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1.
Wiad Lek ; 73(9 cz. 2): 2017-2019, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33148852

RESUMO

OBJECTIVE: The aim: The purpose of the study was to determine the correspondence between the location of the tongue median line and the degree of distortion of the vertebral column at different levels in children with scoliosis. PATIENTS AND METHODS: Materials and methods: Totally 56 children (30 girls, 26 boys) aged 11-14 years were examined, with a duration of musculoskeletal disorders 1-3 years. For each participant an oral cavity examination was performed, the position of the middle line of the tongue was determined. X-ray images of vertebral column of the patients from investigated groups were analyzed. RESULTS: Results: In the group with 1year duration of the disease 25.02% patients had a violation of the medial line of the tongue, in the group with 2 years of duration of the disease - 65,52% participants had the deviation of the medial line of the tongue, in the group with 3 years of duration of the disease 86.66% of patients had the deviation of the medial line of the tongue. CONCLUSION: Conclusions: This research allows us to recommend paying attention not only to the size, color, state of the papillae of the tongue, but also to the position of the middle line, which distortion may significate the deviation of the vertebral column in different portions.


Assuntos
Sistema Musculoesquelético , Escoliose , Adolescente , Criança , Diagnóstico Precoce , Feminino , Humanos , Masculino , Língua
2.
Bone Joint J ; 102-B(11): 1560-1566, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33135451

RESUMO

AIMS: To report the mid-term results of a modified self-growing rod (SGR) technique for the treatment of idiopathic and neuromuscular early-onset scoliosis (EOS). METHODS: We carried out a retrospective analysis of 16 consecutive patients with EOS treated with an SGR construct at a single hospital between September 2008 and December 2014. General demographics and deformity variables (i.e. major Cobb angle, T1 to T12 length, T1 to S1 length, pelvic obliquity, shoulder obliquity, and C7 plumb line) were recorded preoperatively, and postoperatively at yearly follow-up. Complications and revision procedures were also recorded. Only patients with a minimum follow-up of five years after surgery were included. RESULTS: A total of 16 patients were included. Six patients had an idiopathic EOS while ten patients had a neuromuscular or syndromic EOS (seven spinal muscular atrophy (SMA) and three with cerebral palsy or a syndrome). Their mean ages at surgery were 7.1 years (SD 2.2) and 13.3 years (SD 2.6) respectively at final follow-up. The mean preoperative Cobb angle of the major curve was 66.1° (SD 8.5°) and had improved to 25.5° (SD 9.9°) at final follow-up. The T1 to S1 length increased from 289.7 mm (SD 24.9) before surgery to 330.6 mm (SD 30.4) immediately after surgery. The mean T1 to S1 and T1 to T12 growth after surgery were 64.1 mm (SD 19.9) and 47.4 mm (SD 18.8), respectively, thus accounting for a mean T1 to S1 and T1 to T12 spinal growth after surgery of 10.5 mm/year (SD 3.7) and 7.8 mm/year (SD 3.3), respectively. A total of six patients (five idiopathic EOS, one cerebral palsy EOS) had broken rods during their growth spurt but were uneventfully revised with a fusion procedure. No other complications were noted. CONCLUSION: Our data show that SGR is a safe and effective technique for the treatment of EOS in nonambulatory hypotonic patients with a neuromuscular condition. Significant spinal growth can be expected after surgery and is comparable to other published techniques for EOS. While satisfactory correction of the deformity can be achieved and maintained with this technique, a high rate of rod breakage was seen in patients with an idiopathic or cerebral palsy EOS. Cite this article: Bone Joint J 2020;102-B(11):1560-1566.


Assuntos
Pinos Ortopédicos , Escoliose/cirurgia , Fusão Vertebral/instrumentação , Vértebras Torácicas/cirurgia , Fatores Etários , Criança , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/etiologia , Fusão Vertebral/métodos , Vértebras Torácicas/diagnóstico por imagem
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2039-2042, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018405

RESUMO

Scoliosis is a 3D spinal deformation where the spine takes a lateral curvature, which generates an angle in a coronal plane. For periodic detection of scoliosis, safe and economic imaging modality is needed as continuous exposure to radiative imaging may cause cancer. 3D ultrasound imaging is a cost-effective and radiation-free imaging modality which gives volume projection image. Identification of mid-spine line using manual, semi-automatic and automatic methods have been published. Still, there are some difficulties like variations in human measurement, slow processing of data associated with them. In this paper, we propose an unsupervised ground truth generation and automatic spine curvature segmentation using U- Net. This approach of the application of Convolutional Neural Network on ultrasound spine image, to perform automatic detection of scoliosis, is a novel one.


