摘要
Abstract Adolescent idiopathic scoliosis is considered the most severe and common spinal deformity, affecting children and adolescents still in the neuropsychomotor development phase before they reach skeletal maturity. This study aimed to evaluate the surgical approach to adolescent idiopathic scoliosis (AIS), considering the results associated with the reduction of pathological curvature, pulmonary function, and repercussions on the quality of life of adolescents undergoing such treatment. Systematic literature review, with a quantitative and qualitative approach to the data collected, structured according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), carried out in the databases linked to the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Latin American and Caribbean Health Sciences Literature (LILACS). The total sample of the studies was 638 adolescents with AIS, with a mean age of 14.93 years ± 1.24. The mean correction of the main pathological curvature in the studies was 55.06% ± 12.24. In all of the selected studies using posterior spinal fusion to correct AIS, there was a significant reduction in pathological curvatures (> 49%), and the recurrence of curvature in none of the studies exceeded a pathological gain of more than 5%. As for lung function, the studies showed significant increases in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) in patients with severe AIS, and no pulmonary function losses were reported after surgery to correct AIS.
Resumo A escoliose idiopática do adolescente (EIA) é considerada a deformidade vertebral de maior gravidade e ocorrência, que acomete crianças e adolescentes ainda na fase de desenvolvimento neuropsicomotor, antes de atingirem a maturidade esquelética. Este estudo teve como objetivo avaliar a abordagem cirúrgica da EIA, considerando resultados associados à redução de curvatura patológica, função pulmonar e repercussões na qualidade de vida dos adolescentes submetidos a tal tratamento. Revisão Sistemática de literatura, com abordagem quanti-qualitativa dos dados coletados, cuja estruturação se deu conforme as orientações de Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) realizada nas bases de dados vinculadas à Medical Literature Analysis and Retrieval System Online (MEDLINE) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). A amostra total dos estudos foi de 638 adolescentes com EIA, com uma idade média de 14,93 anos ± 1,24. A correção média da curvatura patológica principal nos estudos foi de 55,06% ± 12,24. Em todos os estudos selecionados com fusão espinhal posterior para correção da EIA verificou-se redução significativa das curvaturas patológicas (> 49%), sendo que a reincidência de curvatura em nenhum dos estudos superou um ganho patológico superior a 5%. Quanto à função pulmonar, os estudos apontaram ganhos significativos de volume expiratório forçado em 1 segundo (VEF1) e capacidade vital forçada (CVF) em pacientes com EIA grave. Além disso, não foram relatados prejuízos de função pulmonar após intervenção cirúrgica para correção da EIA.
摘要
La escoliosis idiopática del Adolescente (EIA) es una deformidad tridimensional de la columna vertebral que aqueja de diversas formas la condición de vida de quien la padece, afectando el desarrollo físico y psicológico del paciente. Proponemos evaluar el resultado clínico, radiológico y el componente de calidad de vida de pacientes tratados quirúrgicamente con EIA, en el servicio de Neurocirugía, Hospital Jesús Yerena del Lídice. Se evaluó patrón de la curva, clasificación según Lenke, ángulo de Cobb pre y postquirúrgico, edad de tratamiento quirúrgico, gradode corrección, calidad de vida según cuestionario SRS-22 pre y postquirúrgica, valoración funcional mediante la escala de discapacidad de Oswestry (ODI) y complicaciones postoperatorias. Se estudiaron 22 casos (95 % femenino), el principal grupo etario fue de 11-14 años (55 %), la escoliosis tipo 1 fue la predominante (60 %), el ángulo de Cobb inicial fue mayor a 50° (50 %) y la madurez esquelética principal fue Risser 3 (55 %). La edad de resolución quirúrgica predominante fue entre 15-18 años (60 %), el grado de corrección postoperatorio fue de 75-100 % (73 %) y la densidad de los tornillos pediculares fue de 1.4-1.7 (64 %). En el cuestionario SRS-22, hubo mayor afectación en las dimensiones de autoimagen con una media de 1.8 y la valoración por ODI mostró un índice de incapacidad mínima, que fue mejorando en los controles sucesivos. Nuestra principal complicación fueron las infecciones (36 %). Concluimos que la cirugía correctiva temprana en la EIA ofrece a una mejoría clínica, radiológica y de la calidadde vida de estos paciente(AU)
Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine that affects the living condition of those who suffer from it in various ways, affecting the physical and psychological development of the patient. We propose to evaluate the clinical and radiological outcome and the quality-of-life component of patients treated surgically with EIA, in the Neurosurgery Service, Hospital Jesús Yerena del Lídice. Curve pattern, Lenke classification, pre-and post-surgical Cobb angle, age at surgical treatment, degree of correction, quality of life according to pre-and post-surgical SRS-22 questionnaire, functional assessment using the Oswestry Disability Scale (ODI) and postoperative complications were evaluated. 22 cases were studied (95% female), the main age group was 11-14 years (55%), type 1 scoliosis was predominant (60%), the initial Cobb angle was greater than 50° (50%) and the main skeletal maturity was Risser 3 (55%). The predominant age of surgical resolution was between 15-18 years (60%), the degree of postoperative correction was 75-100% (73%) and the density of pedicle screws was 1.4-1.7 (64%). In the SRS-22 questionnaire, there was greater impairment in the self-image dimensions with a mean of 1.8 and the ODI assessment showed aminimal disability index, which improved in successive controls. Our main complication was infections (36%). We conclude that early corrective surgery in AIS offers clinical, radiological and quality of life improvement for these patient(AU)
