surgeon interested in the spine. It is of note that at that time, there was not a separate orthopedic surgery discipline in Turkey. This discipline was combined with pediatric surgery. Therefore, the specialists of this discipline had to treat many cases of congenital disorders. This fact was probably 1 of the most important factors contributing to Dr. Sarpyener’s definition of congential lumbar spinal stenosis.
It is also of note that his studies on spina bifida started in the 1920s. He treated such cases for a long time. He elegantly demonstrated the stenosis of the lumbar spinal canal using myelography, the most advanced spine radiology technique of that time. His classification was very interesting and useful. Based on his classification, he proposed the treatment of choice.
It seems that his didactic approach to lumbar spinal stenosis and his native classification stimulated forthcoming researchers to address this clinical entity. Dr. Verbiest was aware of the importance of his studies and cited them in his papers.
In summary, based on the scientific studies and spine applications, it is concluded that Dr. Sarpyener was a pioneer in the field of congenital spinal stenosis and should be regarded from a historical surgery point of view
讨论
土耳其的现代脊柱外科历史可追溯到19世纪晚期Cemil Topuzlu教授报告了脊柱外伤病例行椎板切除术后。二十世纪早期Ottoman帝国(1923年前)和年轻的土耳其共和国(1923年后)的普通外科医师及神经外科医师完成了大量脊柱手术。
普通外科医师完成了首例椎板切除术(1984),首例脊柱融合术(1925),及首例脊柱手术为解决痉挛状态。神经外科医师完成了首例脊柱肿瘤手术(1924)和椎间盘手术(1948)。
Dr.Sarpyener是一位钟情于脊柱的外科医生。众所周知当时的土耳其没有独立的骨外科。本学科与小儿外科所结合。因此该领域专家必须处理很多先天性疾病。这个客观事实恐怕也是Dr.Sarpyener能对先天性腰椎管狭窄症做定义的最重要因素之一。
另一众所周知的情况是他对脊柱裂的研究开始于1920年左右。他研究此种疾病很长一段时间。并用当时最先进的放射学技术——脊髓造影术完美的展示了腰椎管的狭窄。他所做的分型非常有趣和实用。基于他的分型,他提出了治疗的选择意见。
似乎是他所倡导的腰椎管狭窄的入路及他的分型激励了后来的研究者更进一步探究到本病的实质。Dr.Verbiest了解他的研究的重要性并在自己的文章中有所引用。
总之,从他的科研及临床实践中,可以看出Dr.Sarpyener是一位先天性椎管狭窄领域的先驱,应当从外科学历史的观点来审视他。

Evaluation of Spinal Kinematics Following Lumbar Total Disc Replacement and Circumferential Fusion Using In Vivo Fluoroscopy
活体内透视评价腰椎全椎间盘置换和外周融合后的脊柱动力学


Abstract
Study Design. In vivo fluoroscopic analysis of lumbar spinal motion with total disc replacement (TDR), fusions, and controls.
研究设计:活体内透视分析全椎间盘置换(TDR)、融合和正常对照者的腰椎运动。

Objectives. Compare and contrast lumbar spinal motion profiles in TDR, circumferential fusion, and controls.
目的:比较和对比TDR、融合和正常对照者腰椎的运动轨迹。

Summary of Background Data. TDR has been shown to preserve motion and possibly prevent abnormal loading at the adjacent level. Although in vitro cadaveric studies have provided invaluable information, they are not capable of assessing the physiologic motion profile of the lumbar spine that is initiated and stabilized by in vivo trunk muscular contractions.
背景资料概述:已经证实,TDR能保存活动度并可能能防止相邻节段的异常负荷。虽然体外的尸体研究已经提供了非常宝贵的信息,但这些都不能评价腰椎的生理运动轨迹,而这些运动的开始和稳定都是由活体内躯干肌肉的收缩来完成的。

Methods. Cross-sectional evaluation using high-frequency low-dose pulsated video fluoroscopy to evaluate lumbar spinal motion in subjects who underwent TDR (n = 8), circumferential fusion (n = 5), and controls (n = 4). Angulation and translation were recorded at 20 time points during the extension-flexion arc. Motion gradients, or slopes of the motion curves, were generated to allow for comparison of lumbar spinal motion profiles.
方法:横切面上的评价采用高频低量脉冲荧光影像直视检查法,以评价经TDR(n=8)、外周融合(n=5)和正常对照(n=4)的受试者腰椎的运动情况。在屈伸活动过程中的20个时间点记录其角度和移位情况。得出运动的倾斜度或运动曲线的斜率以对腰椎的运动轨迹进行比较。

Results. Circumferential fusions exhibited significantly steeper motion gradients at the proximal adjacent level compared with TDR during flexion. TDR had more physiologic motion profiles at the proximal adjacent level than fusions during flexion and extension. At operative levels L4/5 and L5/S1, TDR and controls exhibited similar motion profiles in flexion, while fusions exhibited significantly less motion. In extension, however, TDR had a steeper slope than controls at the L4/5 operative level. Between L3 and S1, the total range of motion accounted for by the L4/5 proximal adjacent level was 59% in 1-level fusions, 38% in 1-level TDR, and 29% in controls. While no control or TDR subjects underwent sagittal plane translation >3 mm during flexion-extension, 80% of fusions did (average 3.7 mm), most notably during the latter phase of extension.
结果:屈曲时,外周融合与TDR相比,近侧相邻节段显示出的运动倾斜度明显较陡。在屈伸运动中TDR者近侧相邻节段有着更多的生理运动轨迹。在L4/5和L5/S1两个手术节段,TDR和正常对照者在屈曲时显示出类似的运动轨迹,而融合者活动度则明显较少。然而,伸展时,在L4/5手术节段TDR与正常对照相比倾斜度更大。在L3和S1之间,L4/5近侧相邻节段分配的总的活动范围,在融合者1个节段为59%,TDR者1个节段位38%,而正常对照者为29%。屈伸运动时矢状面上的位移,正常对照和TDR受试者均没有大于3mm者,80%的融合者却有这种移位(平均3.7mm),在伸展的后阶段尤其明显。

Conclusions. TDR produces physiologic lumbar spinal motion profiles in flexion and extension at the operative and proximal adjacent levels. Fusions, however, produced steeper motion gradients at the proximal adjacent level, while undergoing significantly greater sagittal plane translation during flexion-extension.
结论:在手术节段和相邻近侧节段,TDR在屈伸运动中产生了生理性的腰椎运动轨迹。然而,在近侧相邻节段,融合则导致了脚的运动倾斜度,而屈伸运动时,矢状面上的移位也明显较大。

Key words: lumbar disc replacement; fluoroscopy; motion profile; fusion; adjacent segment
关键词:腰椎间盘置换;荧光透视;运动轨迹;融合;相邻节段

Segmental Motion Adjacent to Anterior Cervical Arthrodesis: A Prospective Study
颈椎前路融合邻近节段的运动:一项前瞻性研究


Abstract
Study Design. Prospective, observational study.
研究设计:前瞻性观察研究。

Objective. The present study describes in a prospective setting the kinematics changes occurring at segments adjacent to a one-level cervical arthrodesis.
目的:本研究在预期的背景下描述单一节段颈椎融合后邻近阶段发生的运动学改变。

