Factors as predictors for thoracic and thoracolumbar/lumbar structural curves in adolescent idiopathic scoliosis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Recent studies have demonstrated that the Lenke system is relatively efficient and consistent in classifying scoliosis curves. Basically, fusion should include the main curve and the structural minor curve. The criteria for defining the structural minor curve were established to help guide these decision-making process. The present study was designed to investigate predictors of the structural curve, and see whether it was possible to prevent the formation of the structural curve by interfering with influencing factors to decrease the fusion level.</p><p><b>METHODS</b>Age, gender, Cobb angle, Perdriolle rotation, Risser sign and the number of vertebrae included in the curve, brace treatment, and curve location were recorded in 145 idiopathic scoliosis patients from July 2001 to January 2007. The patients were divided into two groups: structural and non-structural groups. Demographics and baseline characteristics were compared between the two groups as an initial screen. Logistic regression was used to analyze factors affecting the minor curve to become the structural curve.</p><p><b>RESULTS</b>Compared with the non-structural group, the structural group had a higher Cobb angle ((51.34 ± 13.61)° vs. (34.20 ± 7.21)°, P < 0.001), bending angle ((33.94 ± 9.92)° vs. (8.46 ± 5.56)°, P < 0.001) and curve rotation ((23.25 ± 12.86)° vs. (14.21 ± 8.55)°, P < 0.001), and lower flexibility ((33.48 ± 12.53)% vs. (75.50 ± 15.52)%, P < 0.001). There was no significant difference in other parameters between the two groups. The results of the Logistic regression analysis showed that the Cobb angle (OR: 9.921, P < 0.001) and curve location (OR: 4.119, P = 0.016) were significant predictors of structural curve in adolescent idiopathic scoliosis. Every 10° change of Cobb angle increased the possibility of turning the minor curve into the structural curve by 10-fold. And thoracic curve showed, on the average, the possibility of becoming the structural curve about 4-fold more often than did the thoracolumbar/lumbar curve.</p><p><b>CONCLUSIONS</b>Curve severity and curve location affect the minor curve's structural features in adolescent idiopathic scoliosis.</p>

Analysis of posterior pedicle screw-only constructs in surgical treatment of adolescent idiopathic scoliosis with a minimum three-year follow-up / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate clinical outcomes of a group of adolescent idiopathic scoliosis (AIS) patients undergoing posterior pedicle screw-only instrumentations.</p><p><b>METHODS</b>Between April 2002 and July 2006, 121 AIS patients (93 female and 28 male, average age at operation was 15.5 years which ranged from 10 to 20 years) received posterior pedicle screw-only instrumentation and fusion. All the patients were evaluated by the various-parameters measured in X-ray films before and after surgery, including Cobb angle on coronal plane, Cobb angle on sagittal plane, clavicle angle and shoulder height difference, lowest instrumented vertebrae (LIV) angulation, proximal junction kyphotic angle, the distances of central sacral vertical line (CSVL) to the LIV, to the apical vertebra and to the C(7) plumb line respectively. Complications were followed.</p><p><b>RESULTS</b>An average of (11.0 + or - 1.5) levels was fused. An average coronal correction of proximal thoracic curve was 41.8%, of thoracic curve was 70.8%, of thoracolumbar/lumbar curves was 74.0%. No significant change was found in sagittal alignment. Shoulder balance and apex vertebral to central sacral line were restored well. There were no pseudoarthroses and loss of correction during the follow-ups. One adding-on, 4 proximal thoracic decompensation and 15 proximal junction kyphosis were found during the follow-ups.</p><p><b>CONCLUSION</b>Posterior pedicle screw-only instrumentation and fusion has excellent radiographic and clinical results with minimal complications in the surgical treatment of AIS.</p>

