Comparison of Cobb angles measured manually,calculated from 3-D spinal reconstruction,and estimated from torso asymmetry

While scoliotic spinal deformity is traditionally measured by the Cobb angle, we seek to estimate scoliosis severity from the torso surface without X-ray radiation. Here, we measured the Cobb angle in three ways: by protractor from postero-anterior X-ray, by computer from a 3-D digitized model of the vertebral body line, and by neural-network estimation from indices of torso surface asymmetry. The estimates of the Cobb angle by computer and by neural network were equally accurate in 153 records from 52 patients (standard deviation of 6 degrees from the Cobb angle, r=0.93), showing that torso asymmetry reliably predicted spinal deformity. Further improvements in predictive accuracy may require estimation of other 3-D indices of spinal deformity besides the Cobb angle with its wide measurement variability.     

Comparison of Cobb Angles Measured Manually,Calculated from 3-D Spinal Reconstruction,and Estimated from Torso Asymmetry

While scoliotic spinal deformity is traditionally measured by the Cobb angle, we seek to estimate scoliosis severity from the torso surface without X-ray radiation. Here, we measured the Cobb angle in three ways: by protractor from postero-anterior X-ray, by computer from a 3-D digitized model of the vertebral body line, and by neural-network estimation from indices of torso surface asymmetry. The estimates of the Cobb angle by computer and by neural network were equally accurate in 153 records from 52 patients (standard deviation of 6° from the Cobb angle, r =0.93 ), showing that torso asymmetry reliably predicted spinal deformity. Further improvements in predictive accuracy may require estimation of other 3-D indices of spinal deformity besides the Cobb angle with its wide measurement variability.     

Pelvis morphology, trunk posture and standing imbalance and their relations to the Cobb angle in moderate and severe untreated AIS

Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis and usually affects young girls. Studies mostly describe the differences between scoliotic and non-scoliotic girls and focus primarily on a single set of parameters derived from spinal and pelvis morphology, posture or standing imbalance. No study addressed all these three biomechanical aspects simultaneously in pre-braced AIS girls of different scoliosis severity but with similar curve type and their interaction with scoliosis progression. The first objective of this study was to test if there are differences in these parameters between pre-braced AIS girls with a right thoracic scoliosis of moderate (less than 27°) and severe (more than 27°) deformity. The second objective was to identify which of these parameters are related to the Cobb angle progression either individually or in combination of thereof. Forty-five scoliotic girls, randomly selected by an orthopedic surgeon from the hospital scoliosis clinic, participated in this study. Parameters related to pelvis morphology, pelvis orientation, trunk posture and quiet standing balance were measured. Generally moderate pre-brace idiopathic scoliosis patients displayed lower values than the severe group characterized by a Cobb angle greater than 27°. Only pelvis morphology and trunk posture were statistically different between the groups while pelvis orientation and standing imbalance were similar in both groups. Statistically significant Pearson coefficients of correlation between individual parameters and Cobb angle ranged between 0.32 and 0.53. Collectively trunk posture, pelvis morphology and standing balance parameters are correlated with Cobb angle at 0.82. The results suggest that spinal deformity progression is not only a question of trunk morphology distortion by itself but is also related to pelvis asymmetrical bone growth and standing neuromuscular imbalance.     

不同后路术式治疗胸腰椎爆裂骨折的临床效果比较

目的：探讨不同后路术式治疗胸腰椎爆裂骨折的临床效果。方法：将我院骨科收治的96例胸腰椎爆裂骨折患者随机分为两组,分别使用经伤椎椎弓根六钉固定法（六钉组,65例）和跨伤椎短节段四钉固定法（四钉组,31例）进行复位固定,测量并比较术后6个月两组矢状面Cobb角、冠状面Cobb角和伤椎椎体前缘压缩比及术后并发症情况的差异。结果：两组患者术前矢状面和冠状面Cobb角、伤椎椎体前缘压缩比的差异无统计学意义（P〉0．05）。术后6个月,六钉组矢状面Cobb角、伤椎椎体前缘压缩比、术后并发症发生率均显著低于四钉组（P〈0．05）,两组冠状面Cobb角均为0°。四钉组术后并发痘的发生率为22．6％,而六钉组术后并发症的发生率为4．6％,显著低于四钉组（P〈0．05）。结论：经伤椎椎弓根六钉固定法治疗胸腰椎爆裂骨折疗效优于跨伤椎短节段四钉固定法．且不良反应较少．具有较高的临床应用价值。     