Summary of Background Data. The development of adjacent segment disease has been noticed by many clinicians. Whether symptoms develop due to fusion induced accelerated spondylosis or due to a natural development in a predisposed person is currently under debate. The motivation for introducing motion preservation procedures in the neck is primarily to protect the patients from developing symptomatic adjacent disc disease. To accept this rationale, it has to be demonstrated that a fusion creates an unfavorable biomechanical situation at adjacent levels.
背景资料概述:很多临床医生已经注意到邻近节段性疾病的发展。而症状的发展是否是由于融合的诱导加快了脊椎关节僵硬,还是由于易感人群的自然发展过程,目前还存在争论。采用保存颈部活动度的方法,其目的主要是防止这些患者邻近椎间盘疾病症状的进展。接受这一理论,就必须证实融合在相邻节段导致了不利的生物力学状况。

Methods. Forty-six patients underwent standard anterior cervical decompression and fusion using a cylindrical cage implant. Lateral radiographic views of the cervical spine in flexion and extension were obtained before surgery, and at 12 months of follow-up. Employing Distortion Compensated Roentgen Analysis, rotational and translational motion at adjacent levels was quantified prospectively.
方法:46例患者都进行了标准的颈椎前路减压圆柱形钛笼植入融合手术,术前和随访12个月时拍摄颈椎过伸过屈位侧位X线片。应用变形补偿X线分析,并对相邻节段旋转和平移活动进行预期的量化。

Results. Rotational and translational motion at adjacent cranial and caudal levels did not exhibit a significant change between the preoperative state and the state 12 months after the operation.
结果:手术前状态和术后12个月的状态相比,头侧和尾侧相邻节段旋转和平移活动没有体现出显著的变化。

Conclusion. The assumption of an iatrogenically caused increased mobility by a one-level cervical fusion could not be confirmed 12 months after surgery.
结论:手术后12个月时,尚不能证实颈椎单节段融合后,医源性的原因导致了(相邻节段)活动度增加的这一假说。

Key words: cervical fusion; adjacent level; segmental motion
关键词:颈椎融合;相邻节段;节段活动
Internal Thoracic Vessels Used as Pedicle Graft for Anastomosis with Vascularized Bone Graft to Reconstruct C7–T3 Spinal Defects
使用胸廓内血管作为血管蒂移植物与血管化骨移植物吻合重建C7-T3脊柱缺损
全文


The advantages of using a free vascularized bone graft in reconstructive spinal surgery have been well described and include rapid incorporation and fusion at the anchorage sites, superior mechanical properties and hypertrophic reaction guided by mechanical load, resistance against infection, and better toleration of radiation therapy.1–4 However, many important decisions have to be made when using a vascular graft in spinal surgery: the type of graft to take (fibula, iliac crest, or others), how to approach the affected spinal region,5 and the selection of suitable recipient vessels. Since Vineberg and Miller first described the internal thoracic vessels as a conduit in 1950,6 these vessels have become more and more appealing as a donor graft because of its documented long-term patency in coronary bypass surgery (the golden standard).7 Moreover, they are also recommended as the first-choice recipient vessels for microvascular breast reconstruction.8
在重建性脊柱外科中使用游离的血管化骨移植物的优点已被详尽描述过,包括锚定点的迅速骨连接及骨性融合,较好的机械性能及机械负荷诱导的肥大反应,抗感染能力以及对放疗的良好耐受。然而,应用血管化移植物的时候必须做一些重要的抉择:移植物的类型(腓骨、髂嵴或其他),如何显露脊柱缺损区及如何选择合适的受体血管。自从Vineberg和Miller首次描述了将胸廓内血管作为移植血管后,该血管作为供体越来越受到欢迎,因资料显示它在冠状动脉旁路移植术中长期未闭故已作为金标准使用。而且它还被推荐作为微血管乳房重建术的首选受体血管。

To our knowledge, no literature exists on the application of the internal thoracic vessels as the recipient vascular pedicle in reconstructive spinal surgery. We describe a new technique using vascularized fibula grafts anastomosed to the internal thoracic vessels to reconstruct the cervicothoracic junction after en bloc resection of primary spinal tumors or for correction of progressive deformities in this region.
据笔者所知,目前没有关于胸廓内血管作为受体血管蒂用于脊柱外科重建手术的文献报道。笔者描述一种新技术使用血管化腓骨移植物吻合到胸廓内血管重建颈胸结合部原发肿瘤整块切除后的缺损或矫正此区域的进行性加重的畸形。

Methods
Anatomy.
The internal thoracic artery, previously called the internal mammary artery, originates from the first part of the subclavian artery, about 2 cm above the clavicle’s sternal end, opposite the root of the thyrocervical trunk 9 (Figure 1). It passes inferiorly, posterior to the respective brachiocephalic vein and medial to the scalenus anterior muscle. At this point, it is crossed by or may cross the phrenic nerve from its own side and continues downwards with the internal thoracic vein medially, lying deep to the costal cartilage and superficial to the underlying parietal pleura. At the third intercostal space, the artery runs inferiorly but now superficial to the transverse thoracic muscle. At the level of the sixth intercostal space, it divides into 2 branches. On the way down, it gives off some branches, such as the pericardiophrenic branch and the anterior intercostal arteries, and it is cloaked by venae comitanes, which drain to the respective brachiocephalic vein via the internal thoracic vein.9
方法
解剖:胸廓内动脉,以前也称乳内动脉,发自锁骨下动脉第一段,大约位于锁骨胸骨端2cm以上,正对甲状颈干根部。它向下走行在头臂静脉后方、前斜角肌中部。在此处它与膈神经交叉或在同侧越过膈神经继续与内侧的胸廓内静脉下行,向深面到肋软骨,浅面到潜在的壁胸膜。在第三肋间隙,本来在下方走行的动脉此时走向表浅的胸横肌。在第六肋间隙分为两支。在下降途中,它发出一些分支如心包膈动脉、肋间前动脉,并被伴行静脉覆盖,这些静脉通过胸廓内静脉引流至相应的头臂静脉。


The length of the internal thoracic artery is 18.05 to 20.4 cm on average.10–12 The internal diameter of the artery ranges from 2.5 to 5 mm 13–17; the average diameter of the vein is 2.82 to 3 mm.18,19 However, overall, 20% of left-sided internal thoracic vessels were found to have an inadequate recipient vein.8 The most consistent interval is at the level of the third rib, which offers an appropriate recipient vein (40% >=3 mm on the left and 70% >=3 mm on the right).20
胸廓内动脉的长度平均为18.05-20.4cm。动脉内径的范围是2.5-5mm,平均静脉内径为2.82-3mm。然而,总体说来,有20%的左侧胸廓内血管被发现缺少合适的受体静脉。最一致的区间是第3肋水平,可提供合适的受体静脉。(左侧40%≥3mm,右侧70%≥3mm)。

