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Objective:To explore the accuracy and repeatability of the smartphone scoliosis screening APP developed by our team in the measurement of the Cobb angle of adolescent idiopathic scoliosis (AIS).Methods:Clinical data of 60 patients with AIS admitted to Department of Spine and Spinal Surgery, Henan Province People′s Hospital from August 2020 to February 2021 were analyzed retrospectively.Three surveyors measured the coronal main curvature Cobb angle, sagittal thoracic kyphosis (TK) angle, thoracolumbar kyphosis (TLK) angle and lumbar kyphosis (LL) angle on whole-spine lateral X-ray films of 60 patients with AIS by means of the protractor, scoliosis screening APP and computerized Picture Archiving and Communication System (PACS). The time and results of each measurement were recorded.The measurement was repeated once after 2 weeks.Paired t-test was used to compare the measurement time of the APP method and the protractor method.Taking the Cobb angle measurement results of the PACS system as the reference standard, the accuracy of Cobb angle measurement by the APP method was analyzed by paired t-test.The repeatability of the surveyor and the consistency between the surveyors was compared by intraclass correlation coefficient (ICC). Results:Among the 60 patients with AIS, there were 17 males and 43 females, aged from 10 to 16 years [(12.2±2.4) years]. The main bends were thoracic curvature (Lenke Ⅰ) in 23 cases, Lenke Ⅱ in 18 cases and thoracolumbar curvature/lumbar curvature (Lenke V) in 19 cases.The APP method took significantly less time to measure the Cobb angle than the protractor method ( P<0.05). There was no significant difference in the Cobb angle measured by the APP method and PACS method ( P>0.05). The results of the coronal main curvature Cobb angle, TK angle, TLK angle and LL angle measured by 3 surveyors through the APP method were all in good agreement (ICC=0.990, 0.988, 0.986, 0.987). The repeatability (ICC 0.973-0.982) of the coronal main curvature Cobb angle, TK, TLK and LL measured twice before and after the APP method were both better that of the protractor method (ICC 0.933-0.954). Conclusions:Compared with the traditional protractor, the smartphone scoliosis screening APP has the advantages of short measurement time, high efficiency, excellent accuracy and good repeatability in measuring the Cobb angle of AIS.
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Objective:To quantify any correlation between the severity of spinal curvature of an adolescent with idiopathic scoliosis and their cardiopulmonary exercise endurance.Methods:The cardiopulmonary exercise test (CPET) results and the full-length spinal X-rays in a standing position of 64 adolescents with idiopathic scoliosis were reviewed retrospectively. Independent t-tests were used to compare the two datasets obtained from those with left or right thoracic scoliosis. The correlation between the Cobb angle and cardiopulmonary exercise endurance was analyzed using Pearson correlation coefficients, multiple factor linear regression and two-stage linear regression.Results:After adjusting for gender, age, height and weight, the multiple linear regression analysis showed that the Cobb angle was significantly negatively correlated with maximum tidal volume (β=-0.013) and significantly positively correlated with the rate of respiration (β=0.421). The relationship between the Cobb angle and cardiopulmonary exercise endurance was non-linear. With a Cobb angle > 34°, a 1° increase reduces cardiopulmonary exercise endurance by a factor of 1.4 on average. At smaller Cobb angles the corresponding increase is about 0.87 times.Conclusions:The Cobb angle is a negative predictor of ventilation during exercise among adolescents with idiopathic scoliosis. The more severe a patient′s spinal curvature, the lower the cardiopulmonary exercise endurance is likely to be.