Subject(s)
Humans , Male , Female , Child , Adolescent , Scoliosis摘要
BACKGROUND:The distribution of horizontal pressure in adolescent idiopathic scoliosis can be used to evaluate the coronal imbalance.Currently,there are no reports on the characteristics of coronal pressure distribution and its correlation with coronal imbalance. OBJECTIVE:To explore the correlation between coronal pressure variation and coronal imbalance in adolescent idiopathic scoliosis patients. METHODS:A total of 39 adolescent idiopathic scoliosis patients who met the inclusion and exclusion criteria in Lianyungang First People's Hospital from March 2021 to June 2022 were selected as the adolescent idiopathic scoliosis group,and 30 matched healthy volunteers were recruited from the outpatient department as the control group.The horizontal position pressure,folding position pressure,coefficient of variation,and global and trunk pressure variation were measured by the TBED Postural Couch evaluation system.In the adolescent idiopathic scoliosis group,full-length spine radiographs were taken to measure Cobb angle,coronal balance,apical vertebral deviation and Nash-Moe rotation.The characteristics of coronal pressure variation and its correlation with coronal imbalance were analyzed. RESULTS AND CONCLUSION:(1)Compared with the control group,there was no statistically significant difference in the horizontal position pressure and folding position pressure in the adolescent idiopathic scoliosis group(P>0.05),but the global pressure variation and coefficient of variation were significantly increased(all P<0.05).(2)There were differences in both sides of the trunk of the adolescent idiopathic scoliosis group and the control group(P<0.05),and the convex side pressure variation in the adolescent idiopathic scoliosis group was higher than the concave side pressure variation in the left and right side pressure variation in the control group(all P<0.05).(3)The variation of the convex side pressure of the trunk in adolescent idiopathic scoliosis patients was positively correlated with coronal balance intensity(r=0.692,P<0.05),moderately positively correlated with Cobb angle and apical vertebral deviation(r=0.499,0.595,all P<0.05),and weakly correlated with Nash-Moe grade(r=0.377,P<0.05).The variation of the concave side pressure of the trunk was moderately positively correlated with coronal balance(r=0.410,P<0.05),and the rest was weakly correlated or not correlated(P>0.05).(4)These findings indicate that pressure variation may be used as an adjoint assessment tool in patients with mild to moderate scoliosis.
摘要
BACKGROUND:In recent years,with the development of 3D printing,surgical surgery has become personalized and accurate.3D printed guide template technique can realize preoperative planning and intraoperative navigation,making surgery more accurate.In clinical orthopedic surgery for moderate and severe stiff scoliosis,there is still a problem that the accuracy of screw placement is not high,resulting in screw loosening and even nerve complications.There are few studies on 3D printed guide template technique to guide screw placement in surgery for severe stiff scoliosis. OBJECTIVE:To evaluate the clinical effect of the 3D printed guide template technique combined with multiple posterior derotation in the treatment of severe rigid scoliosis. METHODS:The clinical data of six patients with severe scoliosis undergoing 3D printed guide template technique of pedicle screw combined with multiple posterior derotation were retrospectively analyzed.There were 3 males and 3 females,with a mean age of(18.17±3.49)years(range,15-23 years).The changes of parameters related to lateral bending were analyzed at postoperative 2 weeks and 18 months,and the results were obtained by statistical analysis. RESULTS AND CONCLUSION:(1)The operation time was 280-540 minutes(mean 340.83±102.20 minutes).The intraoperative blood loss was 1 000-4 000 mL(mean 2 000.00±1 073.70 mL).The fixed segments were 9-14 vertebral bodies(mean 11.83±1.72),and no screw loosening occurred during the operation.(2)All patients were followed up.At postoperative 2 weeks,the anteroposterior and lateral radiography of the whole spine showed that the cobb angle,the distance between the vertical line of C7 on the coronal plane and the median line of S1,the distance between the vertical line of C7 in the sagittal plane and the posterior edge of S1,apical vertebral translation,thoracic kyphosis,and lumbar lordosis were significantly corrected.The average correction rate of the cobb angle in the main curve was 62.22%.After 18 months of follow-up,there was no significant change in all parameters compared with 2 weeks after operation;the orthopedic effect was satisfactory,and there was no infection or internal fixation fracture.(3)There was one case of delayed wound healing;scar healing appeared after dressing change treatment;no neurological complications occurred.(4)The results show that the 3D print-guide template combined with multiple posterior rod derotation technique is safe and effective in the treatment of severe rigid scoliosis,and the correction effect is satisfactory.
