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<p><b>OBJECTIVE</b>To evaluate the role and value of Changhai fulcrum bending radiograph(CH-FBR) in curve flexibility assessment of adolescent idiopathic scoliosis(AIS) patients.</p><p><b>METHODS</b>Thirty-seven AIS patients treated between June 2012 and August 2013 were enrolled, including 31 female and 6 male patients whose age ranged from 10 to 19 years, averaged of 15.0 years. The assessment of radiographs included preoperative standing posterior-anterior radiograph, supine side-bending radiograph, traditional fulcrum bending radiograph, Changhai fulcrum bending radiograph and postoperative standing posterior-anterior radiograph. Postoperatively, radiographs were assessed at one week. The CH-FBR was performed at the lowest height and the optimized height which means the weight on the fulcrum touch the maximum. All measurements of angle were made with use of the Cobb method. The flexibility of the curve as well as the correction rate and fulcrum bending correction index (FBCI) were calculated for all patients. The maximum height of CH-FBR, basic weight and maximum weight were measured for all AIS. Paired t-tests were used to assess differences between preoperative and postoperative curves within group samples. The Pearson correlation coefficients were calculated using bivariate analysis between CH-FBR flexibility rate and correction rate, the maximum height of CH-FBR and maximum weight, the height changes of CH-FBR and weight changes.</p><p><b>RESULTS</b>A total of 46 curves were involved in this study, including 28 thoracic and 18 thoracolumbar/lumbar curves. Preoperatively, the mean Cobb angle of the 46 structural curves was 47° ± 11°. Postoperatively, the mean Cobb angle was 11° ± 5°. Cobb's angle in supine side-bending(t = 7.2, P = 0.001), traditional fulcrum bending (t = 7.1, P = 0.001) and lowest height of Changhai fulcrum bending (t = 6.5, P = 0.001) were significantly different from the postoperative Cobb angle; Cobb's angle in traditional FBR (t = 11.0, P = 0.001) and lowest height of Changhai fulcrum bending (t = 13.6, P = 0.001) were significantly different from the optimized height CH-FBR Cobb angle. There was no significant difference found between traditional FBR Cobb angle and lowest height CH-FBR Cobb angle (t = 2.0, P = 0.051), optimized height CH-FBR Cobb angle and postoperative Cobb angle (t = 0.9, P = 0.36), lowest height CH-FBR Cobb angle and traditional FBR Cobb angle(t = 2.0, P = 0.051). The maximum height of CH-FBR, basic weight and maximum weight were (29.6 ± 1.4)cm,(20 ± 6)kg, and (40 ± 6) kg. Preoperatively, the mean Cobb angle of the 28 structural curves(main thoracic curves) was 46° ± 11°. Postoperatively, the mean Cobb angle was 12° ± 6°. Preoperatively, the mean Cobb angle of the 18 structural curves(thoracolumbar/lumbar curves) was 49° ± 12°. Postoperatively, the mean Cobb angle was 10° ± 5°. The results were same in 28 structural curves, 18 structural curves as well as 46 curves. Correlation analysis of 46 curves indicated that the maximum height of CH-FBR positively correlated with maximum weight (r = 0.69, r(2) = 0.47, P = 0.001), the height changes of CH-FBR positively correlated with weight changes on CH-FBR (r = 0.62, r(2) = 0.38, P = 0.001).</p><p><b>CONCLUSIONS</b>CH-FBR is a more reliable and effective method than traditional FBR and supine side-bending for curve flexibility evaluation in AIS patients. Moreover, compared to the traditional FBR and side-bending radiograph, the flexibility suggested by the optimized height CH-FBR more closely approximates the postoperative result made by pedicle screws fixation and fusion.</p>
Subject(s)
Adolescent , Child , Female , Humans , Male , Young Adult , Prospective Studies , Radiography , Range of Motion, Articular , Scoliosis , Diagnostic Imaging , General SurgeryABSTRACT
20?) or vertebral semiluxation and vertebral pathological fracture group (n=14),which was treated with full laminectomy and limited correction with pedicle screw/rod internal fixation system by augmentation and restoration with bone cement in the screw tract; mild coronal plane deformity (Cobb’s angle
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Objective: To evaluate the efficacy of the third-generation instrumentation including TSRH, CD and ISOLA in the treatment of adult scoliosis. Methods:Thirty-five adult patients with idiopathic or degenerative scoliosis who received treatment with third-generation instrumentation (TSRH,CD and ISOLA) between July 1999 to January 2003 were retrospectively reviewed. The mean preoperative cobb angle of major curves of the frontal plane was 58.1°(42°-95°). The patients received a combined anteroposterior approach or a single posterior procedure. The mean follow-up time was 20 months(10-48 months). Preoperative and postoperative Cobb angles of the frontal plane and sagittal plane and the distance between C7 and CVLS were measured. The subjective assessment was judged by questionnaire. Results: Postoperative clinical appearance of all patients improved significantly. Mean correction of major curves of the coronal plane was 53.2%. Mean loss of correction of the coronal plane in the last follow-up was 4.3°. The distance between the midline of C7 and CVSL was corrected from 2.6 cm to 0.24 cm. The results of follow-up showed that 89.3% patients were satisfied with the outcome. Pneumatothorax and haematothorax occurred in 2 patients. Three patients still complained of low back pain one year after operation because of adjacent degeneration in 2 patients and pseudoarthrosis in the remaining 1 patient. Conclusion: Imageologic findings and subjective assessment of the patients showed that the third-generation instrumentation can achieve good correction and trunk balance in the treatment of adult scoliosis with fewer complications.
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Objective To find out if different doses of melatonin have different roles in the cause or treatment of idiopathic scoliosis, and to illuminate whether melatonin can be a substitution in the treatment of pinealectomized chickens. Methods Fifty Little-Shaoxing chickens, in which pinealectomy was performed when 3-day-old, were divided into five groups. Ten served as control group, were kept in light-dark (12h: 12h) cycle, 500 lx in daytime and 0-5 lx in nighttime after surgery. Ten served as M-5 group, were given 5 mg/kg (5 milligrams per kilogram of body weight) melatonin twice every day. Ten as M-10 group, given 10 mg/kg melatonin abdominally twice every day, ten as M-20 group, given 20 mg/kg melatonin twice every day, and ten as M-40 group, given 40 mg/kg melatonin twice every day. The light-dark (12h: 12h) cycle was the same as control group. Radiological examinations were performed on all chicken spines for scoliosis when at 3 months old. Measured of the angle of the scoliosis was taken by Cobb's technique, and the data was analyzed by statistical software. Results Overall, there was 25 chickens developed to scoliosis in all when the chickens were 3 months. The attack rate was only 56%; this rate was consistent throughout all experimental groups. In the control group, 6 chickens had obvious scoliosis, and 5 in M-5 group, 5 in M-10 group, 4 in M-20 group, and 5 in M-40 Group. And the average Cobb's angle of control group was 26.7?. There were 23.5?, 21.7?, 24.5? and 23.2? in M-5, M-10, M-20 and M-40 respectively. There was no statistical significance in the average Cobb's angle and the incidence of scoliosis among all groups. It was determined that neither the prevalence nor the pattern of the scoliosis was affected by the therapy in any of the experimental groups. Conclusion Different dose of melatonin can't reduce the rate of scoliosis in the pinealectomized chickens, and also can't prevent the development of the experimental scoliosis. The results of this study raise doubts regarding the role of melatonin in the development of scoliosis after pinealectomy in the young chicken. Melatonin acting as a vicarious therapeutic tool in the treatment of idiopathic scoliosis is premature, deserved further research.