Surgical Technique.
When an en bloc resection of a primary spinal tumor or a correction of a spinal deformity of the cervicothoracic junction is planned with the use of vascularized graft for the osseous reconstruction, a preoperative plan is made concerning: 1) planning of the operative procedure, 2) choice of vascularized graft, 3) technique of inserting and securing the graft, and 4) selection and monitoring of vessels for anastomosis.
In case of a total en bloc resection of one or more high thoracic vertebrae, we start with a dorsal approach by exposing the affected spinal segments, cut and remove rib ends bilaterally, perform one or multilevel laminectomies and bilateral foraminectomies and facetectomies, followed by an incision and reaming of the intervertebral discs at the appropriate levels. The dura is gently dissected laterally and anteriorly and some nerve roots are ligated at the spinal canal level to allow the en bloc removal of the remaining parts of the vertebrae from anterior. Subsequently, a dorsal spinal instrumentation, usually a screw-rod construction, is mounted on 2 to 3 spinal segments above and below the resection area for stability followed by wound closure.
外科技术:
当计划应用血管化移植物行脊柱原发肿瘤整块切除或颈胸结合部畸形矫形术时,术前准备应包括:1、计划手术步骤,2、选择血管化移植物,3、嵌入及稳定移植物的技术,4、选择并监测要吻合的血管。
假设要做一个或多个高位胸椎椎体的整块切除,我们采用背侧入路显露病变节段,切除双侧肋骨末端,行一节或多节段椎板切除,双侧椎间孔及小关节切除,继以相应节段椎间盘切除和刮除。硬膜应从外侧和前方小心解剖,某些神经根在椎管水平应结扎以便从前方完成剩余椎体的整块切除。接下来,安放后路脊柱内固定系统(一般为钉棒系统)做固定,注意切除区域上下2-3个节段均应做固定。最后闭合伤口。


The next session of the surgical procedure is continued in a supine position. At this stage of the surgery, 2 surgical teams work in parallel; one team exposes the cervicothoracic junction and performs the resection, while the other team raises the free vascularized fibula graft. Harvesting the vascularized fibular graft is a very standardized procedure 21 and will not be described here.
When an en bloc resection-reconstruction includes the lower cervical segments (C5 and below), a curved anterolateral skin incision over the lower part of the neck is combined with a midline sternal skin incision. Alternatively, by a lower resection–reconstruction (e.g., below C7) a T-like incision just above and parallel to the clavicles in combination with a midline sternal incision is performed (Figure 2). Anteromedial to the sternocleidomastoideus muscle and the internal carotic vein and artery, the lower part of the cervical spine is exposed (usually C5, C6, C7) followed by dissection of the sternal notch. After partial or complete median sternotomy and division of the mediastinal fat in the midline, the internal thoracic artery and vein are palpated bilaterally but not dissected. A chest wall retractor is placed and identification and dissection of the major vessels, pericardia, and lungs is performed exposing the anterior part of the upper thoracic spine (T1–T5). The spinal en bloc resection is completed by anterior dissection and incision of the pleurae parietalis, the anterior longitudinal spinal ligament, and the intervertebral discs at the appropriate levels; hereafter en bloc removal of the vertebra.
接下来的步骤在仰卧位完成。在此阶段,2个手术小组应同时开始,一组暴露颈胸结合部并做切除,另一组获取游离血管化的腓骨。获取血管化腓骨移植物是一种非常标准化的手术操作这里不再赘述。
当整块切除-重建术包含下颈椎(C5及以下)时,应使用低位颈前外侧弧形切口加胸骨正中切口。另外,更低的位置(如C7以下)可以做锁骨上平行切口联合胸骨正中切口,即所谓T型切口。在胸锁乳突肌及颈内动静脉前内侧,下部颈椎(C5,C6,C7)可通过切开胸骨切迹得到显露。部分或全部胸骨正中切开、中线上纵隔脂肪切开后,胸廓内动静脉可以在两侧触及但不解剖。放置胸壁牵开器,辨认并解剖主要血管、心包及肺,显露上胸椎前方(T1-T5)。通过前路切开壁胸膜、前纵韧带和相应节段椎间盘完成脊柱整块切除。此后完整移除椎体。


To reconstruct the osseous defect, we prefer the fibula as the emphasis is on compression strength. We normally use double- or triple-barrel fibula grafts. Before inserting the grafts, a slot is made in both endplates of adjacent vertebrae and the lengths of the fibular parts are measured. Subsequently, the fibula is osteotomized subperiosteally; at the osteotomy sites, the periost is mobilized over a few millimeters to facilitate both a smooth bend of the vascularized pedicle and insertion into the slots. The vascularized pedicle should be on the outside of the combined struts as much as possible. The fibula parts are folded and pressed or gently hammered into one slot taking care not to damage, compress or kink the vascular pedicle, followed by pressing the other ends of the fibula parts into the other slot. A dangerous pitfall in positioning and fixing the bone graft is when the most dorsal fibula graft is being pushed too far dorsally on one or both sides, thereby compressing the spinal cord. To avoid this problem, the slot in both vertebral endplates should not be open at the dorsal side and the surgeons should securely check the area by palpation and or radiograph before and after final bone graft placement. Usually, a ventral reconstruction system (anterior cervical plate screw system) is used for both further stabilization of the spine and axial compression on the fibula strut grafts.
为重建骨性缺损,我们更喜欢用腓骨作为抗压的重点。我们通常使用两个或三个管状腓骨移植物。在嵌入移植物之前,邻近椎体的终板均开槽备用并测量腓骨部的长度。接着行腓骨的骨膜下截骨,在截骨处,骨膜应游离数毫米以便获得良好的血管蒂同时方便嵌入槽内。血管蒂应尽可能在支撑物的外面。然后将腓骨块合拢、捆紧,轻柔的锤入一侧槽内,注意避免损伤、压迫或纽绞血管蒂,再将另一端锤入槽内。危险的地方在于放置和固定腓骨移植物的时候,如腓骨块被推入背侧太多则可对脊髓构成压迫。为避免此问题,在终板开槽时应避免一直打通到背侧,术中术者可用触摸或透视的方法在嵌入移植物前后来检查确认。通常使用前路重建系统(前路颈椎钢板螺钉系统)稳定脊柱及轴向加压植骨块。

The final step is the dissection of the internal thoracic artery and vein to avoid damage by compression, coiling, kinking, or stretching of the vascular pedicle.7 Usually, the internal thoracic artery and vein are exposed at the level of the first rib; branches are clipped next to the main branch while the other ends of the branches are either electrocauterized (bipolar coagulation) or clipped. Injury to the phrenic nerves should be avoided. Before definitive cut and transposition of the vessels, the distance to the affected vertebra has to be estimated to certify enough pedicle length. Usually, we cut the vessels at the level of T6 or T7. After transposition through the approach of the mediastinum, the anastomosis can be performed by using loupe glasses or microscope (Figure 3). After finishing the anastomosis, the surgical field is checked followed by wound closure. In case of a spinal correction-stabilization of the cervicothoracic junction due to progressive deformity or instability caused by for instance osteoporosis, trauma, neurofibromatosis, or infection, the same ventral approaches can be used. After corpectomy or making an axial slot in one or more vertebrae, the same technique is used for both the reconstruction of the osseous defect and the vessels anastomosis. After surgery, the neck is protected by a soft neck collar and the patient is gradually mobilized.
最后一步则是胸廓内动静脉的解剖,避免压迫、卷绕、纽绞或牵扯血管蒂。一般胸廓内动静脉可在第一肋水平显露;主支旁的分支可以结扎切断,其他分支可以双极电凝或结扎切断。应注意避免损伤膈神经。在最后切断和移植血管之前,一定充分估计距离目的椎体的距离以免血管蒂长度不够。通常我们在T6或T7水平切断血管。穿过纵隔将血管移位后,可在放大镜或显微镜下吻合血管。吻合完毕后清点术野关闭伤口。对颈胸结合部脊柱矫形固定的病例,如进行性加重的畸形或由于骨质疏松症、创伤、神经纤维瘤病及感染导致的不稳定,可使用相同的腹侧入路。椎体切除或在一个多多个椎体上开出轴向槽后,可使用相同的技术重建骨缺损及吻合血管。术后软质围领保护颈部,病人逐渐活动。