一期后路半椎体切除短节段内固定与一期前路半椎体切除短节段内固定治疗先天性半椎体畸形的疗效对比

目的：对比一期后路半椎体切除短节段植骨融合内固定术与一期前路半椎体切除短节段植骨融合内固定术治疗先天性半椎体畸形的疗效。方法：抽取兰州军区兰州总医院骨科中心脊柱外科46例住院手术治疗先天性半椎体畸形的患者,随机化分为2组,每组23例,分别行一期后路半椎体切除短节段植骨融合内固定术和一期前路半椎体切除短节段植骨融合内固定术,观察比较两纽的手术时间、出血量、术后住院时间、术前和术后6个月侧凸cobb角、后凸cobb角及矫正率。结果：两组间的手术时间、出血量、术后住院时间、术后6个月后凸cobb角及后凸矫正率对比差异有统计学意义。结论：一期后路半椎体切除短节段植骨融合内固定术在后凸畸形矫正方面优于一期前路半椎体切除短节段植骨融合内固定术,且其手术创伤较小、术后恢复较快。     

Genetic algorithm-neural network estimation of cobb angle from torso asymmetry in scoliosis

Scoliosis severity, measured by the Cobb angle, was estimated by artificial neural network from indices of torso surface asymmetry using a genetic algorithm to select the optimal set of input torso indices. Estimates of the Cobb angle were accurate within 5 degrees in two-thirds, and within 10 degrees in six-sevenths, of a test set of 115 scans of 48 scoliosis patients, showing promise for future longitudinal studies to detect scoliosis progression without use of X-rays.     

两种植骨方式在胸腰椎结核手术中的应用

目的:比较不同植骨方式治疗胸腰椎结核的手术效果,探讨颗粒自体骨与块状自体骨两种植骨方式在治疗胸腰椎结核的临床疗效。方法:2008年1月至2010年12月期间在我院手术治疗的胸腰椎结核患者132例,其中采用块状自体骨进行骨移植的患者60例,采用颗粒状自体骨进行骨移植的患者72例,随机从两种植骨方式中各抽取20例患者进行回顾性分析,对两组患者术中出血量、住院时间、术后神经功能改善情况、植骨融合情况、后凸畸形矫正状况进行对比。结果:所有患者均一期愈合,无全身并发症,两组患者随访12~36个月,平均18个月,影像学提示内固定位置良好,无松动及断裂,结核病灶无复发。块状骨组术后6个月随访植骨融合率15%(3/20)术后9个月融合率45%(9/20),术后12个月融合率95%(19/20)。颗粒骨组术后6个月随访植骨融合率45%(9/20)术后9个月融合率80%(16/20),术后12个月融合率100%。块状骨组术前Cobb角为29.8°±5.0°,术后Cobb角为14.7°±2.5°,末次随访Cobb角为16.0°±2.9°。颗粒骨组术前Cobb角为30.9±7.6°,术后Cobb角为15.6°±3.8°,末次随访Cobb角为16.7°±3.8°,两组病人术后cobb角较术前有明显矫正,末次随访无明显丢失,两组比较无显著性差异(P0.05)。颗粒骨组术中出血量明显少于块状骨组,两组比较有统计学意义(P0.05)。住院时间两组比较无显著性差异(P0.05)。结论:颗粒状自体骨与块状自体骨相比在胸腰椎结核手术中植入方便,出血量少,植骨融合时间短,融合率高,是胸腰椎结核植骨的理想选择。     

Conservative treatment in Scheuermann’s kyphosis: comparison between lateral curve and variation of the vertebral geometry

Background

Conservative treatment in the Scheuermann’s kyphosis obtain, during skeletal growth, remodelling of the deformed vertebras. In a previous paper on Scheuermann’s kyphosis, we have studied the geometry variations of all vertebrae included in the curve, before and after the treatment.

The purpose of this study was to confirm the effectiveness of conservative treatment in Scheuermann’s kyphosis and was to evaluate and compare the variation of the vertebral geometry with the curve trend in Cobb degrees, before and after conservative treatment.