Assuntos
Imageamento Tridimensional , Escoliose , Humanos , Redes Neurais de Computação , Escoliose/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Ultrassonografia
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2101-2104, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018420

RESUMO

Ultrasound (US) imaging technique has been applied to measure the proxy Cobb angle and spinous process angle (SPA) for spinal curvatures of scoliosis. However manual measurement of ultrasound images is time consuming and greatly relying on the experience of raters. The objectives of this work are to develop an automatic measurement method to assess SPA of spine curves and to evaluate the accuracy and reliability of the method. The spinous process curves were identified and fitted on US images, and the automatically measured SPA were compared with the results from US manual and radiographic measurements. It illustrates that the US-auto measurement of SPA presents higher correlation and smaller difference with clinical standard radiographic results than the US-manual measurement.


Assuntos
Escoliose , Curvaturas da Coluna Vertebral , Humanos , Reprodutibilidade dos Testes , Escoliose/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Ultrassonografia
5.
Adv Clin Exp Med ; 29(10): 1169-1174, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33064377

RESUMO

BACKGROUND: Non-invasive distractions of recently introduced magnetically controlled growing rods (MGCRs) spare multiple operations in the surgical treatment of early onset scoliosis (EOS). Since the costs of the implants are high, concerns have been raised regarding cost-effective, optimal but safe MGCR options: single or dual constructs. OBJECTIVES: To report deformity control, spinal growth and complication incidence in EOS patients treated with MCGR singleor dual-rod constructs. MATERIAL AND METHODS: The study involved 47 patients with MCGRs inserted at Great Ormond Street Hospital, London (UK) in 2013-2014, who were followed up for at least 1 year. In 32 patients, T1-S1 distances, and coronal and sagittal curves were measured on preoperative and postoperative X-rays, and at a one-year follow-up. All complications were recorded. The patients were analyzed in 2 groups: those with single-rod constructs (24 patients) and those with dual-rod constructs (23 patients). RESULTS: Comparing postoperative with one-year follow-up measurements, T1-S1 length increase was better in the dual-rod group (3.29%) than in the single-rod group (0.34%) (p = 0.031). In the whole series, mean scoliosis magnitude dropped by 27.5% at the one-year follow-up. The dual-rod group showed better mean curve correction: 36.5% compared to 15.3% in the single-rod group (p = 0.0076). Overall, 34.04% of the patients had complications: 45.8% in the single-rod group and 30.4% in the dual-rod group (p = 0.0413). Metalwork failure was observed in 8 patients, lengthening problems in 5 and wound infections in 2; there was also 1 case of proximal junctional kyphosis (PJK). Preoperative hyperkyphosis was associated with more complications (75%, p = 0.037), most of which were metalwork failure (41.6%). CONCLUSIONS: The MCGRs are efficient at controlling EOS; however, the complication rate is high, particularly in single-rod constructs. The use of dual-rod constructs allows for better curve control, greater T1-S1 length increase and a lower complication rate.


Assuntos
Escoliose , Humanos , Cifose/diagnóstico por imagem , Próteses e Implantes , Radiografia , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Coluna Vertebral
6.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(5): 875-880, 2020 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-33047722