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BACKGROUND: At present, the traditional orthosis manufacturing technology needs a lot of time and materials. The larger expansion coefficient of gypsum and the springback of material cooling will reduce the accuracy of orthosis. Therefore, the application of computer-aided design technology and three-dimensional printing technology in the field of orthosis is booming. OBJECTIVE: Based on the concept of multidisciplinary collaboration, a new scoliosis orthopedic device was designed and manufactured by optical scanning, computer-aided design and 3D printing, and its correction effect was evaluated. METHODS: Seven adolescent idiopathic scoliosis patients, who were treated in the Three-Dimensional Printing Center of Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University between March and October 2019, were enrolled in this study. The patient’s trunk was scanned with three-dimensional scanner. Virtual orthopedic treatment was conducted in Rodin4D software. Data were imported into Magics to carry out the hollow out design of orthosis, which was made by three-dimensional printing technology. Seven patients were followed up for 6 months after wearing orthopedic devices for more than 20 hours every day. The scoliosis before and after intervention was analyzed to observe the clinical efficacy. RESULTS AND CONCLUSION: (1) The contactless iPad scanner was successfully used for mold taking. The orthopedic model was designed in the French Rodin4D software, and the orthopedic model was hollowed-out by the Magics software. A suitable three-dimensional printed personalized scoliosis orthopedic device was produced through three-dimensional printing. (2) All the seven patients were improved significantly. Cobb angle before treatment was (29.43±7.68)°, and the angle of trunk inclination was (11.57±2.76)°. At 6 months after treatment, Cobb angle was (8.71±5.96)° (corrected 72%), and the angle of trunk inclination was (3.57±2.57)° (corrected 70%). The Cobb angle and angle of trunk inclination were significantly different before and after treatment (P < 0.01). (3) The digital medicine and 3D printing technology are applied in the field of rehabilitation AIDS, based on the concept of multidisciplinary collaboration. The production of personalized scoliosis orthopedic program is feasible, and the orthopedic rehabilitation effect is remarkable.
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OBJECTIVE@#To observe the clinical effect of lever positioning manipulation for the treatment of lumbar disc herniation and its effect on Cobb angle.@*METHODS@#From December 2017 to November 2018, 67 patients with lumbar disc herniation were included in the study. The patients were randomly divided into treatment group and control group by digital table method. There were 34 cases in the treatment group, including 20 males and 14 females, with an average age of (36.09±8.26) years old and a course of (13.79±15.50) months. Treatment group was treated with lever positioning manipulation. There were 33 cases in the control group, including 18 males and 15 females, with an average age of(36.48±7.81) years old and a course of (12.82±15.68) months. Control group was treated with lumbar slanting manipulation. Two groups were treated 3 times a week, once every other day, 6 times for a course of treatment, after 2 courses of treatment, the changes of Cobb angle before and after treatment were compared between two groups by imaging. The symptoms and signs were scored with reference to clinical evaluation standard;overall efficacy was evaluated with reference to "Diagnostic Efficacy Criteria of Traditional Chinese Medicine Syndrome" issued by the State Administration of Traditional Chinese Medicine for lumbar disc herniation.@*RESULTS@#One patient in each group dropped out. The symptom and sign scores of treatment group and control group before treatment were 18.56± 4.81, 18.61±3.72, while after treatment were 9.41±5.19, 13.55±3.68;treatment group was significantly lower than control group after treatment (@*CONCLUSION@#Both the lever positioning manipulation and the lumbar slanting manipulation methods are effective for the treatment of lumbar disc herniation, but clinical effect of lever positioning method on lumbar disc herniation is more significant, and the effect on Cobb angle is more obvious. It is worthy of promotion.