Methods

From a consecutive series of patients, we selected 90 patients with thoracic Scheuermann’s kyphosis, treated using anti-gravity brace: 59 male, 31 female. The mean age at the beginning of the treatment was 14 years.

Radiographical measurements were performed on radiographs from a lateral projection, at the beginning (t1) and at the end of the treatment (t5). Vertebral geometry modifications at t1 and t5 were analysed according to the following parameters and evaluated by three independent observers: Anterior wedging angle (ALFA) of the apex vertebra and Posterior wall inclination (APOS) of the limiting lower vertebra. The curve was measured in Cobb degrees.

Results

The results from our study showed that of the 90 patients with a thoracic curve mean value of Cobb degrees was 57.8 ± 6.0 SD at t1 and 41.3 ± 5.6 SD at t5. The differences between t1(angle at baseline) and t5 (end of treatment) were calculated for Cobb, ALFA and APOS angle and were respectively −16.4 ± 4.5, −6.4 ± 1.4 and −2.7 ± 1.2; tested with paired t-test were significative (p < 0.01). The results of the regression analysis to test the relationship between the three measures for the kyphosis (Cobb degree, ALFA and APOS) showed that the best association was between Cobb t5 and ALFA t5 (p < 0.01) and Cobb t1 and APOS t1 (p < 0.01). No significative association was found between the difference between ALFA and APOS.

Conclusion

We sustain that using new parameters to study vertebral remodelling allows us to reach a better comprehension of Scheuermann spine response to anti-gravity brace treatment. Furthermore, the evaluation of the ALFA angle of the apex vertebra confirms to be more reliable than Cobb’s angle because it cannot be affected by the radiological position.

     

Precise Cobb Angle Measurement System Based on Spinal Images Merging Function

Background

Convenient and precise measurement of the Cobb angle using a small size X-ray detector has been required for local clinics.

The three-dimensional easy morphological (3-DEMO) classification of scoliosis – Part III, correlation with clinical classification and parameters

Background

The shape of the torso in patients with idiopathic scoliosis is considered to reflect the shape of the vertebral column, however the direct correlation between parameters describing clinical deformity and those characterizing radiological curvature was reported to be weak. It is not clear if the management proposed for scoliosis (physiotherapy, brace, surgery) affects equally the shape of the axial skeleton and the surface of the body. The aim of the study was to compare clinical deformity of (1) idiopathic scoliosis girls being under brace treatment for radiological curves of 25 to 40 degrees and (2) non treated scoliotic girls matched for age and Cobb angle.

Methods

Cross-sectional study of 24 girls wearing the brace versus 26 girls without brace treatment, matched for age and Cobb angle. Hypothesis: Patients wearing the brace for more than 6 months, when comparing to patients without brace, may present different external morphology of the trunk, in spite of having similar Cobb angle. Material. Inclusion criteria: girls, idiopathic scoliosis, growing age (10–16 years), Cobb angle minimum 25°, maximum 40°. The braced group consisted of girls wearing a TLSO brace (Cheneau) for more than 6 months with minimum of 16 hours per day. The non-braced group consisted of girls first seen for their spinal deformity, previously not treated. The groups presented similar curve pattern. Methods. Scoliometer exam: angle of trunk rotation at three levels of the spine: upper thoracic, main thoracic, lumbar or thoracolumbar. The maximal angle was noted at each level and the sum of three levels was calculated. Posterior trunk symmetry index (POTSI) and Hump Sum were measured using surface topography.

Results

Cobb angle was 34.9° ± 4.8° in braced and 32.7° ± 4.9° in un-braced patients (difference not significant). The age was 14.1 ± 1.6 years in braced patients and 13.1 ± 1.9 years in un-braced group (p = 0.046). The value of angle of trunk rotation in the main curvature was 8.4° ± 2.7°in braced and 11.4° ± 2.7° in un-braced patients (difference extremely significant, p = 0.0003). The value of the sum of angles of trunk rotation at three levels of the trunk was 12.8° ± 4.6° in braced and 16.5° ± 3.8° in un-braced patients (difference very significant, p = 0.0038). The POTSI did not differ significantly between the groups (p = 0.78), the Hump Sum values were not quite different (p = 0.07).