RESUMO

OBJECTIVE: To evaluate the clinical efficacy of short-term halo-pelvic traction (HPT) combined with surgery in the treatment of severe spinal deformities. METHODS: In the study, 24 patients diagnosed as severe spinal deformity accepted the treatment of one-stage short-term HPT and two-stage surgery from January 2015 to May 2018 in our orthopedics department. 24 cases (9 males and 15 females) were retrospectively reviewed. The average age of the cohort was (28.8±10.0) years (12-48 years). The height, scoliosis angle, kyphosis angle, the height difference of shoulders, the height difference of crista iliaca, C7PL-CSVL and the perpendicular distance of S1 and the convex point of the patients were assessed at pre-traction, post-traction and post-surgery. The paired t test was used to analyze the difference among pre-traction, post-traction and post-surgery. RESULTS: The average traction time of 24 cases was (2.5±1.1) weeks (1-5 weeks). The height of pre-traction and post-traction were (141.7±11.2) cm (116-167 cm) and (154.1±9.5) cm (136-176 cm) respectively, showing significant difference (P < 0.05), and the increased height was (12.4±4.6) cm (4-20 cm). The average scoliosis angle before traction was 104.9°±35.0°(25°ï¼158°), and it was significantly decreased in post-traction[64.8°±21.0°(19°ï¼92°)] and post-surgery[39.3°±17.0° (10°-70°)] (P < 0.05). The traction's coronal correction rate was 37.2%±10.9% (11.9%-51.2%) and the total coronal correction rate was 61.9%±12.6%(26.9%-79.0%). The average kyphosis angle before traction was 106.9°±29.2°(54°ï¼163°), and it was significantly decreased in post-traction [63.1°±17.1°(32°ï¼92°)] and post-surgery [39.0°±16.8°(10°ï¼68°)](P < 0.05). The traction's sagittal correction rate was 40.0%±10.7%(16.7%-55.5%) and the total sagittal correction rate was 64.3%±10.7%(49.0%-87.5%). The average C7PL-CSVL before traction was (3.2±2.8) cm, and it was significantly decreased in post-traction [(2.5±2.5) cm] (P < 0.05). The perpendicular distance of S1 and the convex point before traction was (10.5±4.8) cm, and it was significantly decreased in post-traction[(8.4±3.5) cm] (P < 0.05). CONCLUSION: The one-stage short-term HPT combined with two-stage surgery is a safe and effective procedure for severe spinal deformities. The clinical efficacy is satisfactory and the complication is relatively less.


Assuntos
Cifose , Escoliose , Adolescente , Adulto , Feminino , Humanos , Cifose/cirurgia , Masculino , Estudos Retrospectivos , Escoliose/cirurgia , Tração , Resultado do Tratamento , Adulto Jovem
7.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5806-5809, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019294

RESUMO

The customized design of braces for adolescent idiopathic scoliosis (AIS) treatment requires the acquisition of the 3D external geometry of the patients' trunks. Three body scanning systems are available at CHU Sainte-Justine in Montreal: a fixed system of InSpeck Capturor II LF digitizers and two portable scanners, BodyScan and Structure Sensor. The aim of this study is to compare them by evaluating their accuracy and repeatability. To achieve this, we placed 46 surface markers on an anthropomorphic manikin and scanned it three times with each system. We also measured the 3D coordinates of the same markers using a coordinate measuring machine (CMM), serving as ground-truth. We evaluated the repeatability and accuracy of the three systems: the former, by measuring the bidirectional mean distance between the three surfaces acquired with a given modality; the latter, by calculating the residual normal distance separating each of the 3D surfaces and the CMM point cloud. We also compared texture mapping accuracy between InSpeck and Structure Sensor by examining the CMM point cloud versus the marker 3D coordinates selected on the trunk surface. The results show good accuracy and repeatability for all three systems, with slightly better geometric accuracy for BodyScan (p-value ≈ 10-6). In terms of texture mapping, InSpeck showed better accuracy than Structure Sensor (p-value = 0.0059).


Assuntos
Imageamento Tridimensional , Escoliose , Adolescente , Braquetes , Humanos , Aparelhos Ortodônticos Fixos , Tronco
8.
Zhongguo Gu Shang ; 33(9): 853-9, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32959574