摘要
BACKGROUND:With the continuous improvement and progress of the magnetically controlled growing rod technology in the field of the treatment of spinal deformities,numerous studies have been put into this field,but the main research status,hot spots,and development trends are not clear enough. OBJECTIVE:Based on bibliometrics,this paper discusses the quality and quantity of articles in the field of using magnetically controlled growing rods to treat spinal deformities from different countries,aiming to clarify the global development trend of magnetically controlled growing rods and evaluate the research productivity,research trends,and research hotspots in the world. METHODS:The articles published from 1998 to 2023 were retrieved mainly based on the Web of Science database.CiteSpace 5.8 and VOSviewer 1.6.19 software were used to analyze the data and generate a visual knowledge map.The following parameters were evaluated for all studies:the total number of published papers,centrality,h index,the contribution of countries,authors,and journals,and the trend and hot spots were explored through the analysis of co-citation,highly cited literature,and literature keyword explosion. RESULTS AND CONCLUSION:(1)Finally,138 articles were included.From 2009 to 2020,the number of published articles in this field gradually increased.The United States has the largest number of articles(53,37.32%),and the United States has the highest h index and centrality of articles.(2)The results of keyword analysis showed that:the top ten keywords,such as early-onset scoliosis,surgery,complications,and so on,objectively and truly reflected the current situation and hot spots of magnetically controlled growing rod in the field of spinal deformity treatment.In recent years,the research focus in this field is the treatment failure caused by risk factors such as the pull-out of the magnetically controlled growing rod,implantation failure,and rod fracture,the accurate use of the corresponding medical classification,the monitoring and treatment of complications such as quality of life and cerebral palsy.(3)The co-citation results showed that:combined with the innovative and effective research of the magnetically controlled growing rod technology,the classification application of spinal deformity and the monitoring and treatment of related complications may be the research trend in this field.(4)Many highly cited articles further emphasized the therapeutic effect of magnetically controlled growing rod technology,providing an effective new idea and technical support for the field of spinal deformity correction.(5)The results of literature keyword explosion analysis demonstrate that the risk factors,medical classification,quality of life,and cerebral palsy of the application of magnetically controlled growing rods may become the research frontier in this field.(6)It can be seen that the application of magnetically controlled growing rod technology in the classification of spinal deformities and the in-depth study of related complications are the development trend in this field,but to further understand the effectiveness and safety of magnetically controlled growing rod technology in the treatment of spinal deformities,we still need long-term follow-up evidence.The overall research level of this field has steadily improved in recent years,but there are also problems such as the small number of high-quality articles and the unbalanced development of research in various regions.
摘要
BACKGROUND:The pedicle navigation template has many advantages,but there are still some problems.For example,poor soft tissue dissection leads to poor adhesion of the pedicle navigation template,resulting in screw path deviation;careful dissection of soft tissue to fit the pedicle navigation template leads to prolonged surgery time and increased bleeding;the design of the pedicle navigation template cannot predict the vertebral rotation and the impact of body position changes,resulting in the poor fitting. OBJECTIVE:To explore the utility of a new 5-point positioning point-contact pedicle navigation template in the case of scoliosis and complex pedicle. METHODS:A total of 20 patients with scoliosis and complicated pedicle admitted to the Department of Spinal Surgery,Guizhou Hospital,Beijing Jishuitan Hospital from February 2020 to February 2023 were selected for scoliosis orthopedics.During the operation,the 5-point positioning point-contact pedicle navigation template was used to guide the screws.According to the inclusion and exclusion criteria,34 cases were matched as the empirical nail placement group,and conventional barehanded nail placement was performed.The time of placement,the amount of bleeding,the number of fluoroscopies,the number of manual diversions,the level and accuracy of pedicle screws,the complications of placement,and the rate of correction of main curvature were compared between the two groups. RESULTS AND CONCLUSION:(1)There were no significant differences in sex,age,coronal Cobb's angle of the main curvature,bending Cobb's angle of the main curvature,pedicle variation,apex rotation,fusion segment,number of screws,level of screws,accuracy of screws,and rate of correction of main curvature between the navigation template group and the empirical nail placement group(P>0.05).(2)Compared with the empirical nail placement group,the navigation template group had more advantages in time of placement(P=0.034),amount of bleeding(P=0.036),number of fluoroscopies(P=0.000)and number of manual diversions(P=0.021).(3)There were 0 cases of screw-related complications in both groups.(4)In conclusion,the 5-point positioning point-contact 3D printing pedicle navigation template has a claw-like structure.It can firmly adapt to various deformities of the lamina articular process,avoid drift,and accurately place the screws.It has a point-like contact lamina structure to avoid extensive and complete dissection of the posterior structure,and reduce bleeding,operation time,and trauma.Pre-designed screw entry points and directions can reduce the number of fluoroscopy and operation time.Segmental design can avoid discomfort due to changes in anesthesia position.The operation is simple and the accuracy of screw placement is high.
摘要
BACKGROUND:Halo gravity traction is a pre-operative traction method recognized by many scholars,but most of them rely on clinical observation and lack finite element analysis. OBJECTIVE:To explore the best traction force of Halo gravity traction on Lenke 3 scoliosis by finite element method and to provide a theoretical basis for clinics from a biomechanical point of view. METHODS:The CT images scanned by patients with scoliosis were processed by reverse modeling,and a finite element model was established.The validity of the model was verified by taking normal segments(T1-T4 vertebral bodies).Five groups of different stress conditions were set on the lumbar-thoracic scoliosis model to simulate the correction of patients under different traction forces.In all five groups,the lower surface of L5 was completely restrained,and different traction forces were applied to the upper surface of T1 along the positive direction of the Z axis(the opposite direction of gravity),which were 50,100,150,200,and 250 N,respectively.The displacement of the scoliosis spine,Cobb angle change of the main bending,elongation of the spine,and Von Mises stress were compared under different traction forces. RESULTS AND CONCLUSION:(1)When the Halo gravity traction force was 150 N to 200 N,the reduction of the Cobb angle of the main bending was 69.4%to 88.9%of the maximum reduction;the elongation of the Z axis was 69.4%to 85.9%,and the stress was 63.6%to 82.9%of the maximum stress.(2)When the traction force was greater than 200 N,the reduction of the Cobb angle and the elongation of the Z axis did not change obviously,but the stress value increased sharply.At this time,the distance from the centroids of T6,T7,and T8 to the vertical line of L5 was the most obvious.(3)When the Halo gravity traction force was 150 N to 200 N,the correction effect on this type of patient was the best—the reduction of Cobb angle and the elongation of the Z axis were better without the sharp increase in stress.(4)It has certain theoretical support for clinical correction and can ensure the safety of patients when scoliosis is corrected to a large extent.