Conclusion

(1) Adolescent girls wearing the brace for idiopathic scoliosis of 25 to 40 degrees of Cobb angle, reveal smaller clinical rotational deformity of their back than non-treated girls having similar radiological deformity. (2) evaluation of the results of treatment for idiopathic scoliosis should consider parameters describing both clinical and radiological deformity.     

椎体成形术治疗脊柱压缩骨折的临床疗效

目的:探讨脊柱压缩骨折患者的椎体成形术应用方法与效果。方法:脊柱压缩骨折患者150例根据随机抽签法分为治疗组与对照组各75例,对照组给予传统开放性手术,治疗组给予椎体成形术。通过比较两组手术时间,术中出血量,术后住院时间,术后疼痛评分,术后局部Cobb角的差异评价治疗效果,其中,疼痛评分采用VAS量表,局部Cobb角通过脊椎侧围X片测定。结果:所有患者都顺利完成手术,无严重并发症发生,治疗组的术中出血量与术后住院时间明显少于对照组(P0.05)。两组术前疼痛评分对比差异无统计学意义,术后疼痛评分都呈现明显下降的趋势(P0.05),同时术后治疗组的疼痛评分明显低于对照组(P0.05)。两组术前局部Cobb角对比差异无统计学意义,术后局部Cobb角都明显下降(P0.05),同时术后治疗组的局部Cobb角都明显低于对照组(P0.05)。结论:脊柱压缩骨折患者的椎体成形术应用能有效缓解疼痛程度,改善椎体前中部高度脊柱后凸情况,对于患者的创伤比较少,有很好的推广应用价值。     

运用CT三维重建测量重度先天性脊柱侧凸Cobb角的临床应用

目的:评价在CT三维重建上测量重度先天性脊柱侧凸Cobb角度的可重复性和可靠性。方法:收集在我院诊治的重度先天性脊柱侧凸病人的CT三维重建和脊柱全长X线片,共计67例。由五名不同测量者对CT三维重建脊柱畸形冠状面主弯Cobb角测量两次,两次间隔在三周以上,并测量脊柱全长X线片脊柱畸形冠状面主弯Cobb角一次,运用组内相关系数分析测量结果之间的可重复性和可靠性。结果:同一测量者两次测量结果之间的差值平均为4.5°。同一测量者两次测量结果之间的组内相关系数为0.969,不同测量者之间测量结果的组内相关系数为0.913。取五名测量者在CT三维重建上第一次测量的Cobb角度,其平均值为(110.5±23.5)°,五名测量者在X线片上测量结果的平均值为(103.1±22.0)°,对两组数据进行Mann-Whitney非参数检验差异有统计学意义(Z=-2.86,P=0.004)。结论:在CT三维重建上测量重度先天性脊柱侧凸的Cobb角,可以减小测量的误差,提高测量的可重复性和可靠性,是一种相对准确的测量方法。     

Computer-Assisted Radiographic Calculation of Spinal Curvature in Brachycephalic “Screw-Tailed” Dog Breeds with Congenital Thoracic Vertebral Malformations: Reliability and Clinical Evaluation

The objectives of this study were: To investigate computer-assisted digital radiographic measurement of Cobb angles in dogs with congenital thoracic vertebral malformations, to determine its intra- and inter-observer reliability and its association with the presence of neurological deficits. Medical records were reviewed (2009–2013) to identify brachycephalic screw-tailed dog breeds with radiographic studies of the thoracic vertebral column and with at least one vertebral malformation present. Twenty-eight dogs were included in the study. The end vertebrae were defined as the cranial end plate of the vertebra cranial to the malformed vertebra and the caudal end plate of the vertebra caudal to the malformed vertebra. Three observers performed the measurements twice. Intraclass correlation coefficients were used to calculate the intra- and inter-observer reliabilities. The intraclass correlation coefficient was excellent for all intra- and inter-observer measurements using this method. There was a significant difference in the kyphotic Cobb angle between dogs with and without associated neurological deficits. The majority of dogs with neurological deficits had a kyphotic Cobb angle higher than 35°. No significant difference in the scoliotic Cobb angle was observed. We concluded that the computer assisted digital radiographic measurement of the Cobb angle for kyphosis and scoliosis is a valid, reproducible and reliable method to quantify the degree of spinal curvature in brachycephalic screw-tailed dog breeds with congenital thoracic vertebral malformations.     