RESUMO

OBJECTIVE: To assess the early clinical effects of oblique lateral lumbar interbody fusion (OLIF) combined with posterior long-segment internal fixation through O-arm CT navigation for the treatment of degenerative scoliosis. METHODS: The clinical data of 15 patients with degenerative scoliosis treated by OLIF combined with posterior long-segment internal fixation through O-arm CT navigation between April 2016 and December were retropectively analyzed. There were 3 males and 12 females, aged from 55 to 73 years old with an average of (62.2±5.3) years. The operation time, intraoperation blood loss, the rate of excellentand good of pedicle screw placement, and complications were recorded. Before surgery, 1 week after surgery and at the final follow-up, the visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the patients' clinical symptoms;standing X-ray film, lumbar spine CT examination was performed at 6 months after surgery to observe coronal scoliosis Cobb angle, lumbar lordosis (LL), intervertebral space height, sagittal vertical axis (SVA), intervertebral fusion, etc. RESULTS: The mean operation time and intraoperative blood loss were respectively (98.7±16.8) min and (50.2±10.7) ml in OLIF surgery, while were (101.5±23.4) min and (63.1±19.7) ml in the surgery of posterior long segment internal fixation. The total mean operation time and intraoperative blood loss were (200.2±40.2) min and (113.3±30.4) ml. All patients were followed from 12 to 25 months with an average of (16.5±5.3) months. Low back pain VAS, lower limb pain VAS and ODI reduced from preoperative (6.8±1.6), (6.2±1.1) scores and (64.6±10.4)% to (1.4±1.0), (1.0±0.5) scores, and (15.8±4.5)% at the final follow-up, the differences were statistically significant(P<0.05). Coronal scoliosis Cobb angle and SVA decreased from preoperative (20.3±13.5)°, (42.3±16.5) mm to (5.5±3.1)°, (25.1±10.9) mm at the final follow-up, and the differences were statistically significant (P<0.05). LL and intervertebral space height increased from preoperative (25.8±8.2)°, (5.9±2.7) mm to (39.3±9.1)°, (10.9±1.2) at the final follow-up, and the differences were statistically significant(P<0.05). Total 240 nails were placed through O-arm CT navigation with the rate of excellent and good of 96%(230/240). Six months after operation, CT of lumbar spine showed interbody fusion of bone. One patient developed anterior medial pain in the left thigh, and two patients experienced transient lefthip flexion after surgery, both of whom recovered during subsequent follow-up. CONCLUSION: The early clinical effect of oblique lateral lumbar interbody fusion combined with posterior long segment internal fixation through O-arm CT navigation is satisfactory in treatment of degenerative scoliosis. It has the advantages of minimal invasion, accurate navigation of nail placement, high bone fusion rate and few complications. It can provide new options for minimally invasive treatment of degenerative scoliosis.


Assuntos
Escoliose , Fusão Vertebral , Cirurgia Assistida por Computador , Idoso , Feminino , Humanos , Imageamento Tridimensional , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
Medicine (Baltimore) ; 99(39): e22426, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991478

RESUMO

Razor back deformity is one of the most noticeable problems of severe scoliosis. Thoracoplasty has been reported to be a useful approach to correct the rib hump deformity. However, the outcomes of thoracoplasty in patients with severe, rigid, thoracic scoliosis have not yet been evaluated.To evaluate the effectiveness and safety of a modified technique of thoracoplasty (rib ends fixed under transverse process) for rib hump deformity in adults with severe thoracic scoliosis and severe pulmonary dysfunction.Patients with severe thoracic scoliosis and severe pulmonary dysfunction who underwent staged surgical strategy including halo-pelvic traction, spinal osteotomy combined with the modified thoracoplasty were included. To avoid paradoxical breathing result from multiple rib resections and enlarge the capacity of thoracis, the ends after rib resection were fixed under transverse process compared with conventional thoracoplasty. Patients were excluded on the basis of pulmonary diseases and inadequate follow-up. Data on deformity correction and pulmonary complications were reviewed. A t test was performed on the pre- and postoperative data of pulmonary function, height of the rib hump deformity, and total lung area.Eighteen patients (5 men and 13 women) with a major thoracic curve of >130° were included. The mean age of patients was 25.3 ±â€Š3.6 years (range, 19-32 years), with an average length of follow-up of 30.2 months. After application of halo-pelvic traction, the mean major thoracic curve decreased from 168.2°â€Š±â€Š14.28° to 97.3°â€Š±â€Š10.75° and the thoracic kyphosis decreased from 159.4°â€Š±â€Š20.60° to 94.8°â€Š±â€Š9.58°. On average, 6.3 (range, 4-8) ribs were resected. The height of the rib hump decreased from 84.6 ±â€Š13.3 to 15.3 ±â€Š3.4 mm. The average predicted forced vital capacity (FVC%) before surgery was 37.2 ±â€Š13.30%, indicative of severe pulmonary impairment, with a small but non-significant improvement in the FVC% at the final follow-up. The mean total lung area increased from 2583.2 ±â€Š501.36 to 2890.1 ±â€Š537.30 mL at the last follow-up. No severe pulmonary complications occurred.Our modified approach to thoracoplasty procedure is effective and safe in correcting a razor back deformity in patients with severe, rigid, scoliosis, and severe pulmonary dysfunction, without causing any significant change in long-term pulmonary function.