Magnetic resonance imaging of artificial lumbar disks: safety and metal artifacts / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>This study was to investigate the safety of two types of commercially available lumbar artificial discs (CHARITE and PRODISC-L) during a magnetic resonance imaging (MRI) procedure in a 1.5-Tesla MR system, and to evaluate the size of metal artifacts on the MR image for different sequences.</p><p><b>METHODS</b>A 1.5-Tesla clinical MR imaging system was used. The degree of deflection of the endplates of two artificial discs was evaluated by an angle-measurement instrument at the portals of the MRI scanner. The heating effect of the radio frequency (RF) magnetic field was evaluated by using "worst-case" imaging sequences on a human cadaver implanted with an artificial lumbar disc at the L5/S1 intervertebral disc location. The temperatures of the tissue adjacent to the implant, and of the L4/L5 intervertebral disc (used as a control) were measured, respectively, using a digital probe thermometer before and after the MRI scan sequence. A rectangular water phantom was designed to evaluate the metal artifacts of these two artificial discs under different MR imaging sequences.</p><p><b>RESULTS</b>The maximal deflection angle of the endplate of the implants under a static MR field was 7.5 and 6.0 degrees, for the CHARITE and PRODISC-L, respectively. The difference between temperature rise of tissue adjacent to the two types of artificial discs and the temperature rise of the L4/L5 control location was 0.4 and 0.6 degrees C, respectively. The size of metal artifacts on images of TSE (T1/T2 -weighted), STIR and Turbo Dark Fluid sequences were relatively less than those of TSE fat saturation, Flash and SE (T1-weighted) sequences.</p><p><b>CONCLUSIONS</b>The CHARITE and the PRODISC-L artificial disc do not present an additional hazard or risk to a patient undergoing an MRI procedure using a scanner operating with a static magnetic field of 1.5 T or lower. Image artifacts from the implants may present problems if the anatomical region of interest is in or near the area where these implants are located (e.g., vertebral canal at affected segment).</p>

Combination of volar buttress plate with external fixator for the distal radial fractures of type C3 caused by high-energy injuries / 中国骨伤

<p><b>OBJECTIVE</b>To preliminarily explore the effect of combination of volar buttress plate with external fixator for the distal radial fractures of type C3 caused by high-energy injuries.</p><p><b>METHODS</b>From January 2001 to June 2007, 13 patients with distal radial fracture of type C3, 9 males and 4 females aged from 26 to 47 (average 37 years), were treated with volar buttress plate combined with external fixator plus the techniques of K-wires and bone grafting as necessary, whose effects were evaluated preliminarily through comparing the volar tilt, radial inclination, radial shortening and wrist function.</p><p><b>RESULTS</b>Followed up from 7 to 29 months (average 18 months), the volar tilt, radial inclination, radial shortening and wrist function of all patients recovered remarkably. Nine patients achieved excellent and 4 good according to Sarmiento score (modified by Stewart) in the radiological manifestation, while 5 patients displayed excellent, 6 good, and 2 fair according to Gartland-Werley functional assessment system.</p><p><b>CONCLUSION</b>1) Volar buttress plate could support the valor cortex in order to prevent comminuted fragment from displacing and maintain volar tilt and to provide the volar fulcrum for external fixator. 2) External fixator, with the assistance of volar fulcrum, could maintain the volar tilt and the height of distal radius and help unload the fossa. 3) Supplemental K-wires fixation and the bone graft may assist fracture stable.</p>

Current situation and prospect in treatment of spine and spinal cord injuries / 中华创伤杂志(英文版)

Spine and spinal cord injuries represent one of the most survivable, yet disabling injuries known to man. Many countries and governments have contributed great resources to study on it. With the rapid development of modern basic and clinical medicine, many effective methods can be selected to restore the mechanical stability of damaged spinal column, including several minimal invasive surgical operations. Unfortunately, up to now, there are few effective therapeutic tools for the treatment of severe spinal cord injury. But new discoveries in basic research field and progress in modern rehabilitation medicine bring us great prospects.