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Adult , Female , Humans , Male , Intervertebral Disc Degeneration , Intervertebral Disc Displacement/therapy , Lumbar Vertebrae , Manipulation, Spinal , Medicine, Chinese Traditional , Treatment OutcomeABSTRACT
BACKGROUND: The sciatic scoliosis is considered as a compensatory attempt of the body to relieve nerve irritation. If dealt with inappropriate and delayed, it may be developed in structural scoliosis. There was controversial about the treatment of such cases. OBJECTIVE: To compare the safety and effectiveness of single-level open versus minimally invasive transforaminal lumbar interbody fusion in the treatment of sciatic scoliosis caused by lumbar disc herniation. METHODS: Data of 47 patients with sciatic scoliosis caused by lumbar disc herniation who were treated in Peking University People’s Hospital from January 2010 to January 2014 were retrospectively analyzed. The main symptom was severe back and lower limb pain, complicated with trunk tilt. Twenty-five patients underwent single-level open transforaminal lumbar interbody fusion therapy (open group). Twenty-two patients underwent minimally invasive transforaminal lumbar interbody fusion therapy (minimal invasion group). The single-level surgery was conducted in both groups. The patients were followed up for at least 2 years. The clinical effects and photographic parameters were compared between the two groups. RESULTS AND CONCLUSION: (1) There was no significant difference in age, gender, spinal levels operated and all the coronal and sagittal parameters preoperatively between the two groups (P > 0.05). (2) There was no significant difference in operation time between the two groups (P >0.05). The amount of bleeding, postoperative time to the ground, and average length of hospital stay were better in the minimal invasion group than in the open group (P 0.05). (4) Balance of coronal plane and sagittal plane: The deformity at 2 years after operation was significantly improved compared with that before operation (P 0.05). (5) Solid fusion was achieved in both groups. (6) It is concluded that minimally invasive transforaminal lumbar interbody fusion in the treatment of single-level sciatic scoliosis caused by lumbar disc herniation obtained similar effect as open fusion. Moreover, it has the advantages of less bleeding, faster recovery and shorter hospital stay.
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BACKGROUND: Currently, surgical methods for the treatment of degenerative scoliosis include simple decompression and decompression combined with internal fixation. However, there is still controversy over the choice of fixation and fusion segment in surgery, which requires more reliable evidence-based medical evidence for reference. OBJECTIVE: To evaluate the clinical efficacy and complication of short versus long segments of internal fixation for the treatment of degenerative scoliosis using meta-analysis. METHODS: CNKI, Wanfang Database, VIP, CBM, EMBase, PubMed, Web of Science, and Cochrane Library were searched to collect the randomized and non-randomized controlled studies which compared long fusion with short fusion in the treatment of degenerative scoliosis from inception to February 2019. Relevant conference papers and authoritative journals in the field were retrieved manually. The quality of the included studies was assessed by two evaluation members according to the Cochrane collaboration network standard or the Newcastle-Ottawa Scale. The included studies were analyzed by using RevMan 5.3 software. RESULTS AND CONCLUSION: (1) A total of 20 articles were included, involving a sample of 1 329 individuals. Long segment group consisted of 601 cases, and short segment group consisted of 728 cases. (2) The meta-analysis results showed that long-segment internal fixation surgery had better improvement of coronal Cobb angle (P=0.000 4), coronal balance (P=0.000 2), Oswestry disability index (P=0.003) and visual analogue scale score (P 0.05). (4) These findings verify that long-segment internal fixation is superior to short-segment internal fixation in the correction of scoliosis, but the recovery is slow and the incidence of some complications after operation is high. It should be considered comprehensively when selecting specific surgical procedures.