Assuntos
Escoliose/cirurgia , Toracoplastia/métodos , Adulto , Feminino , Humanos , Masculino , Radiografia , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Toracoplastia/efeitos adversos , Toracoplastia/estatística & dados numéricos , Adulto Jovem
11.
Zhonghua Wai Ke Za Zhi ; 58(9): 707-712, 2020 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-32878418

RESUMO

Objective: To evaluate the feasibility of placement of S(2) alar iliac screw (S(2)AI) using free-hand technique for sacrapelvic fusion in lumbar degenerative scoliosis. Methods: Eighteen patients with Lumbar Degenerative Scoliosis treated by S(2)AI screw fixation at Department of Orthopedics, General Hospital of Southern Theater Command of People's Liberation Army and Department of Orthopedics, 89th hospital of People's Liberation Army from August 2014 to October 2018 were analyzed retrospectively. There were 5 males and 13 females, aged 63.2 years old (range:55 to 71 years old).Parameters of spine including: Cobb Angle, C(7) plumb line -center sacral vertical line (C(7)PL-CSVL), lumbar lordosis(LL), sagittal vertical axis(SVA), pelvic incidence(PI), pelvic tilt(PT), sacral slope (SS) and pI-LL were measured on the whole spine X-ray before operation and at final follow-up. Pelvic CT scan was performed postoperatively to assess the accuracy of S(2)AI placement. Oswestry disability Index (ODI) was also recorded. The data were compared by paired t test or Wilcoxon tests. Results: All patients were followed up for 23.7 months (range: 12~62 months).At the last follow up, Cobb Angle decreased from (32.28±4.97) °preoperative to (6.56±3.20) ° (t=41.142, P<0.01) and C(7)PL-CSVL deceased from (1.11±2.07) cm preoperative to (0.18±1.08) cm (t=41.142, P=0.06) .LL improved from (-22.39±13.07) °preoperative to (-36.39±4.29) ° (t=4.470, P<0.01) , PI-LL decreased from (26.83±14.83)°preoperative to (13.72±8.3)° (t=4.396, P<0.01) , PT decreased from (27.94±4.26) °to (23.39±6.08) ° (t=2.680, P=0.02) , and SS increased from (22.22±6.36) °to (26.28±7.24) ° (t=-2.178, P=0.04) .SVA decreased from (6.54±4.51) cm preoperative to (2.62±1.29) cm (t=3.052, P=0.01) .ODI decreased from 0.58(0.40) (M(Q(R))) to 0.18 (0.15) (Z=-4.567, P<0.01) .No complications such as nerve and blood vessel injury occurred during the operation. A total of 32 S(2)AI screws were placed, 3 screws were placed with mild to moderate cortical breaches, 2 were perforated the pelvis ventrally, 1 was perforated posteriorly, with no clinically notable neurovascular or visceral complications. Eight patients finished the SRS-22 questionnaire, with mean score of 4.4 in terms of satisfaction with management. Conclusions: Free-hand technique of S(2)AI screw placement for sacrapelvic fusion in degenerative lumbar scoliosis is safe and feasible.S(2)AI fixation in DLS can provide great correction of deformity, maintain the stability of lumbo-pelvic area and improve the clinical symptoms.


Assuntos
Ílio/cirurgia , Sacro/cirurgia , Escoliose/cirurgia , Fusão Vertebral/métodos , Idoso , Animais , Parafusos Ósseos , Estudos de Viabilidade , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Resultado do Tratamento
12.
Am J Phys Med Rehabil ; 99(10): 887-894, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32960527

RESUMO

OBJECTIVE: This study used a 3-point pressure spinal orthosis made of fabric material in neuromuscular scoliosis patients with flexible spinal curve to evaluate the in-brace correction of the spinal curve and to estimate changes in pulmonary function associated with brace wearing. DESIGN: Twenty-eight children with neuromuscular scoliosis with spinal curve flexibility of more than 50% were enrolled. A custom-made 3-point pressure spinal orthosis was fitted for each patient. The Cobb angles in sitting and supine positions, forced vital capacity, forced expiratory volume in the first second, and peak cough flow were measured before and after applying spinal orthoses. Each participant recorded the brace wearing duration, and questionnaires on brace tolerance were collected. RESULTS: Cobb angles after application of orthosis decreased from 31.0 degrees (interquartile range = 21.9-45.0 degrees) to 16.6 degrees (interquartile range = 10.0-34.0 degrees) in the sitting position and from 13.3 degrees (interquartile range = 4.0-21.0 degrees) to 1.4 degrees (interquartile range = 0.0-19.0 degrees) while supine (P < 0.01, P = 0.04, respectively). Preorthosis and postorthosis application forced vital capacity, forced expiratory volume in the first second, and peak cough flow were unaffected. Caregivers reported improved sitting postures and manual activities. CONCLUSIONS: In children with flaccid-type neuromuscular scoliosis, curve correction can be achieved using a simple fabric-type spinal orthosis when applied to patients with flexible scoliosis, without compromising lung function. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Describe the factors associated with the effects of spinal braces in neuromuscular scoliosis; (2) Discuss the characteristics of flaccid-type neuromuscular scoliosis; and (3) Discuss the benefits of fabric-type orthosis regarding pulmonary function and patient compliance. LEVEL: Advanced. ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.