A reliability and validity study for Scolioscan: a radiation-free scoliosis assessment system using 3D ultrasound imaging

Background

Radiographic evaluation for patients with scoliosis using Cobb method is the current gold standard, but radiography has radiation hazards. Several groups have recently demonstrated the feasibility of using 3D ultrasound for the evaluation of scoliosis. Ultrasound imaging is radiation-free, comparatively more accessible, and inexpensive. However, a reliable and valid 3D ultrasound system ready for clinical scoliosis assessment has not yet been reported. Scolioscan is a newly developed system targeted for scoliosis assessment in clinics by using coronal images of spine generated by a 3D ultrasound volume projection imaging method. The aim of this study is to test the reliability of spine deformity measurement of Scolioscan and its validity compared to the gold standard Cobb angle measurements from radiography in adolescent idiopathic scoliosis (AIS) patients.

Methods

Prospective study divided into two stages: 1) Investigation of intra- and inter- reliability between two operators for acquiring images using Scolioscan and among three raters for measuring spinal curves from those images; 2) Correlation between the Cobb angle obtained from radiography by a medical doctor and the spine curve angle obtained using Scolioscan (Scolioscan angle). The raters for ultrasound images and the doctors for evaluating radiographic images were mutually blinded. The two stages of tests involved 20 (80 % females, total of 26 angles, age of 16.4?±?2.7 years, and Cobb angle of 27.6?±?11.8°) and 49 (69 % female, 73 angles, 15.8?±?2.7 years and 24.8?±?9.7°) AIS patients, respectively. Intra-class correlation coefficients (ICC) and Bland-Altman plots and root-mean-square differences (RMS) were employed to determine correlations, which interpreted based on defined criteria.

Results

We demonstrated a very good intra-rater and intra-operator reliability for Scolioscan angle measurement with ICC larger than 0.94 and 0.88, respectively. Very good inter-rater and inter-operator reliability was also demonstrated, with both ICC larger than 0.87. For the thoracic deformity measurement, the RMS were 2.5 and 3.3° in the intra- and inter-operator tests, and 1.5 and 3.6° in the intra- and inter-rater tests, respectively. The RMS differences were 3.1, 3.1, 1.6, 3.7° in the intra- and inter-operator and intra- and inter-rater tests, respectively, for the lumbar angle measurement. Moderate to strong correlations (R²?>?0.72) were observed between the Scolioscan angles and Cobb angles for both the thoracic and lumbar regions. It was noted that the Scolioscan angle slightly underestimated the spinal deformity in comparison with Cobb angle, and an overall regression equation y?=?1.1797x (R²?=?0.76) could be used to translate the Scolioscan angle (x) to Cobb angle (y) for this group of patients. The RMS difference between Scolioscan angle and Cobb angle was 4.7 and 6.2°, with and without the correlation using the overall regression equation.

Conclusions

We showed that Scolioscan is reliable for measuring coronal deformity for patients with AIS and appears promising in screening large numbers of patients, for progress monitoring, and evaluation of treatment outcomes. Due to it being radiation-free and relatively low-cost, Scolioscan has potential to be widely implemented and may contribute to reducing radiation dose during serial monitoring.

     

椎体成形术治疗老年骨质疏松性脊柱骨折的临床研究

目的:研究椎体成形术治疗老年骨质疏松性脊柱骨折的疗效。方法:选择2012年1月至2014年1月我院收治的120例老年骨质疏松性脊柱骨折患者,均使用Sky骨扩张系统经皮穿刺行椎体成型术治疗,74例患者取俯卧位设为俯卧位组,46例患者取侧卧位设为侧卧位组,比较两组患者术前及术后3 d、3个月时椎体高度、后凸畸形角(Cobb角)及视觉疼痛模拟评分(VAS评分)。结果:术前两组患者椎体高度比较差异具有统计学意义(F=4.231,P=0.042),术后3d及3个月两组患者椎体高度较术前明显增高,比较差异具有统计学意义(F=4.03,P=0.047)。术前两组患者Cobb角变化比较差异无统计学意义(F=3.042,P=0.072),术后3 d及3个月两组患者Cobb角均值较术前明显降低,比较差异具有统计学意义(F=9.86,P=0.021)。术前两组患者VAS评分比较差异无统计学意义(F=2.035,P=0.089),术后3 d及3个月两组患者VAS评分较术前明显降低,比较差异具有统计学意义(F=12.86,P=0.005)。结论:使用椎体成形术治疗老年骨质疏松性脊柱骨折疗效显著,可有效恢复椎体高度及Cobb角度,并可迅速缓解其疼痛症状。     