摘要
BACKGROUND:Orthosis is a common and effective treatment for mild to moderate scoliosis,which can delay and inhibit the progression of scoliosis and reduce the incidence of severe deformity.Different types of orthoses have different indications,application characteristics,and efficacies.In recent years,the application of new technology like digital and intelligent has promoted the improvement and development of new orthoses. OBJECTIVE:To classify and compare the commonly used scoliosis orthoses,and describe the application progress of new technologies such as digital and intelligent technology in recent years,so as to provide a reference for the clinical selection of orthoses and the improvement of new orthoses. METHODS:PubMed,Embase,IEEE,CNKI and WanFang databases were searched for relevant literature.Chinese and English search terms were"scoliosis,orthosis,brace,progress,artificial intelligence,digitization".The search time limit was from 2012 to 2022.Finally,56 articles were included for review and analysis. RESULTS AND CONCLUSION:(1)Scoliosis orthosis has a good effect on mild to moderate adolescent idiopathic scoliosis.Through the Hueter-Volkmann law,it can accelerate the growth of the concave spine with a high success rate and has been widely used in this field.(2)The indications,application characteristics and efficacy of different types of orthoses are different,and the clinical selection is targeted.(3)Scoliosis orthosis has been developed in the direction of more humanity,paying attention to the comfort of patients,and the manufacturing process has been transformed from plaster casting to computer-aided manufacturing.It is simple and hygienic,with higher correction accuracy,and patients'compliance has been significantly improved.(4)Scoliosis orthosis is developing in the direction of digitalization and intelligence and has been widely integrated with artificial intelligence,Internet of things and other technologies to monitor the patient's orthopedic force,body temperature,and compliance in real time,so as to provide patients with more accurate treatment.(5)At present,there are still many defects in scoliosis orthosis that cannot be ignored,such as affecting development,decreased muscle strength,and body stiffness,which need further exploration and improvement.
摘要
BACKGROUND:Adolescent idiopathic scoliosis is the most common scoliosis deformity,accounting for about 80%of all scoliosis.Its pathogenesis is unknown.In recent years,the incidence rate has shown an obvious upward trend,which seriously threatens the physical and mental health of adolescents. OBJECTIVE:To perform the visualization analysis of the relevant literature on adolescent idiopathic scoliosis in recent 20 years through the Bibliometrics method,and explore the research hotspots and trends in this field to provide references for further research. METHODS:The relevant articles included in the Web of Science core collection database from January 1,2002 to December 31,2021 were searched by computer.The scientific knowledge map was drawn by CiteSpace 5.8.R3 software.The cooperation network,co-citation network,keyword co-occurrence,burst,clustering and timeline map were visually analyzed. RESULTS AND CONCLUSION:A total of 5245 papers were included.In the past 20 years,the annual publication volume has shown a fluctuating upward trend.The analysis of the cooperation network shows that the author with the most publications is Qiu Yong;the institution is Nanjing University;the country is USA.The author with the highest intermediary centrality is Lowe TG;the institution is Childrens Hosp Philadelphia,and the country is Switzerland.The co-citation network analysis exhibits that the author with the highest frequency of citations is Lenke LG;the document is Weinstein SL,2013,N Engl J Med;the journal is Spine,and the author with the highest intermediary centrality is Suk SI,and the cited document is Danielsson AJ,2001,Eur Spine J;the cited journal is Spine.Keyword analysis displays that the research hotspots mainly focus on conservative treatment,imaging parameters,pathogenesis,and genome-wide associations.Through the visualization analysis of the literature in this research field,this study clarifies the context of the research in this field,reveals the research hotspots and trends in this field,and provides research ideas and methods for many scholars.
摘要
BACKGROUND:Vibration environment can cause spinal injury,especially in patients with scoliosis.At present,there is no information about the inherent mode of the whole spine from T1 to the pelvis in scoliosis patients in the free state. OBJECTIVE:To analyze the dynamic characteristics of the whole spine in patients with scoliosis by the finite element method. METHODS:Based on CT scan images,a three-dimensional finite element model of the T1-pelvic total spine of an 11-year-old patient with thoracolumbar biflexion scoliosis was established,and the Cobb angles of thoracolumbar scoliosis were 36° and 24°,respectively.The mode analysis in the free state of the whole spine was carried out by the finite element method. RESULTS AND CONCLUSION:The fifteen-order free modes of the spine were extracted,and the dynamic characteristics of the scolio-curved spine were obtained.The resonance frequency distribution of the spine was concentrated.The thoracic vertebra was the most deformed in the whole spine model,and the amplitude of the thoracic vertebra was larger than that of the lumbar vertebra.Modal analysis was used to analyze the vibration characteristics of scoliosis patients in the vibration environment.It is of great significance to determine the natural frequency,vibration mode,and amplitude of scoliosis patients for analyzing the vibration characteristics of scoliosis.