Results
To date, 4 patients having a primary tumor (3 cases) (Figure 4) or a severe progressive kyphotic deformity due to tuberculosis (1 case) were treated according to one of the above described techniques (Table 1). One female and 3 males underwent this complex surgery (age range, 12–54 years).
Two en bloc resections of T1–T3 (case 1, 2) and one T1–T2 (case 3) en bloc resection were performed in a staged anteroposterior approach. Ventral reconstruction of the osseous defect consisted of a vascularized graft interposition between C7 and T4 in 2 cases and between C7 and T3 in another case. An axial slot was milled through the T1–T2 vertebral bodies to straighten the spinal cord and to accept an osteotomized vascularized fibular graft in another patient (Case 4). This patient had myelopathy due to a 90° kyphosis at T1–T2 after collapse of these vertebrae due to tuberculosis. In all cases, insertion of the grafts, ventral plate-screw placement, and vessel dissection and anastomosis went smoothly and without complications (Figure 5). However, in the postoperative period, a surgical reintervention was performed in 1 patient (Case 4) due to a deep wound infection. After thorough wound debridement and soft tissue cover of the plate-screw system, the further postoperative period was uneventful. At present, all patients are alive (mean follow-up, 28 months; range, 24–48 months), there is no evidence of recurrent disease and unchanged or improved neurology (Table 1). Oncologically, in 2 of 3 patients, marginal resection margins were achieved, and in 1 patient a wide margin. Case 1, having a Ewing’s sarcoma, received neoadjuvant chemotherapy, but no postoperative radiation therapy because of both the excellent response to the preoperative chemotherapy (as judged clinically, radiographically, and histopathologically) and the fear of further damage to the spinal cord. Case 3, having a staged 3 giant cell tumor and a marginal en bloc resection,22 received after surgery radiotherapy (an institutional protocol). In all patients, the fibula grafts are completely incorporated as seen on repeated thin sliced CT studies with 3-dimensional reconstruction (Figure 6).
结果
到目前为止,4个病人包括原发肿瘤(3例)及结核引起的严重进行性加重的后凸畸形(1例)均经上述技术治疗。包括一位女性及3位男性(年龄范围12~54岁)。
两例T1-T3整块切除,一例T1-T2整块切除经分阶段的前后路手术完成。腹侧重建骨缺损包括两例C7到T4的血管化移植物填充,另一例为C7到T3。最后一例从T1-T2椎体打磨出一条轴向槽以矫直脊髓并容纳血管化腓骨移植物。这位病人因T1-T2椎体结核塌陷导致90度的后凸畸形进而产生脊髓病。所有病例移植物放置、腹侧钉板固定、血管解剖及吻合均顺利无并发症。然而在术后,最后一例病人因为深部感染进行了二次手术。行彻底清创术及软组织覆盖钉板系统后再未见异常。目前,所有病人均存活(平均随访28个月;范围24-48个月),没有证据显示疾病复发,神经功能均有改善(原文直译为没有神经疾病无变化或加重的证据)。肿瘤学方面,3例肿瘤病人中的2例获得了边缘性切除边缘,1例行广泛性切除的尤文肉瘤患者接受了新辅助化疗,但未行术后放疗,原因在于他对术前化疗反应很好(通过临床、影像学及组织学评估),同时担心对脊髓的进一步损伤。另一例病人为3期巨细胞瘤,行边缘性整块切除,术后继以放疗。所有病人以薄层CT扫描三维重建观察腓骨移植块均完全融合。


Discussion
Compared with autogenous and allogenous bone grafts, free vascularized bone grafts do not undergo resorption, and maintain twice the bone density of nonvascularized grafts.23 We favor the use of a vascularized fibula graft because of its superior mechanical quality, and the graft is easy to fit to the type, size, shape, and location of the defect in different anatomic areas of the spine.4,24
Compared with a vascularized rib graft, for instance, a vascularized fibula has superior mechanical quality and axial strength, providing up to 30 cm of bone in the adult male,25 and has low donor site morbidity.26 The use of free vascularized fibula grafts to reconstruct spinal osseous defects, however, is a time-consuming, technical demanding, complex surgical procedure that needs a skillful team. Therefore, these surgeries are only performed in our and other institutes when prior attempts of spinal fusion have failed, or in case of the existence of very complex spinal deformities due to diseases such as osteoporosis, osteogenesis imperfecta, and osteomyelitis, or in selected spinal tumor cases.4,24
The cervicothoracic junction is one of the most difficult and challenging areas for spinal reconstruction due to the complex local anatomy. When in this area a reconstruction of a spinal defect with a vascularized fibula graft is considered, selection of suitable recipient vessels can be a major problem. The choice of recipient vessels is not only dependent on the approach (ventral, dorsal, lateral, or a combination) that has been chosen, but also on the availability (which vessels remain in the vicinity after an en bloc resection), the quality (diameter) and the length of the pedicle.
讨论
相比自体骨移植和异体骨移植,游离血管化骨移植不会吸收,并能维持非血管化骨两倍的骨密度。我们喜欢使用血管化腓骨,因其较高的机械强度,而且移植物可以很容易的做成适合脊柱不同解剖区域骨缺损的类型、大小、形状及位置。
相对血管化的肋骨移植,血管化腓骨移植有更好的机械强度及轴向力量,成年男性可以提供长达30cm的骨并且供体部位患病率较低。然而使用游离血管化腓骨移植重建脊柱骨性缺损耗时、复杂、技术要求高,需要一个技术熟练的团队。因此这种手术在我们和其他机构里只有当首选的脊柱融合术失败,或因骨质疏松症、成骨不全、骨髓炎导致非常复杂的脊柱畸形或在择期的脊柱肿瘤病例中方才实行。
颈胸结合部由于复杂的局部解剖成为了脊柱重建领域里最难、最具挑战性的区域之一。当在此区域使用血管化腓骨移植重建脊柱缺损时,选择合适的受体血管是一个主要的问题。受体血管的选择不但取决于手术采用的入路(腹侧、背侧、外侧或联合),而且取决于可用性(整块切除后哪根血管仍然在附近),血管的质量(直径)及血管蒂的长度。


Via a combined low anterolateral cervical and midsternal approach or a midline sternotomy (Figure 2), the spine can be reached easily (Figure 4). The distance between sternum and spine is surprisingly short, giving an excellent accessibility and possibilities to perform anterior spinal surgery in this region. As shown in this study, the internal thoracic vessels can easily be identified and fulfill all criteria to be the principal recipient vessels for a vascularized graft reconstruction. The field of dissection is not violated when using the described approach; there is no perivascular scarring in the delayed reconstruction scenario. Next to the favorable topographic anatomy and location, there is sufficient pedicle length and pliability, which allow an anastomosis with the donor artery and vein without kinking or stretching between C6–T4. Flows to the subclavian or the vertebral arteries are not compromised. The long-term patency has been demonstrated. They are superior to the thoracodorsal vessels with regard to graft positioning as well as positioning for the vascular anastomoses.17
Patients who undergo this complex spinal surgery often need wide exposed surgical fields, and the surgery usually takes up to 8 hours or more. There is an increased risk of deep venous thrombosis of the legs, including the peroneal veins. It is therefore advisable to leave the donor leg covered and warm for as long as possible, raising the fibular graft and its vessels as close to the moment of actual transfer as possible. Although rare, another potential complication that can occur is the development of a sternal infection due to a significant decrease of sternal blood supply in the retrosternal area when harvesting the internal thoracic vessels.27
通过联合低位颈前外侧和胸骨正中入路或正中胸骨切开,脊柱可以轻易的显露。胸骨和脊柱的距离令人意外地短,提供了前路脊柱手术的非常好的可行性和易行性。正如本研究中所示,胸廓内血管可轻易地识别出并符合所有作为血管化移植重建术所需主要血管的标准。使用上述入路术野解剖破坏不大,在进行延期重建手术计划时没有血管周围的瘢痕形成。除了良好的局部解剖和位置,还有足够的血管蒂长度和柔韧性,允许在C6到T4之间吻合供体动静脉且无纽绞和牵扯。流向锁骨下或椎体动脉的血液并未因此减少。已有长期未闭的示例。它们优于胸背侧血管不论在移植物放置还是在血管吻合的位置上。
行此手术的患者多需要广泛的术野暴露,手术时间一般8小时或更多。故下肢深静脉血栓形成的风险增加,包括腓静脉。因此建议供体下肢尽可能长地覆盖及保温,获取腓骨移植物及其血管时尽可能与移植的时间贴近。虽然罕见,另一个潜在的并发症是胸骨感染,由于分离出胸廓内动脉后显著减低了胸骨后的血供。