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BACKGROUND: The biomechanical characteristics of kyphosis of the upper thoracic vertebra are unique. Decompression and internal fixation are relatively difficult. Previous relevant studies and case reports are few, and there is a lack of research on correction of kyphosis of the upper thoracic section with the assistance of computer navigation. OBJECTIVE: To explore the clinical effect of computer navigation-assisted surgical treatment of upper thoracic kyphosis by screws and osteotomy. METHODS: Totally 18 patients with kyphotic deformity of the spine (T1-T4) were admitted in Beijing Jishuitan Hospital from June 2011 to June 2018, including 11 males and 7 females, aged 12 to 59 years. They were all treated with computer-assisted surgical treatment with PSO osteotomy. Local Cobb angle of the upper thoracic kyphosis was determined during final follow-up. Cervical visual analogue scale, Nurick grades, EMS scores and satisfaction of the surgery were evaluated. This study was approved by the Ethics Committee of Beijing Jishuitan Hospital (approval No. 201709-23). RESULTS AND CONCLUSION: (1) A total of 18 patients were followed up for 6-90 months at an average time of (33. 73±35. 33) months. (2) The local Cobb angle of 18 patients at the last follow-up was significantly improved [(47. 32±9. 92)°, (24. 01 ±7. 64)°, P < 0. 001]. Cervical visual analogue scale score at the last follow-up was significantly lower than that before surgery (3. 64±2. 16, 0. 73±1. 01, P< 0. 001). Nurick score at the last follow-up was significantly lower than that before surgery (2. 91 ±0. 94, 0. 82±1. 47, P < 0. 001). EMS score at the last follow-up was significantly higher than that before surgery (14. 45±0. 93), 17. 09±1. 45, P< 0. 001). (3) Surgical satisfaction was excellent (n=16) or good (n=2). (4) At the last follow-up, 18 patients had no adverse reactions related to implants, and the wound healed well without screw loosening. (5) The results showed that reasonable osteotomy correction with computer-assisted surgery and PSO osteotomy could effectively treat kyphosis of upper thoracic segment.
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BACKGROUND: It remains disputed whether bone filling bag vertebroplasty and percutaneous kyphoplasty have different treatment efficacy in the treatment of thoracolumbar osteoporotic compression fractures. OBJECTIVE: To systematically analyze the efficacy and safety of bone filling bag vertebroplasty and percutaneous kyphoplasty in the treatment of thoracolumbar osteoporotic compression fractures. METHODS: A computer-based online search of CNKI, Wanfang, VIP, CBM, EMBASE, MEDLINE, and Cochrane libraries was performed to retrieve randomized controlled trial studies regarding bone filling bag vertebroplasty and percutaneous kyphoplasty in the treatment of thoracolumbar osteoporotic compression fractures published before February 2019. Two researchers independently conducted literature screening and data extraction. According to the Cochrane Collaboration Network standard, the quality of the randomized controlled trial studies was evaluated one by one. The studies that met the inclusion criteria were analyzed using the RevMan5. 3 software. RESULTS AND CONCLUSION: Six randomized controlled trial studies were included. A total of 517 patients were included in the final analysis. Among them, 257 patients received bone filling bag vertebroplasty and 260 patients received percutaneous kyphoplasty. Meta-analysis showed that there were no significant differences in postoperative Visual Analogy Score (MD=0. 00, 95%CI: -0. 09-0. 10, P=0. 94), vertebral height recovery (SMD=0. 11, 95%CI: -0. 26-0. 48, P=0. 57), and Oswestry Disability Index (MD=1. 47, 95%CI: -0. 45-3. 39, P=0. 13) between these two surgical procedures. But postoperative Cobb angle (MD=-1. 08, 95%CI: -1. 47 to -0. 70, P < 0. 000 01) and bone cement leakage rate (RR=0. 24, 95%CI: 0. 13-0. 45, P < 0. 000 01) were significantly different between these two surgical procedures. Bone filling bag vertebroplasty exhibits significant advantages in improving postoperative Cobb angle and reducing bone cement over percutaneous kyphoplasty. These two surgical procedures have similar clinical outcomes such as postoperative Visual Analogy Score, vertebral height recovery, and Oswestry Disability Index. Therefore, a large number of high-quality multicenter randomized controlled trials are needed to provide more evidence.