经皮椎体后凸成形术对绝经后女性椎体骨折的疗效分析

目的：分析经皮椎体后凸成形术对绝经后女性椎体骨折的疗效。方法：选取68例绝经后女性椎体骨折患者并随机分为研究组和对照组,每组各34例。研究组采用经皮椎体后凸成形术（PKP）治疗,对照组采用经皮椎体成形术PVP）治疗。分剐在术前、术后1d以及术后1年对患者进行疼痛视觉类比评分WAS）,观察随访期间Cobb角的矫正程度和骨水泥渗漏情况以及相邻椎体的骨折发生率。结果：两组患者在术后各时间点VAS评分和Cobb角的矫正程度均有明显的改善（P〈0．05）,其中研究组术后Cobb角的矫正程度要明显优于对照组（P〈0．05）,同时研究组患者术后骨水泥渗漏的发生率低于对照组（P〈0．05）,在随访期内,对照组相邻椎体骨折的发生率高于研究组（P〈0．05）。结论：PVP和PKP均能显著缓解OVCF疼痛,但是PKP比PVP更有利于矫正脊柱后凸的畸形,同时降低骨水泥渗漏和相邻椎体骨折的发生率。     

The transformation of spinal curvature into spinal deformity: pathological processes and implications for treatment

Background

Chêneau-Brace treatment of a certain standard reduces the rate of surgery, prevents progression and in a certain patient population leads to marked improvement of Cobb angle and cosmetic appearance. During the last two years a patient refusing surgery with a double major curvature of initially 60° showed a clear cosmetic improvement and a clear radiological progression at the same time. The findings of this patient have been reviewed in order to find out how cosmetic appearance and Cobb angle can develop differently.

Methods

The patient entered conservative treatment at the age of 13 years, premenarchial with Tanner II and a Cobb angle of 60° thoracic and 59° lumbar. The angle of trunk rotation (ATR; Scoliometer) was 13° thoracic and 13° lumbar. We have documented the findings of this patient (Surface topography, ATR, Cobb angles and angles of vertebral rotation (according to Raimondi) during the treatment period (27 Month) until 2 years after the onset of menarche.

Results

After a treatment time of 27 Month the Cobb angle increased to 74° thoracic and 65° lumbar. The angles of vertebral rotation according to Raimondi increased slightly from 26° thoracic and 28° lumbar to 30° thoracic and 28° lumbar. The ATR improved to 12° thoracic and 5° lumbar while Lateral deviation improved from 22,4 mm to 4,6 mm and average surface rotation improved from 10,6° to 6°. In the X-rays a reduction of decompensation was visible. The patient felt comfortable with the cosmetic result.

Conclusion

Conservative treatment may improve cosmetic appearance while the curve progresses radiologically. This could be explained by assuming that (1) the Rigo Chêneau brace is able to improve cosmetic appearance by changing the shape of the thorax when the curve itself is too stiff to be corrected by a brace, that (2) reduction of decompensation leads to significant cosmetical improvements or (3) that the patient gained weight and therefore the deformation is masked. However, the weight the patient gained cannot explain the cosmetical improvement in this case. Conservative treatment with a certain standard of quality seems a viable alternative for patients with Cobb angles of > 60° when surgical treatment is refused. Specialists in scoliosis management should be aware of the fact that curve progression can occur even if the clinical measurements show an improvement.     