Conclusion
The described technique indicates that the internal thoracic vessels are appropriate donor vessels (pedicle length, diameter, rerouting capacity) for anastomosis with vascularized grafts used for reconstruction of vertebral column defects in the low cervical (C6–C7) and/or upper thoracic (T1–T3) region.

结论
本文描述的技术提示胸廓内血管是血管化移植重建下颈椎(C6-C7)上胸椎(T1-T3)椎体缺损合适的受体血管(蒂长度、直径、变向能力)。

Reliability of 3D Reconstruction of the Spine of Mild Scoliotic Patients.
轻微脊柱侧凸患者的脊柱3D重建的稳定性

Abstract:
摘要:
Study Design. A reliability study was conducted in quantitative 3-dimensional (3D) measurements for mild scoliosis.
研究设计:我们设计了一个用量化的3D方法检测轻微脊柱侧凸的可靠研究。
Objective. To evaluate the intrarater and interrater reliability of a computer tool used for 3D reconstruction of the spine.
目标:我们用电脑软件实现脊柱的3D重建,从而评估其在种族内和种族间的可靠性。
Summary of Background Data. No reliability study of spinal in vivo 3D medical imaging measurements has been performed in the literature.
背景概述:目前文献中尚无关于使用3D医学影像方法测定脊柱的可靠的研究的记载。
Methods. This study included 30 patients (mean age 13 years) with mild idiopathic scoliosis. Spinal 3D reconstruction was performed using a new technique called semiautomatic 3D reconstruction, which requires only the location of the corners of each vertebral body on 2 orthogonal views. Three raters performed the 3D reconstruction procedure on the 30 pairs of radiographs in random order. One of the raters repeated the procedure for the 30 patients 15 days later. Inter-reliability and intra-reliability were estimated for different parameters: thoracic kyphosis, lumbar lordosis, Cobb's angle, pelvic morphologic and positional parameters, and axial rotation.
方法:本次研究包括了患有轻微原发型脊柱侧凸的30位患者(平均年龄13岁)。 通过一种叫做半自动3D重建的技术,我们就实现了脊柱的3D重建,这种技术只需要每个椎体成直角的两个角度的位置就能实现。在这30对影像随即排列的基础上,3个评定者实施了3D重建过程。在15天后,其中的一位评定者为这30名患者再次重复了这个程序。通过不同的参数,我们评估了其种族间稳定性和种族内稳定性,这些参数分别是:胸椎后凸、腰椎前凸、科布角、骨盆形态和位置参数以及中轴旋转度。
Results. Intraclass correlation coefficient showed good or very good agreement for most of the measurements. The 95% prediction limits are approximately 4[degrees] for the measurements of spinal curves, 2[degrees] for pelvic parameters, and axial vertebral rotation.
结果:同类相关系数显示,这些测量结果有很好甚至非常好的一致性。其中关于脊柱曲线的95%限制区间大约为4度,骨盆参数以及中轴旋转度均为2度。
Conclusions. The reliability of 3D reconstruction of the spine is acceptable, and this technique can be used for clinical studies.
结论:3D脊柱重建的可靠性是可以接受的,这项技术可以在临床研究中推广使用。
Three-Dimensional Analysis of Formation Failure in Congenital Scoliosis.
先天性脊柱侧凸成形失败的3D分析


Abstract:
摘要:

Study Design. Morphologic analysis was performed by 3-dimensional (3D) CT in 75 patients with congenital scoliosis exhibiting formation failure.
研究设计:我们对75例患有先天性脊柱侧凸成形失败的患者的3D CT的形态学分析。

Objectives. The objectives of this study were to conduct 3D analysis of the morphology of spinal malformation and to elucidate the association between malformed vertebrae and adjacent vertebrae.
目标:研究的目的在于使用3D分析技术分析脊柱异常成形以及畸形椎体与相邻椎体间的联系。

Summary of Background Data. The morphology of spinal malformation has conventionally been evaluated by plain radiograph radiography. Although the usefulness of 3D CT has recently been reported, these reports have only demonstrated that this technique allows more detailed evaluation than plain radiography.
背景概述:脊柱的形态学异常常规是有平片技术来评估的。虽然3D CT的实用价值在最近曾经被报道过,但这些报导仅仅能说明这项技术可以获得比平片更详细的信息而已。

Methods. We examined the morphology of the posterior components in spinal malformation of formation failure and evaluated the association between the anterior and posterior components by 3D CT. We clarified the morphologic variations of the posterior components in spinal malformation by dividing 75 cases of formation failure into solitary and multiple numbers of malformed vertebrae and into simple and complex modes of malformation between anterior and posterior components.
方法:我们使用3D CT测定了脊柱形成失败时的脊柱后部分的形态,并且评估了前部分与后部分之间的联系。我们通过或者将75个成形失败的病例分为单处脊柱畸形和多处畸形,或者将它们分为简单的畸形和复杂的畸形,从而分清了前部与后部之间的形态学变异。

Results. Thirty-three patients exhibited a single malformed vertebra in the entire spine (solitary malformation group), while the other 42 had multiple malformed vertebrae (total, 102 malformed vertebrae: multiple malformation group). The multiple malformation group consisted of 26 patients (57 malformed vertebrae) in whom the cause of scoliosis could be explained separately for each of the malformed vertebrae and 16 patients (45 malformed vertebrae) in whom the structure was complicated and the cause of scoliosis could not be explained for each of the malformed vertebra.
结果:33个病人表现为整个脊柱单处的脊柱畸形(单发畸形组),其他的42例为多发的脊柱畸形(总共有102处脊柱畸形:多发畸形组)。在多发畸形组中,有26个病人(57处脊柱畸形)中的每一处畸形的病因都能得到独立的解释。而剩下的16个病人(45处脊柱畸形)的畸形的结构就比较复杂,并且没处畸形都不能够得到独立的解释。