摘要
BACKGROUND:Traditional scoliosis orthosis has some disadvantages,such as complex manufacturing process,long processing cycle,poor fit and so on.Three-dimensional printed scoliosis orthosis has the advantages of high manufacturing precision and personalization. OBJECTIVE:To evaluate the efficacy of three-dimensional printed scoliosis orthosis for scoliosis based on multi-criteria decision model. METHODS:Clinical data of 72 patients with scoliosis admitted to Chen Xinghai Hospital of Integrated Traditional Chinese and Western Medicine from January 2019 to October 2022 were retrospectively collected and divided into two groups according to the treatment of orthosis.Study group(n=23)received three-dimensional printed scoliosis orthosis.Traditional group(n=49)received the traditional polypropylene spine brace treatment.The clinical efficacy and complications were compared between the two groups.A multi-criteria decision model for the treatment of scoliosis with three-dimensional printed scoliosis orthosis was established,and the stability of the benefit value,risk value and decision model of the two groups were evaluated. RESULTS AND CONCLUSION:(1)Compared with the traditional group,there were significant differences in the top vertebral offset distance,Cobb angle,top vertebral rotation,Functional Movement Screen score,visual analog scale score and total effective rate in the study group at 6 months after surgery(P<0.05).(2)Among the benefit indexes,Cobb angle had the greatest impact on the condition of patients,while the risk indexes had the greatest impact on dyspnea.(3)The benefit values of the study group and the traditional group for scoliosis were 79 and 64,and the risk values were 74 and 57,respectively.The combined benefit and risk values found that the benefit-risk value of the study group was 16 higher than that of the traditional group.(4)In the range of 0-100%relative risk weight,the benefit-risk value of the study group was always higher than that of the traditional group,which proved that the multi-criteria decision-making model had good stability.(5)It is indicated that three-dimensional printed scoliosis orthosis can better restore the physiological curvature of scoliosis and improve the efficiency of treatment.
摘要
BACKGROUND:Scoliosis mainly refers to sequence abnormalities in the coronal,sagittal,and axial positions of the spine,with a Cobb angle of≥10°.The patients may experience symptoms such as unequal shoulder height and back asymmetry.Severe cases may affect the patient's cardiopulmonary function,thereby affecting their daily life.Conservative treatment can control the progression of scoliosis and avoid later surgery.Scoliosis orthosis is currently a commonly used and effective treatment measure in conservative treatment. OBJECTIVE:To summarize and analyze the current research status,hotspots,and trends of scoliosis orthoses both domestically and internationally,providing reference for related research. METHODS:Using bibliometrics and visual analysis as tools,and using a comparison between China and foreign countries as a method,this paper analyzes the literature on scoliosis orthosis journals in the past decade.Based on bibliometrics,the current status of research on scoliosis orthoses is determined.Citespace software is used to analyze key words and identify the current hotspots and future trends in scoliosis orthosis research. RESULTS AND CONCLUSION:(1)At present,the number of literature on scoliosis orthoses is still on a fluctuating upward trend.China and the United States are the main countries for research,with a literature share of over 40%.However,the average citation rate of foreign language literature by Chinese scholars is relatively low.(2)The basic fields of domestic research are mainly surgery and pediatrics,while orthotics and clinical neurology are mainly studied abroad.Among them,there is also a certain number of documents in domestic Chinese medicine,indicating that China is also engaged in the combination of Chinese and Western treatment of scoliosis.The National Natural Science Foundation of China has the highest proportion in the aspect of Chinese and foreign literature,reflecting the importance of the fund attaches to the research of scoliosis orthosis.(3)The authors with the highest number of publications are Qiu Yong and Negrini Stefano,and the most published institutions are the Spinal Surgery Department of Gulou Hospital affiliated to Nanjing University Medical College and UDICE-French Research University.Domestic and foreign authors and institutions have certain communications about this,but not closely,which requires relevant institutions and scholars to further explore and study.(4)From the research hotspots and future trends,the main treatment type is adolescent idiopathic scoliosis,while the production method of the short-column side bending orthosis is three-dimensinoal printing,and the main treatment index is convex progression.The ultimate purpose of treatment is to improve the quality of life of the patients.
摘要
BACKGROUND:The study of the lumbar spine and pelvis in patients with Lenke type 5 lordosis is limited to the coronal and sagittal planes,and the three-dimensional relationship between the scoliosis and the pelvis has not yet been clarified. OBJECTIVE:To analyze the effect of lumbar scoliosis on the pelvis in patients with Lenke type 5 lordosis and to study the correlation between the lumbar spine and the three-dimensional spatial position of the pelvis. METHODS:Imaging data of 60 patients with Lenke type 5 lordosis scoliosis admitted to the 3D Printing Reception Center of Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine from January 2019 to September 2023 were retrospectively analyzed,including Cobb angle,coronal pelvic tilt,lumbar lordosis,left and right pelvic hip width ratio(sacroiliac-anterior superior iliac spine),spinal rotation angle,pelvic tilt,sacral slope,pelvic incidence,coronal deformity angular ratio,sagittal deformity angular ratio,C7 plumb line-center sacral vertical line,apical vertebral translation,and coronal sacral inclination.The information was summarized as a database.SPSS 22.0 software was used to analyze the data related to the lumbar spine and pelvis of the patients with Lenke type 5 primary lumbar curvature adolescent idiopathic scoliosis using Spearman's correlation analysis and linear regression. RESULTS AND CONCLUSION:(1)Cobb angle was highly positively correlated with coronal deformity angular ratio,apical vertebral translation,and spinal rotation angle(r=0.91,r=0.841,r=0.736).(2)Coronal deformity angular ratio was highly positively correlated with apical vertebral translation(r=0.737),moderately positively correlated with C7 plumb line-center sacral vertical line(r=0.514),and moderately negatively correlated with sagittal deformity angular ratio(r=-0.595).(3)There was a high positive correlation between lumbar lordosis and sagittal deformity angular ratio(r=0.942)and a moderate negative correlation with coronal deformity angular ratio(r=-0.554).(4)There was a moderate positive correlation between Cobb angle with coronal pelvic tilt and coronal sacral inclination(r=0.522,r=0.534)and a moderate positive correlation between C7 plumb line-center sacral vertical line and coronal pelvic tilt(r=0.507).Apical vertebral translation with coronal pelvic tilt and coronal sacral inclination showed a moderate positive correlation(r=0.507,r=0.506).Lumbar lordosis with sacral slope and pelvic incidence showed a moderate positive correlation(r=0.512,r=0.538).Sagittal deformity angular ratio was moderately positively correlated with sacral slope and pelvic incidence(r=0.614,r=0.621).(5)Studies have found that the relative position of the lumbar spine and the pelvis is closely related in the horizontal,sagittal and coronal planes.When the lumbar spine affects scoliosis and is rotated,the relative position of the pelvis will also change to compensate,which indicates that while correcting scoliosis,the correction of the pelvis cannot be ignored.