单球囊双侧扩张后凸成形术治疗不同程度骨质疏松性椎体压缩骨折的疗效

目的:观察单球囊双侧交替扩张后凸成形术治疗老年骨质疏松性椎体压缩骨折的疗效。方法:选择我院2014年7月-2015年5月收治的老年骨质疏松性椎体压缩骨折患者60例,按照椎体塌陷程度分为重度骨折组和轻度骨折组,每组各30例。两组患者均接受单球囊双侧交替扩张后凸成形术治疗,观察治疗效果和椎体变化等。结果:与轻度骨折组比较,重度骨折组手术时间长、骨水泥注射量少,且椎体前缘高度恢复率、椎体中部高度恢复率、Cobb角矫正度高(P0.05)。治疗后,两组患者VAS评分均优于治疗前(P0.05),但两组间差异无统计学意义(P0.05)。与治疗前比较,两组治疗后椎体前缘高度、椎体中部高度、Cobb角均有所改善(P0.05),轻度骨折组的椎体前缘高度、椎体中部高度明显大于重度骨折组(P0.05),但两组Cobb角比较,差异无统计学意义(P0.05)。结论:单球囊双侧交替扩张后凸成形术治疗老年骨质疏松性椎体压缩骨折具有较好的临床疗效,可以明显纠正椎体塌陷和Cobb角度。     

伤椎置钉联合短节段内固定与单纯短节段固定治疗胸腰椎爆裂性骨折的比较研究

目的:比较伤椎置钉联合短节段内固定与单纯短节段固定治疗胸腰椎爆裂性骨折的临床疗效、固定效果及其对患者炎症反应和脊髓损伤的影响。方法:选取2014年3月到2016年12月期间我院收治的胸腰椎爆裂性骨折患者94例,根据手术方法的不同将患者分为伤椎置钉组(40例)和短节段内固定组(44例)。短节段内固定组患者采用单纯后路短节段椎弓根螺钉内固定进行治疗,伤椎置钉组采用伤椎置钉联合后路短节段椎弓根螺钉内固定进行治疗。比较两组患者的手术时间、术中出血量、住院时间、伤椎前沿高度比、Cobb’s角、伤椎椎体楔形变角、视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI),炎性因子指标、脊髓损伤指标及术后并发症。结果:伤椎置钉组的手术时间长于短节段内固定组(P<0.05),术后6个月、术后12个月伤椎置钉组的伤椎前沿高度比明显高于短节段内固定组,Cobb’s角、伤椎椎体楔形变角明显低于短节段内固定组(P<0.05),术前、术后1周、术后6个月、术后12个月两组患者的VAS评分和ODI比较差异无统计学意义(P>0.05),术后3 d两组患者血清中IL-1β、IL-6、IL-8、TNF-α和pNF-H、NSE、S100β、GFAP水平比较差异均无统计学意义(P>0.05)。随访期间两组患者均未出现严重并发症。结论:伤椎置钉联合后路短节段椎弓根螺钉内固定可有效改善胸腰椎爆裂性骨折患者的椎体高度、Cobb’s角和伤椎椎体楔形变角,并且不会增加脊髓损伤和机体的炎症反应。     

The direct cost of "Thriasio" school screening program

Background

Adolescent girls treated with a brace for scoliosis are submitted to prolonged stress related to both the disease and the therapy. Currently proposed quality of life questionnaires are focused on the outcome of therapy. Bad Sobernheim Stress Questionnaire (BSSQ) enables monitoring of patients being under treatment with a brace or exercises. The aim of the study was to assess the stress level in conservatively managed scoliotic girls using BSSQ.

Materials and methods

111 girls, aged 14,2 ± 2,2 years, mean Cobb angle of the primary curve 42,8° ± 17,0° and mean Bunnell angle of 11,4° ± 4,5° were examined with two versions of BSSQ (Deformity and Brace). The analysis considered the type of treatment, curve location, correlation of the total score with age, Cobb angle and Bunnell rotation angle.

Results

The BSSQ Deformity revealed the median of 17 points in patients managed with exercises (from 4 to 24 points), 18 in patients managed with a brace (from 8 to 24 points) and 12 in patients before surgery (from 3 to 21 points). Braced patients who completed both questionnaires (n = 50) revealed significantly higher score with BSSQ Deformity (median = 18) comparing to BSSQ Brace (median = 9). There was a correlation between the total score of BSSQ Deformity and the Cobb angle (r = -0,34), Bunnell primary curve rotation (r = -0,34) and Bunnell sum of rotation (r = -0,33) but not with the age of patients.

Conclusion

Scoliotic adolescents managed with exercises and brace suffered little stress from the deformity. The brace increased the level of stress over the stress induced by the deformity. The stress level correlated with clinical deformity (Bunnell angle), radiological deformity (Cobb angle) and the type of treatment (exercises, bracing, surgery). Bad Sobernheim Stress Questionnaires are simple and helpful in the management of girls treated conservatively for idiopathic scoliosis.