Conclusion. There were morphologic variations of the posterior components of malformed vertebrae. A completely new complex malformation in which the mechanism of formation failure may differ from the conventionally proposed mechanisms was also found.
结论:脊柱畸形的后部存在着形态学的变异。我们还发现了完全的新的复杂的畸形的形成机制有别与我们常规默认的机制。
Comparison of Thoracic Pedicle Screw to Hook Instrumentation for the Treatment of Adult Spinal Deformity 成人脊柱畸形分别采用胸椎弓螺钉或钩固定后的矫形比较
R. Shay Bess, MD, Lawrence G. Lenke, MD, Keith H. Bridwell, MD, Gene Cheh, MD,Stephen Mandel, BA, and Brenda Sides, MS
Study Design. Retrospective, case-control, matched cohort. 研究设计,对照,配对病例的回顾性研究
Objective. Compare the radiographic and clinical outcomes of adult spinal deformity patients treated with thoracic pedicle screw (TPS) or thoracic hook constructs. 目的:对成人脊柱畸形分别采用胸椎弓螺钉或钩固定,比较它们在平片和临床结果的区别
Summary of Background Data. The efficacy of TPS instrumentation for pediatric spinal deformity correction has been established. Little is known about TPS use in adult spinal deformity. 研究资料简介:人们已经证实胸椎椎弓根螺钉在儿童脊柱畸形的矫形中有效,但它对成人脊柱矫形的效果人们知之甚少。
Methods. Fifty-six patients (average age, 49 years; average follow-up, 3.58 years) were treated with TPS or thoracic hook constructs for coronal (n= 20) or sagittal (n= 36) plane deformities. Patients were evaluated radiographically and with SRS scores. 方法:采用胸椎弓螺钉或钩固定治疗56个成人脊柱畸形病人(平均年龄49岁,平均随访3.58年。)其中冠状面畸形20例,矢状面畸形36例。采用平片和SRS评分来评价矫形效果。
Results. Coronal deformities treated with TPS demonstrated improved main thoracic curve correction compared with hook constructs at last follow-up (24.8° vs. 13.8°; P<0.05), despite having larger (59.8° vs. 44.9°; P<0.05) and more rigid preoperative curves (29.3% vs. 44.9% correction on side-bending radiographs; P<0.001). Sagittaldeformities treated with TPS constructs demonstrated greater thoracolumbar kyphosis correction than hook constructs at last follow-up (12.1° vs. 2.5°; P <0.05). No TPS patient had a thoracic pseudarthrosis. Four hook patients (14%) had thoracic pseudarthroses. 结果:尽管采用胸椎弓螺钉病人比钩固定治疗病人术前有较大的(59.8v44.9度,p<0.05)和较僵硬(侧方应力位矫形29.3v44.9度,p<0.001)的主胸弯冠状面畸形,但是最后随访时,前者矫形更好(24.8v13.8度,p<0.05)。胸椎弓螺钉病人比钩固定治疗病人,最后随访时对矢状面胸腰段后凸的矫形程度大(12.1v2.5度,p<0.05)。胸椎弓螺钉病人没有胸椎假关节。钩固定病人有4例(14%)胸椎假关节。
Conclusions. TPS instrumentation allows greater coronal and sagittal plane correction and may reduce the risk of thoracic pseudarthrosis compared with hook constructs when treating adult spinal deformities. 结论:治疗成人脊柱畸形,胸椎弓螺钉比钩在矢状面和冠状面畸形的矫形程度更大,并且能减少胸椎假关节形成的危险。
Key words: adult spinal deformity, thoracic pedicle screw, spinal instrumentation. Spine 2007;32:555–561
关键词:成人脊柱畸形,胸椎椎弓根螺钉,脊柱内固定。
Fibroblast Growth Factor-2 Maintains the Differentiation Potential of Nucleus Pulposus Cells In Vitro
Implications for Cell-Based Transplantation Therapy


Study Design. To investigate effects of FGF-2 on nucleus pulposus cell growth and differentiation.
Objectives. To elucidate the phenotypic changes that occur during expansion of nucleus pulposus cells in monolayer culture, and to investigate the effects of fibroblast growth factor (FGF)-2 on cell growth and differentiation.
Summary of Background Data. Nucleus pulposus cells would have a limited application for autologous cell transplantation if phenotypic dedifferentiation takes place during culture expansion. FGF-2 has been shown to retain the differentiation potential of monolayer expanded chondrocytic cells. However, its effect on nucleus pulposus cells is not known.
Methods. Bovine nucleus pulposus cells were serially passaged in the presence or absence of FGF-2 (1 and 10 ng/mL). After passage numbers 1 and 7, cells were immobilized in alginate beads and treated with transforming growth factor (TGF)-_1 for 1 week to assess their differentiation.
Results. During culture expansion in monolayer, nucleus pulposus cells maintained the expression of aggrecan messenger ribonucleic acid (mRNA). However, mRNA levels of collagen type I, collagen type II, Sox-9, and versican decreased with increasing passage number for both control (untreated) cells and FGF-2 treated cells. When grown in alginate with TFG-_1, passage 7 cells that received FGF-2 during culture expansion restored the mRNA expression of type II collagen, Sox-9, COMP, chondroadherin, and fibromodulin. Moreover, FGF-2 treatment resulted in increased sulfated proteoglycan synthesis and lower aggrecan turnover compared to untreated controls under identical culture conditions. FGF-2 treated cells continued to express HIF-1_ protein till passage 7, while MMP-2 expression was evident in cells treated with TGF-_1. In addition, cells pretreated with FGF-2 showed higher induction of phospho ERK1/2 after treatment withTGF-_1. Also, FGF-2 maintained smad 2/smad 3 mediated signaling in cells after TGF-_ treatment. FGF-2 action resulted in reduced actin stress fiber formation and migratory cell morphology, with no effect on cell proliferation.
Conclusions. The presence of FGF-2 during culture expansion of nucleus pulposus cells in monolayer can sustain a differentiated cell phenotype by maintaining responsiveness to TGF-_1. Our results suggest that FGF-2 should be tested for its ability to maintain the reactivity of the nucleus pulposus cells to other morphogenic factors that may be used for cell-based transplantation therapy.
Key words: nucleus pulposus cells, fibroblast growth factor-2, culture expansion, differentiation, gene expression. Spine 2007;32:495–502

成纤维细胞生长因子2在体外保持髓核细胞的分化潜力

――细胞移植疗法的应用研究
研究设计:研究FGF-2对髓核细胞生长和分化的作用。
研究目标:阐明发生在单层培养的髓核细胞在扩展时发生的表型变化,调查FGF-2对其生长和分化的作用。
背景资料总结:如果在培养扩展时发生表型的去分化,髓核细胞在自体的细胞移植中将很受限制。在单层培养的软骨细胞扩展中,FGF-2显示出可以保持分化的潜力,但此种作用在髓核细胞中尚不明确。
研究方法:在有或无FGF-2的条件下,传代培养牛的髓核细胞。在传第一代和第七代时,细胞固定在藻酸盐珠中,用转化生长因子-1处理1周来评价其分化。
研究结果:在单层培养的扩展中,髓核细胞保持了对蛋白多糖mRNA的表达。但随着对照组和处理组细胞的传代增加,胶原1,胶原2,Sox-9,以及多能蛋白多糖的mRNA水平减低。在藻酸盐及转化生长因子1中,得到FGF2的第七代细胞在培养扩展中保留了2型胶原、Sox-9,COMP,软骨细胞黏附素,纤维调节素的表达。而且,与在同样培养条件下的对照组相比,FGF2处理导致硫酸化蛋白多醣的合成,以及更少的蛋白多醣的转化。FGF-2处理的细胞直到第七代仍持续表达HIF1蛋白,而用TGF1处理的细胞对于MMP2的表达非常明显。还有,用FGF2预处理的细胞在用TGF1处理后表现为对磷化ERK1/2的高诱导。同样,在TGF1处理之后,FGF2保持了smad2/smad3的信号介导。FGF2可减少肌动蛋白张力丝的形成以及移行细胞的形态,但对细胞增殖没有作用。
研究结论:在单层培养的髓核细胞扩展中,FGF2的存在可以通过维持对TGF1的反应性来保持细胞分化表型。我们的研究说明应该对FGF2保持髓核细胞对其它形态发生因子的反应性从而可能使其应用于细胞移植疗法进行研究。
关键词:髓核细胞;成纤维细胞生长因子2;培养扩展;分化;基因表达。