摘要
OBJECTIVE:At present,there are a variety of treatment methods for scoliosis using specific exercise therapy,but there is a lack of comparison of efficacy between different specific exercise therapy.This article compared the effectiveness of different specific exercise therapies to treat adolescent idiopathic scoliosis through a network meta-analysis. METHODS:Domestic and foreign electronic databases of relevant studies were searched for randomized controlled trials of specific exercise therapy for adolescent idiopathic scoliosis.Search time was from January 2000 to July 2023.The literature was screened by two reviewers using RevMan 5.4 and Stata 16.0 software to extract data and assess the bias risk of of inclusion studies. RESULTS:(1)This article includes 20 randomized controlled trials with 1 377 patients.Of them,12 studies involved Schroth therapy;2 studies involved BSPTS therapy,and 6 studies involved SEAS therapy.(2)The network meta-analysis indicated that in terms of improving Cobb angle and reducing trunk rotation angle in scoliosis patients,the BSPTS therapy group and Schroth therapy group were better than the conventional control group[WMD=-4.60,95%CI(-8.37,-0.82),P<0.05;WMD=-3.37,95%CI(-4.98,-1.75),P<0.05;WMD=-3.20,95%CI(-5.50,-0.90),P<0.05;WMD=-2.13,95%CI(-3.16,-1.09),P<0.05].The Schroth therapy group performed better than the conventional control group effective in improving the International Society for Scoliosis Research-22 Questionnaire quality of life score[WMD=1.41,95%CI(0.07,2.75),P<0.05]. CONCLUSION:Given the current evidence,BSPTS therapy group and Schroth therapy group were better than the conventional control group in improving Cobb angle and reducing trunk rotation angle.In the comparison of different specific exercise therapies,BSPTS therapy can be preferred to improve Cobb angle and reduce trunk rotation angle in adolescent idiopathic scoliosis patients.In addition,Schroth therapy may be the best treatment to improve the quality of life of adolescent idiopathic scoliosis patients.Limited by the quantity and quality of the included studies,the above conclusions should be interpreted with caution and need more high-quality studies to further validation.
摘要
Objective To investigate the efficacy of percutaneous endoscopic transforaminal approach in the treatment of adolescent lumbar disc herniation(ALDH)complicated with scoliosis.Methods A retrospective study was conducted on clinical data of 28 cases of ALDH complicated with scoliosis from January 2018 to June 2021.Percutaneous endoscopic discectomy through the intervertebral foramen approach was performed.The patients were placed in a prone position.The percutaneous puncture was carried out to insert into the working channel,and the protruding nucleus pulposus was visually removed under the intervertebral foramen to relieve nerve root compression and complete decompression.Results The operation time was 45-75 min,with an average of(60.6±9.3)min.No surgery-related complications such as incision infection or nerve injury were found.All the 28 patients were followed up for 14-30 months,with an average of(20.1±5.1)months.The waist Visual Analogue Scale(VAS),leg VAS,Oswestry Dysfunction Index(ODI),Cobb angle,center sacral vertical line-C7 plumb line(CSVL-C7 PL),and sagittal vertical axis(SVA)were significantly lower at 1 month after operation and at the last follow-up than those before operation,with statistically significant differences(all P =0.000).The waist VAS,leg VAS,ODI,Cobb angle,CSVL-C7 PL,and SVA at the last follow-up were significantly lower than those at 1 month after operation,with statistically significant difference(all P<0.05).During the follow-ups,symptoms recurred in 2 patients,and fenestration of the nucleus pulposus was performed,which relieved the symptoms.The modified MacNab standard efficacy evaluation at the last follow-up showed excellent in 22 cases,good in 4 cases,and fair in 2 cases,with an excellent and good rate of 92.9%(26/28).Conclusion Percutaneous endoscopic transforaminal approach in the treatment of ALDH complicated with scoliosis can relieve clinical symptoms and improve scoliosis,the clinical effect being satisfactory.