Assuntos
Aparelhos Ortopédicos , Desenho de Prótese , Ajuste de Prótese , Escoliose/terapia , Têxteis , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Testes de Função Respiratória , Escoliose/diagnóstico por imagem , Inquéritos e Questionários
13.
Bone Joint J ; 102-B(10): 1375-1383, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993330

RESUMO

AIMS: To investigate metallosis in patients with magnetically controlled growing rods (MCGRs) and characterize the metal particle profile of the tissues surrounding the rod. METHODS: This was a prospective observational study of patients with early onset scoliosis (EOS) treated with MCGRs and undergoing rod exchange who were consecutively recruited between February 2019 and January 2020. Ten patients were recruited (mean age 12 years (SD 1.3); 2 M:8 F). The configurations of the MCGR were studied to reveal the distraction mechanisms, with crucial rod parts being the distractable piston rod and the magnetically driven rotor inside the barrel of the MCGR. Metal-on-metal contact in the form of ring-like wear marks on the piston was found on the distracted portion of the piston immediately outside the barrel opening (BO) through which the piston rod distracts. Biopsies of paraspinal muscles and control tissue samples were taken over and away from the wear marks, respectively. Spectral analyses of the rod alloy and biopsies were performed to reveal the metal constituents and concentrations. Histological analyses of the biopsies were performed with haematoxylin and eosin staining. RESULTS: Titanium (Ti), vanadium (V), and neodymium (Nd) concentrations in the biopsies taken near the wear marks were found to be significantly higher than those in the control tissue samples. Significantly increased Nd concentrations were also found in the tissues near the barrel of the MCGR. Chronic inflammation was revealed by the histological studies with fibrosis and macrophage infiltration. Black particles were present within the macrophages in the fibrotic tissues. CONCLUSION: Ti and V were generated mainly at the BO due to metal-on-metal contact, whereas the Nd from the rotor of the MCGR is likely released from the BO during distraction sessions. Phagocytotic immune cells with black particles inside raise concern regarding the long-term implications of metallosis. Cite this article: Bone Joint J 2020;102-B(10):1375-1383.


Assuntos
Reação a Corpo Estranho/etiologia , Próteses e Implantes/efeitos adversos , Escoliose/cirurgia , Biópsia , Criança , Feminino , Reação a Corpo Estranho/diagnóstico por imagem , Humanos , Magnetismo , Masculino , Neodímio/efeitos adversos , Estudos Prospectivos , Escoliose/diagnóstico por imagem , Titânio/efeitos adversos , Vanádio/efeitos adversos
15.
J Pediatr Orthop ; 40(9): e818-e821, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32931689

RESUMO

BACKGROUND: The 6-minute walk test (6MWT) is used to assess the function of cardiopulmonary and neuromuscular conditions in adults and children. The primary research question was to determine the relationship between 6MWT distance and forced vital capacity (FVC) and the major curve among children with congenital scoliosis with rib anomalies. METHODS: The authors recorded 6MWT distance in meters, FVC as a percentage of predicted normal value using arm span for height (FVC%), and Cobb angle in 20 children (13 girls; average age, 6.7±1.3 y) with congenital scoliosis before outpatient surgical treatment. The 6MWT uses a standardized protocol and measures distance traveled in 6 minutes on a flat surface. The authors then determined the correlation between these measures using linear regression analysis. RESULTS: The Cobb angle of the major curvature was 55.4±20.5 degrees. The type of vertebral anomaly was mixed in 17 cases, formation failure in 2 cases, and segmentation failure in 1 case. The range of rib anomalies was 3.4±3.9 levels; 15 and 5 patients, respectively, had unilateral and bilateral rib anomalies. FVC and FVC% were 0.7±0.2 L and 60%±19%, respectively. The ratio of forced expiratory volume at 1 second to FVC (FEV1/FVC), which indicates obstructive lung disease, was normal at 93%±7%. The 6MWT distance was 386.3±59.4 m, which was ≤10% of the predicted distance for normal children. No child was able to walk the normal distance on the basis of published norms. 6MWT distance was significantly correlated with arm span (ρ=0.46, P=0.04) and major curve (ρ=-0.61, P=0.004), but not with FVC% (ρ=0.17, P=0.49). CONCLUSIONS: The 6MWT distance is a feasible measure of function and is substantially reduced before surgery in children with thoracic congenital scoliosis with rib anomalies. The 6MWT distance was significantly correlated with a major curve but not with FVC%. 6MWT distance is not affected by moderate lung function impairment. LEVEL OF EVIDENCE: Level IV-retrospective cohort study.