Intradiscal Thermal Therapy Using Interstitial Ultrasound
An In Vivo Investigation in Ovine Cervical Spine


Study Design. In vivo investigation of intradiscal ultrasound thermal therapy in ovine cervical spine model.
Objective. To evaluate the potential of interstitial ultrasound for selective heating of intradiscal tissue in vivo.
Summary of Background Data. Application of heat in the spine using resistive wire and diofrequency current heating devices is currently being used clinically for minimally invasive treatment of discogenic low back pain. Treatment temperatures are representative of those required for thermal necrosis of ingrowing nociceptor nerve fibers and disc cellularity alone, or with coagulation and restructuring of anular collagen in the high temperature case.
Methods. Two interstitial ultrasound applicator design configurations with directional heating patterns were evaluated in vivo in ovine cervical intervertebral discs (n = 62), with up to 45-day survival periods. Two heating protocols were employed in which the temperature measured 5 mm away from the applicator was controlled to either <54 C (capable of nerve and cellular necrosis) or >70 C (for coagulation of collagen) for a 10-minute treatment period. Transient and steady state temperature maps, calculated thermal doses (t43), and histology were used to assess the thermal treatments.
Results. These studies demonstrated the capability to control spatial temperature distributions within selected regions of the in vivo intervertebral disc and anular wall using interstitial ultrasound.
Conclusions. Ultrasound energy is capable of penetrating within the highly attenuating disc tissue to produce more extensive radial thermal penetration, lower maximum intradiscal temperature, and shorter treatment times than can be achieved with current clinical intradiscal heating technology. Thus, interstitial ultrasound offers potential as a more precise and faster heating modality for the clinical management of low back pain and studies of thermal effects on disc tissue in animal models.
Key words: thermal dosimetry, lumbar spine, discogenic low back pain. Spine 2007;32:503–511

采用间隙超声进行椎间盘内热疗
在牛颈椎进行的体内实验


研究设计:在牛颈椎模型中进行椎间盘内超声热疗的体内研究。
研究目标:评价间隙性超声进行体内椎间盘内组织选择性热疗的价值。
背景资料分析:采用有抵抗力的导线和双频电流热装置进行脊柱热疗在目前临床上作为对椎间盘源性下腰痛的微创治疗。治疗温度代表那些需要热坏死处理的内生的伤害感受器神经纤维以及间盘细胞构成,或者在高温下造成胶原环的凝固和重构。
研究方法:在牛的体内62个颈椎间盘中评价2个采用直接加热模式设计的间隙性超声高频发热电极的作用,存活时间共45天。采用2种加热模式,在距离高频发热电极5mm的地方测量温度,控制在小于54度(可以造成神经和细胞的坏死)和大于70度(可使胶原凝固),治疗时间大约10分钟。采用瞬时以及稳定的温度图,热剂量计算(t43),以及组织学来评价热疗效果。
研究结果:研究表明了采用间隙性超声可以在体内椎间盘和纤维环壁内的选定区域控制空间温度。
研究结论:超声能量可以穿透高度衰减的椎间盘组织,产生更广泛的辐射性热穿透,减低最大的椎间盘内温度,采用现在临床椎间盘内热疗技术,可以缩短治疗时间。因此,间隙性超声为临床治疗下腰痛提供了更精确和迅速的治疗模式,为动物模型椎间盘组织的热治疗研究提供潜在价值。
关键词:热剂量;腰椎;椎间盘源性下腰痛。

Radiologic Assessment of All Unfused Lumbar Segments 7.5 Years After Instrumented Posterior Spinal Fusion.
腰椎后路器械融合术后7.5对各未融合腰椎节段的影响的放射学评估

Diagnostics
Spine. 32(5):574-579, March 1, 2007.
Pellise, Ferran MD, PhD *; Hernandez, Alejandro MD *; Vidal, Xavier MD, PhD +; Minguell, Joan MD *; Martinez, Cristobal MD *; Villanueva, Carlos MD, PhD *
Abstract:
Study Design. Prospective observational single-cohort study.
研究设计:前瞻性单队列观察研究
Objective. To analyze long-term radiographic changes in all unfused lumbar segments after instrumented posterolateral lumbar fusion.
目的:分析腰椎后路器械融合术后未融合节段的长期放射学改变
Summary of Background Data. Adjacent segment degeneration (ASD) after lumbar fusion may be a consequence of biomechanical stress or result from constitutional factors. Most studies analyzing ASD only investigate the motion segments immediately above and below the fusion. None compares adjacent segments to all the other unfused segments after instrumented posterior fusion.
背景:腰椎融合术后邻近节段的退行性改变可能是生物力学或结构性因素的结果。大多数关于邻近节段退行性改变的研究只涉及至融合节段的上或下一个运动节段。没有人去进行后路器械融合后其余未融合节段的影响的对比性研究
Methods. Using the distortion-compensated roentgen analysis method, disc height, dorsoventral displacement, and lordosis were measured in 212 unfused segments from 62 patients, on digitized standing radiographs taken before fusion surgery and after a mean follow-up of 7.5 years (range, 4-11 years). The effect of covariables, such as age, length of follow-up, fusion level, number of fused segments, and sagittal and spinopelvic parameters on the preoperative to follow-up changes, were analyzed using a repeated-measurement model.
方法:在标准数字化X光片上,比较术前和术后平均7.5年(4-11年)后62个病人212个未融合节段的椎间盘高度、椎体滑脱及脊柱前凸的情况,可变的影响因素如年齡、随访时间的长度、融合水平、融合节段数、融合节段上下方向和手术前后椎管的改变,用重复测量模型进行分析。
Results. No changes were observed at the segments located below the fusion. All the unfused segments above the fusion showed the same significant loss of disc height. Loss of disc height did not depend on fusion parameters, correlated weakly with age and length of follow-up, and correlated highly across adjacent unfused segments.
结果:在融合节段下方的未融合节段未发现任何改变,所有融合节段上方的未融合腰椎的椎间盘高度明显丢失,椎间盘高度的丢失与融合所使用的器械无关,与患者的年齡的随访的时间有一定联系,与距离融合节段的远近关系密切。