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Objective@#To investigate the comorbidity of myopia and scoliosis among primary and secondary school students in Tianjin, and to analyze the school environment risk factors contributing to these health issues, so as to provide a scientific basis for development effective prevention measures.@*Methods@#A total of 41 654 primary and secondary school students from 16 districts of Tianjin were selected by stratified random cluster sampling from September to October 2023 to screen for myopia and scoliosis. Univariate analysis was performed to examine the data, followed by a bivariate multivariate Logistic regression model and cumulative effect analysis to explore the influencing factors of their comorbidity.@*Results@#In 2023, the prevalence of comorbidity of screening positive myopia and scoliosis among primary and secondary school students in Tianjin was 2.65%. The prevalence was higher in suburban areas (3.26%) compared to urban areas (2.02%), higher among females (3.81%) compared to males (1.59%), and highest in high school students (6.17%) compared to middle school (4.19%) and primary school students (0.44%) (χ2=62.23, 198.69, 953.19, P<0.01). Logistic regression analysis showed that the number of physical education classes ≥3 per week, the number of eye health exercises at school ≥2 per day, outdoor activities between classes, teachers reminding to pay attention to reading and writing posture and strict eye standing posture were negatively correlated with the comorbidity of screening positive myopia and scoliosis (OR=0.66, 0.77, 0.71, 0.78, 0.74, P<0.05). Reading or electronic screen while lying or lying on the stomach was positively associated with the comorbidity of screening positive myopia and scoliosis (OR=1.77, P<0.05). Cumulative effect analysis showed that the cumulative score (4-7, 7-9, ≥10) was negatively correlated with the comorbidity of screening positive of myopia and scoliosis (OR=0.65, 0.55, 0.52, P<0.05).@*Conclusions@#The school environment support and students personal behavior habits in school are related to the comorbidity of comorbidity of screening positive myopia and scoliosis. Prevention and control of myopia and scoliosis should improve the environmental factors related to students health in school.
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Objective@#To investigate the screening results of adolescent scoliosis in Chuzhou City, Anhui Province, and analyze the influencing factors for scoliosis, so as to provide insights into the prevention and control of scoliosis among adolescents.@*Methods@#Students were selected from six primary and middle schools in Chuzhou City using the stratified random cluster sampling method from April to June 2023. Demographic information, daily behaviors and postures, and exercise status were collected through questionnaire surveys. Scoliosis was screened and diagnosed according to the Screening for Abnormal Spinal Curvature in Children and Adolescents. Influencing factors for scoliosis among primary and middle school students were identified using a multivariable logistic regression model.@*Results@#A total of 1 823 questionnaires were allocated, and 1 768 effective questionnaires were recovered, with an effective response rate of 96.98%. There were 537 primary school students, 1 000 junior high school students and 231 senior high school students, with an average age of (13.40±1.92) years. There were 948 male students (53.62%) and 820 female students (46.38%). A total of 131 cases of scoliosis were screened positive, with a positive rate of 7.41%. The results of multivariable logistic regression analysis showed that gender (female, OR=1.759, 95%CI: 1.135-2.727), body mass index (OR=0.593, 95%CI: 0.538-0.654), sleeping position (side lying, OR=0.598, 95%CI: 0.377-0.951; prone lying, OR=2.336, 95%CI: 1.201-4.545), frequency of reading in bed (often, OR=2.099, 95%CI: 1.201-3.670), way of carrying backpack (shoulders, OR=0.580, 95%CI: 0.370-0.908), and exercise level (OR=0.428, 95%CI: 0.296-0.618) were influencing factors of scoliosis among primary and middle school students.@*Conclusion@#The positive rate of scoliosis screening among primary and middle school students in Chuzhou City was 7.41%, which was influenced by gender, age, body mass index, sleeping posture, reading in bed, way of carrying backpack and exercise level.
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Objectives:To assess the efficacy and safety of intravenous use of tranexamic acid(TXA)in re-ducing blood loss during correction surgery for patients with adolescent idiopathic scoliosis(AIS).Methods:The clinical data of 759 AIS patients who underwent posterior corrective fusion surgery at Nanjing Drum Tower Hospital between November 2016 and May 2022 were reviewed retrospectively.There were 544 females and 215 males,with an average age of 14.7±2.1 years.Among the patients,369 patients receiving intra-venous use of TXA during surgery were included in the TXA group,while the other 390 patients receiving the same volume of saline but not TXA were included in the control group.The baseline data(age,gender ratio,Cobb angle,and scoliosis type),pre-and postoperative blood laboratory parameters[hemoglobin(Hb),hematocrit(Hct),platelet count(PLT),prothrombin time(PT),D-dimer,activated partial thromboplastin time(APTT),and fibrinogen(FIB)],blood management indicators(intraoperative blood loss,intraoperative blood trans-fusion,postoperative drainage volume and removal time of drainage tube),and correction-related indicators(pre-and postoperative scoliosis degree,correction rate)and postoperative complications were compared be-tween the two groups.Results:There were no significant differences in baseline data and preoperative blood laboratory parameters between the groups(P>0.05).In TXA group,the intraoperative blood loss(551.7±130.3mL),intraoperative blood transfusion volume(551.3±96.3mL),postoperative drainage volume(468.3±162.5mL),and postoperative drainage time(2.8±0.4d)were all significantly lower than those in the control group(666.7±166.8mL,650.0±138.3mL,550.0±135.1mL,3.1±0.8d,P<0.05).Postoperative D-dimer and PLT in the TXA group were significantly lower than those in the control group(P<0.05),while other blood laboratory parameters showed no significant differences between the two groups(P>0.05).There were no statistically significant differ-ences in scoliosis correction rates,postoperative complication rates between the two groups(P>0.05).Conclusions:The use of TXA in surgery can reduce the perioperative blood loss and transfusion,and improve coagulation status in AIS patients,without increasing the incidence rates of complications.