Assuntos
Escoliose/congênito , Teste de Caminhada , Caminhada/fisiologia , Criança , Pré-Escolar , Feminino , Volume Expiratório Forçado , Humanos , Modelos Lineares , Masculino , Período Pré-Operatório , Radiografia , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/fisiopatologia , Escoliose/cirurgia , Capacidade Vital
16.
Medicine (Baltimore) ; 99(37): e22069, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925743

RESUMO

OBJECTIVE: Long-segment spinal fusion surgery was associated with substantial perioperative blood loss which may increase hospitalization expenses and mortality rates. Substantial studies have reported that tranexamic acid (TXA) could reduce blood products and cost after joint arthroplasty surgery. However, there still exists controversy regarding the efficacy of TXA in long-segment spinal fusion surgery. We performed this protocol to design a randomized controlled study to evaluate the efficacy of TXA in decreasing transfusion rate of allogeneic blood products and transfusion cost in degenerative lumbar scoliosis patients. METHODS: This study was carried out as a double-blinded, randomized clinical trial on patients with degenerative lumbar scoliosis who prepared for long-segment spinal fusion surgery from December 2018 to December 2019. It was authorized via the Institutional Review Committee in Southwest Medical University (ky2019225). Eighty patients were divided randomly into 2 groups (Experimental group = 40, control group = 40). The patients in the experimental group received 1000 mg of TXA mixed in 100 mL normal saline as a single dose intravenously over 20 minutes before the skin incision was made. Control group received equivalent normal saline without TXA. Primary outcomes included total blood loss, estimated intraoperative blood loss, hematocrit and hemoglobin decline, postoperative drain amount, intra-/postoperative allogeneic transfusion amount and rate, and total transfusion cost. Secondary outcomes included surgical time, thrombotic complications including deep vein thrombosis and pulmonary embolism. All the needed analyses were implemented through utilizing SPSS for Windows Version 20.0. RESULTS: Table showed the relevant clinical outcomes between experimental group and control group. CONCLUSION: We hypothesized that TXA was effective and safe in reducing blood transfusion and cost in long-segment spinal fusion surgery. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5854).


Assuntos
Antifibrinolíticos/uso terapêutico , Transfusão de Sangue , Vértebras Lombares/cirurgia , Escoliose/cirurgia , Fusão Vertebral/métodos , Ácido Tranexâmico/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Método Duplo-Cego , Feminino , Humanos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias , Hemorragia Pós-Operatória/prevenção & controle , Embolia Pulmonar , Fusão Vertebral/efeitos adversos , Trombose Venosa
17.
PLoS One ; 15(9): e0238181, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877408

RESUMO

BACKGROUND: Studies have shown a positive correlation between higher physical activity (PA) and health benefits. However, device-based assessment of PA and sedentary time (ST) in people with adolescent idiopathic scoliosis (AIS) has not been deeply investigated. OBJECTIVE: Analysis and comparison of weekend and weekdays PA and ST using multiple accelerometers in people with AIS with different curvature severity compared to healthy controls. METHODS: 24 participants with AIS divided into 2 groups of 12 with Cobb angles < 40° and > 40°, along with 12 age and BMI matched healthy controls. Daily PA and ST during four consecutive days were measured using four tri-axial accelerometers. Clinical functional assessment was performed using the scoliosis research society (SRS-22) questionnaire. RESULTS: The combined weekend and weekdays average daily step count was found to be 22% and 29% lower in the AIS groups with Cobb angle < 40° and > 40°, respectively, compared to the controls. The average ST was also reported to be 5% and 7% higher in the AIS groups with Cobb angle < 40° and > 40°, respectively, compared to the controls. The reported differences were significant in the AIS group with higher Cobb angle (p≤0.05). No significant differences in PA or ST were reported between the AIS groups based on curvature severity. CONCLUSIONS: Decreased PA and increased ST observed in patients with AIS may have long term health implications and may play a role in the disease process. The device-based assessment of PA to understand potential benefits in clinical practice is recommended.