Conclusions. After posterior lumbar instrumented fusion, radiographic changes suggesting disc degeneration appear homogeneously at several levels cephalad to fusion and seem to be determined by individual characteristics.
结论:使用器械的后路脊柱融合术后,X线摄片改变提示靠近融合节段的近端的的几个相邻节段都会发生退行性改变,这种改变可能与个体因素有关.。
(C) 2007 Lippincott Williams & Wilkins, Inc.
Humeral Hemiarthroplasty with Biologic Resurfacing of the Glenoid for Glenohumeral Arthritis Two to Fifteen-Year Outcomes
半肩关节置换术结合关节盂表面生物学重建治疗盂肱关节炎:2-15年疗效观察
Background: Biologic glenoid resurfacing was developed in 1988 as an alternative to total shoulder arthroplasty in selected (usually younger) patients with primary, posttraumatic, or postreconstructive glenohumeral arthritis. A variety of biologic surfaces, including anterior capsule, autogenous fascia lata, and Achilles tendon allograft, have been combined with a humeral hemiarthroplasty.
背景:关节盂表面生物学重建是1988年作为全肩关节置换术的一种替代治疗发展起来的,应用于具有原发性、创伤后或重建术后盂肱关节炎的某些患者(通常是较年轻者)。各种各样的生物表面,包括前囊,自体阔筋膜和异体跟腱移植物等,已经与半肩关节置换术相结合。
Methods: From November 1988 to November 2003, thirty-four patients (thirty-six shoulders) who were managed with biologic glenoid resurfacing and humeral head replacement either with cement (ten shoulders) or without cement
(twenty-six shoulders) were followed prospectively. The study group included thirty men and four women with an average age of fifty-one years. The diagnoses included primary glenohumeral osteoarthritis (eighteen shoulders), postreconstructive arthritis (twelve), posttraumatic arthritis (five), and osteonecrosis (one). Anterior capsule was used for seven shoulders, autogenous fascia lata for eleven, and Achilles tendon allograft for eighteen. All shoulders were assessed clinically and with serial radiographs.
方法:从1988年到2003年,对34例(36肩)行关节盂表面生物学重建结合骨水泥型(10肩)或非骨水泥型(26肩)肱骨头置换术的患者进行前瞻性随访研究。本组病例包括男30例,女4例,平均年龄为51岁。诊断包括原发性盂肱骨关节炎(18肩),重建术后关节炎(12肩),创伤后关节炎(5肩),骨坏死(1肩)。前囊用于7肩,自体阔筋膜用于11肩,异体跟腱移植物用于18肩。对所有肩关节进行临床评价并拍摄系列X线片。
Results: The mean American Shoulder and Elbow Surgeons score was 39 points preoperatively and 91 points at the time of the most recent follow-up. According to Neer’s criteria, the result was excellent for eighteen shoulders, satisfactory
for thirteen, and unsatisfactory for five. Glenoid erosion averaged 7.2 mm and appeared to stabilize at five years. There were no revisions for humeral component loosening. Complications included infection (two patients), instability (three patients), brachial plexitis (one patient), and deep-vein thrombosis (one patient). Factors that appeared to be associated with unsatisfactory results were the use of capsular tissue as the resurfacing material and infection.
结果:美国肩肘外科评分术前平均39分,最后随访时平均91分。依据Neer’s评价标准,结果优18肩,良13肩,差5肩。关节盂浸润平均7.2mm,在5年内保持稳定。没有因肱骨假体松动而进行翻修的病例。并发症包括:感染(2例),不稳定(3例),臂丛神经炎(1例),深静脉血栓(1例)。与不良结果相关的因素是关节囊组织在关节面重建中的应用和感染。
Conclusions: Biologic resurfacing of the glenoid can provide pain relief similar to total shoulder arthroplasty. It allows selected younger patients to maintain an active lifestyle, including weight-lifting and manual work, without the risk of polyethylene wear. On the basis of this and previous reviews, we currently recommend Achilles tendon allograft as the preferred resurfacing material when this option is chosen.
结论:关节盂表面生物学重建术能够和全肩关节置换术一样减轻患者的疼痛。它能够使一些年轻人继续保持一种积极的生活方式,例如举重,手工劳动等,并且没有聚乙烯磨损的风险。在本研究和前人研究的基础上,如果选择关节盂表面生物学重建术,我们推荐利用异体跟腱移植物来作为首选的关节面重建材料。
谢谢各位老师
8.Evaluation of Postoperative Residual Spinal Deformity and Patient Outcome in Idiopathic Scoliosis Patients in Japan Using the Scoliosis Research Society Outcomes Instrument
日本使用脊柱侧弯研究会功能支具的病人手术后脊柱畸形的残留和特发性脊柱侧弯病人预后评价
Study Design. This study clarifies the correlation between the components of the Scoliosis Research Society Outcomes Instrument (SRS-24) and the radiographic parameters after surgery in Japanese idiopathic scoliosis patients.
text研究设计:这个研究阐明了脊柱侧弯研究会功能支具(SRS-24)组成和日本特发性脊柱侧弯病人手术后X线摄片参数的相关性。
Objectives. To investigate the correlation between the magnitude of back deformity after scoliosis surgery and the components of the SRS-24.
目的:调查研究脊柱侧凸手术后后凸畸形大小和SRS-24组成之间的相互联系。
Summary of Background Data. Patient outcomes for Japanese scoliosis patients using the SRS-24 have not been fully investigated.
背景摘要:日本脊柱侧凸病人使用SRS-24的预后没有被完全调查到。
Methods. Idiopathic scoliosis patients (n=81) who were treated with surgery and followed up for more than 2 years were evaluated. Radiographic examination included Cobb angle, rotation angle of apical vertebrae, and translation of the C7 vertebra from the center sacral line on the coronal plane. In addition, the score of one new question regarding postoperative scar was investigated and compared with that of the individual SRS-24 domains.
方法:手术后并随访2年以上的特发性脊柱侧弯的病人(81例)被用来评价。X线检查包括Cobb角,椎体顶点的旋转角和C7椎体在冠状面从骶正中线的平移。另外,研究关于术后斑痕这一个新问题的得分和比较术后斑痕个体SRS-24区域。
Results. A comparison of the SRS-24 and radiographic results revealed a significant inverse correlation between total pain and the postoperative correction of the rotation angle in the thoracic curve (rs=0.27; P <0.05). General self-image was inversely correlated with the Cobb angle (rs=-0.23; P<0.05) and the rotation angle (rs=-0.30; P<0.01) in the thoracic curve. Self-image after surgery was positively correlated with the correction degree of the thoracic Cobb angle (rs=0.27; P<0.05); 60% of patients had some concerns regarding postoperative scar, and the concerned patients demonstrated significantly lower scores in the pain and general self-image domains (P<0.05) than the unconcerned patients did.
结果:SRS-24和X线结果对照显示全身疼痛和术后胸曲旋转角矫正呈现显著负相关(rs=0.27; P <0.05). 胸曲大体自我感觉和Cobb角(rs=-0.23; P<0.05)、旋转角度(rs=-0.30; P<0.01)呈负相关。手术后自我感觉和胸Cobb角矫正角度呈正相关(rs=0.27; P<0.05)。60%的病人有一些担心术后瘢痕,并且在和没顾虑的病人比较,有顾虑的病人在疼痛和大体自我感觉中得到特别低的得分。
Conclusion. Patients with a greater Cobb angle or rotation angle in the thoracic curve had a negative self-image. Self-image improved after surgery by greater correction of the thoracic Cobb angle. Thoracic scoliotic deformity with prominence should be substantially reduced by the surgical treatment to improve satisfaction rates and self-image regarding back appearance. Additionally, physicians should pay more attention to patients’ concern regarding their postoperative scars to obtain better outcomes.
结论:在胸廓曲线中有更大Cobb角或旋转角的病人有一个不良的自我感觉。手术后自我感觉改善通过胸椎Cobb角更大的矫正。胸脊柱侧凸隆凸畸形经过手术治疗后实质上大大减少了,提高了满意率和关于背部外形的自我感觉。另外,医生需要更加关注病人关于手术后斑痕的忧虑以获得更好的预后。
Key words: Japanese idiopathic scoliosis patients, postoperative patient outcome, postoperative spinal deformity, Scoliosis Research Society Outcomes Instrument.
关键词:日本特发性脊柱侧凸病人,术后病人预后,术后脊柱畸形,脊柱侧凸研究协会预后支具
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