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Objectives:To analyze the functional movement characteristics after brace treatment for patients with adolescent idiopathic scoliosis(AIS),and to develop and validate a nomogram model to predict the risk of poor outcome.Methods:AIS patients who were treated with braces at our institution from March 2020 to March 2022 were collected as a training set,and were tested for functional movement before treatment,at initial follow-up and after treatment.The same criteria were used to collect AIS patients who underwent brace treatment in our hospital from April 2022 to August 2022 as the validation set.On the basis of whether the degree of scoliosis progression was＞5° after 1 year of treatment,the patients in the training set were divided into stable(≤5°)and progressive(＞5°)groups.Comparison of data was made between groups.Spearman corre-lation analysis was used to analyze the correlation between variables.Logistic regression model was used to screen the risk factors for poor outcomes.R software was applied to develop a nomogram prediction model.Area under curve(AUC)of receiver operating characteristic(ROC)curve and calibration curve were applied to evaluate the discrimination and accuracy of the model.Internal validation was performed with the model predicted risk values before and after training set Bootstrap self-sampling as the test variables and the actual prognosis of patients as the state variable;External validation of the model was performed after randomization of the validation set Bootstrap self-sampling.Results:A total of 102 patients with AIS were included in the training set.There were 73 cases in the stable group and 29 cases in the progressive group(range of degrees of progression:8° to 27°).The median follow-up time was 15.4 months.Both thoracic and lumbar Cobb angles decreased significantly after treatment(P＜0.05).Rotational stability and push-ups were higher at initial follow-up than before treatment,and scores on bow-step squat,hurdle striding,rotational stability,and push-ups improved after treatment(P＜0.05).There was no significant correlation between functional movement characteristics and Cobb angle(P＞0.05).Pre-treatment Cobb angle≥35°,Risser's sign≥3°,apex rotation≥degree Ⅲ,and spinal length gain≥20mm/year were independent risk factors for scoliosis progression.Lumbar spine bone density≥0.8g/cm2 and spinal flexibility≥50%were protective factors.The total value of the risk of scoliosis progression after brace treatment predicted by the nomogram model was 0.93.The AUCs before and after training set self-sampling were 0.928(95%CI:0.858-0.998)and 0.926(95%CI:0.854-0.997),respectively.The validation set included 37 patients.The external validation AUC for validation set was 0.891(95%CI:0.857-0.998).The calibration curves all showed good degree of fitting.Conclusions:Patients with AIS have poor movement patterns due to spinal restrictions.Brace treatment improves trunk stability and rotational stability,which has good corrective effects on the movement pattern.AIS patients with Cobb angle≥35°,Risser's sign≥3°,apex rotation≥degree Ⅲ,spinal length gain≥20mm/year,lumbar spine bone mineral density＜0.8g/cm2,and spinal flexibility＜50%before treatment who underwent bracing are prone to scoliosis progression.Timely warning shall be made based on the nomogram model and postural correction needs to be supplemented at appropriate time to improve the prognosis of AIS brace treatment.
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Objectives:To compare the effects of 3D-printed personalized guiding template and robot-assisted pedicle screw placements in orthopedic surgery for adult degenerative scoliosis(ADS).Methods:Retrospective analysis was conducted on 18 ADS patients hospitalized and treated with corrective surgery in the department between January 2020 and December 2022.There were 3 males and 15 females,aged 46-73(63.2±8.2)years old.A total of 236 pedicle screws were placed,and the patients were divided into two groups according to the auxiliary screw placement methods:the 3D-printed personalized guiding template group(3D-printed group,1 1 cases,142 pedicle screws were placed)and robot-assisted screw placement group(Robot group,7 cases,94 pedicle screws were placed).The patients were followed up for 6 months and more.The vertex rotation angle and scoliosis Cobb angle were measured and compared between groups before operation.All pedicle screws were classified by Gertzbein-Robbins classification standard at 1 week after operation,and the accuracy and satisfaction of screw placement in the two groups were compared;And the operative time and incidence of complications were also analyzed and compared between the two groups.Re-sults:The 3D-printed group was not statistically different from the robot group in terms of age(63.6±9.0 years vs.62.6±7.3 years),gender ratio(male/female:2/9 vs.1/6),number of screws placed(12.91±3.83 vs.13.43± 3.60),Cobb angle(40.36°±1 1.82° vs.38.14°±12.84°),and vertex rotation angle(30.27°±7.25° vs.29.86°±9.65°),respectively(P＞0.05).The robot group was longer in operative time than that of 3D-printed group(354.29± 53.73min vs.282.27±73.87min,P＜0.05).Of the total 142 pedicle screws placed in the 3D-printed group,128 screws were of class A,10 were of class B,and 4 were of class C;Of the total 94 pedicle screws placed in the robot group,86 screws were of class A,5 were of class B,and 3 were of class C;No class D or E screws in the two groups.The accuracy rate of screw placement(90.14％)and satisfaction rate(97.18％)of the 3D-printed group were not statistically different from the accuracy rate(91.49％)and satisfaction rate(96.81％)of the robot group,respectively(P＞0.05).The incidence of complications in the 3D-printed group(36.36％)was not significantly different from that in the robot group(57.14％,P＞0.05).Conclusions:Both auxiliary screw placement methods can assist spinal surgeons to accurately place screws in ADS patients,but 3D-printed personalized guiding template needs less time in screw placement.