Assuntos
Acelerometria/instrumentação , Exercício Físico , Monitorização Fisiológica/instrumentação , Escoliose/fisiopatologia , Comportamento Sedentário , Adolescente , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Processamento de Sinais Assistido por Computador , Fatores de Tempo
18.
J Pediatr Orthop ; 40(8): e747-e752, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32776773

RESUMO

BACKGROUND: Severe early-onset scoliosis (EOS) has been associated with a multitude of comorbidities, chief among them being deficient thoracic spine growth and pulmonary complications. EOS management with rib-based instrumentation involves repeated lengthening. Despite expansion practice patterns, there is limited literature and no evidence-based guidelines for optimal expansion intervals. Our study evaluates clinical outcomes in relation to lengthening intervals with the aim of optimizing the timing of surgical expansion in EOS patients. METHODS: A single-institution retrospective review of 60 EOS patients treated with rib-based growth instrumentation with a minimum of 3-year follow-up and 3 expansion/revision surgeries. Patients were separated into 2 expansion cohorts: (1) more frequent lengthening [MFL group (≤7 mo)] and (2) less frequent lengthening [LFL group (>7 mo)]. Demographic information and clinical factors were recorded. Univariate and bivariate analyses were performed. RESULTS: Both the MFL group (35 patients) and LFL group (25 patients) were similar in sex distribution, diagnosis, preoperative parameters of interest, and treatment duration. The mean follow-up was 6.0 years. There was an increase in postoperative T1-S1 spine height gained in the MFL group (P=0.006) as well as a higher percent expected spine growth based on normative values (P=0.03) when compared with the LFL group. The MFL group had more expansion/revision surgeries (P=0.003) but no increase in the number of complications (P=0.86). CONCLUSIONS: More frequent lengthenings were associated with statistically significant overall spinal height gain and percent expected growth without a significant increase in complication rates. It was shown that change in major curve and space available for the lungs was not associated with the lengthening intervals. LEVEL OF EVIDENCE: Level III-a comparative retrospective study.


Assuntos
Alongamento Ósseo/métodos , Duração da Terapia , Complicações Pós-Operatórias , Costelas/cirurgia , Escoliose , Coluna Vertebral/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Escoliose/diagnóstico , Escoliose/cirurgia , Parede Torácica , Resultado do Tratamento
20.
Medicine (Baltimore) ; 99(30): e21221, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791696

RESUMO

To decrease postoperative complications in patients with adult lumbar degenerative scoliosis (ALDS), short-segment fusion surgery was used in this study. However, the incidence of adjacent segment disease was found to be remarkable. Therefore, we applied the hybrid treatment (short-segment fusion for responsibility levels plus nonfusion stabilization of lumbar segments, which was called the Wallis system, for the proximal level) to patients enrolled into this study. The purpose of this study was to investigate the feasibility of a novel hybrid therapeutic approach for treating patients with ALDS.From January 2011 to January 2017, a retrospective study was conducted consisting of 16 patients with ALDS who were treated with hybrid treatment. All patients were treated with short-segment decompression and fusion for responsibility levels and nonfusion stabilization of lumbar segments for the proximal levels. The imaging outcomes were evaluated preoperatively and at the time of follow-up.The mean visual analog score for back pain decreased from 6.1 ±â€Š2.0 preoperatively to 2.1 ±â€Š0.7 at 2-year follow-up (P < .05), and the mean visual analog score for leg pain reduced from 8.1 ±â€Š0.6 preoperatively to 1.3 ±â€Š0.8 at 2-year follow-up (P < .05). The Oswestry disability index scores improved from 65.4 ±â€Š16.3% preoperatively to 18.3 ±â€Š5.6% at 2-year follow-up (P < .05). The mean Cobb angle was 22.1 ±â€Š6.2° preoperatively, and 13.8 ±â€Š6.8° at 2-year follow-up (P < .05). The lumbar lordosis changed from -40.4 ±â€Š14.8° to -43.5 ±â€Š11.2° at 2-year follow-up (P < .05). Solid fusion was achieved in all the patients, and no incidence of adjacent segment disease was noted as well.The proposed hybrid treatment for patients with ALDS can achieve favorable clinical outcomes and a lower incidence of ALDS. However, the correction of deformity is still limited that highlights the necessity of further study.


Assuntos
Discotomia/métodos , Vértebras Lombares/cirurgia , Escoliose/cirurgia , Fusão Vertebral/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento , Escala Visual Analógica
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