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BACKGROUND: The bone trabecula of the vertebral body cannot be fully recovered, and the mechanical stability of the sagittal position of the spinal column Is affected. The antl-bendlng force and the anti-torsion force of the short-segment fixation of fractured vertebra are obviously Increased. The bearing load of various activities such as flexion, extension, and rotation of the vertebral body is increased. The stability of the injured vertebra is better maintained, and favorable conditions are created for fracture healing. OBJECTIVE: To compare the early- and mid-term follow-up results of trans-injured and cross-injured vertebra pedicle screw fixation in the treatment of thoracolumbar fractures. METHODS: Eighty-eight patients with thoracolumbar vertebrae fracture treated in Affiliated Hospital of Qinghai University from April 2017 to April 2018 were divided into trans-injured vertebra group and cross-injured vertebra group according to the treatment plan. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Intraoperative blood loss, operation time, postoperative bed rest time, postoperative site infection, and subcutaneous hematoma were analyzed in both groups. Visual analogue scale score, Oswestry Disability Index, anterior edge height ratio and kyphosis Cobb angle were compared before surgery, 6 and 12 months after surgery between the two groups. RESULTS AND CONCLUSION: (1) The operation time was longer and intraoperative blood loss was higher in the trans-injured group than those in the cross-injured group, but the postoperative bed rest time was shorter in the trans-injured group than that in the cross-injured group (P 0.05). (3) At 6 and 12 months after surgery, visual analogue scale score and Oswestry Disability Index were lower in the trans-injured group than in the cross-injured group; anterior edge height ratio was larger in the trans-injured group than in the cross-injured group; kyphosis Cobb angle was smaller in the trans-injured group than in the cross-injured group (all P < 0.05). (4) Incidence of complications was higher in the cross-injured group (30%) than in the trans-injured group (7%) (P=0.001). (5) The treatment of thoracolumbar fracture with trans-injured pedicle screw can not only effectively restore and maintain the injured vertebral height and kyphosis Cobb angle, restore the physiological height and curvature of vertebral body, but also the incidence of postoperative complications is low, which can effectively improve the prognosis of patients and improve the quality of life of patients.
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BACKGROUND: The morbidity rate of thoracolumbar burst fracture is high; however, the simple posterior distraction and reduction technique has poor patient satisfaction on maintaining vertebral height and reducing complications. Therefore, we attempt to explore a better therapeutic regimen. OBJECTIVE: To assess the efficacy of inverse arch roof breaking technique combined with pedicle screw and bone graft in treatment of thoracolumbar burst fractures. METHODS: This was a retrospective study of 78 patients with thoracolumbar burst fractures. All the patients suffered from fresh closed fractures, and all of them were operated by posterior approach. The time from injury to surgery ranged from 4 to 14 days, with an average of 7.8 days. They were randomly assigned to two groups. The 38 cases in the simple distraction group were treated with simple vertebra pedicle screw-rod system distraction and reduction fixation. The 40 cases in the inverse arch roof breaking and bone graft group were treated with inverse arch roof breaking technique combined with pedicle screw and bone graft in fractured vertebra. All patients signed the informed consent. The study was approved by the Hospital Ethics Committee. Operation time, intraoperative blood loss, fracture healing time, anterior height ratio of injured vertebrae, Cobb angle, visual analogue score, Barthel Index and postoperative complications were measured between the two groups. RESULTS AND CONCLUSION: (1) The follow-up period for all patients was 10-22 months. (2) Operation time and intraoperative blood loss were better in the simple distraction group than in the inverse arch roof breaking and bone graft group (P < 0.01). (3) The ratio of anterior height of injured vertebra and Cobb angle were significantly different between the two groups (P < 0.01). Above indexes were better in the inverse arch roof breaking and bone graft group than in the simple distraction group. (4) There were significant differences in fracture healing time and life activity function (Barthel index) between the two groups (P < 0.01), and above indexes were better in the inverse arch roof breaking and bone graft group than in the simple distraction group. (5) No deep infection was found in both groups. There were no complications such as internal fixation failure and excessive loss of vertebral height in arch roof breaking and bone graft group. In the simple distraction group, there were 3 cases of screw pull-out because of failed internal fixation, 2 cases of titanium rod breakage, and 10 cases of obvious vertebral height loss. (6) These findings suggest that compared with simple distraction and reduction fixation, inverse arch roof breaking technique combined with pedicle screw and bone graft can provide bony support to compression center of fractured vertebra. The efficacy was identified in reconstructing the height of anterior and middle columns. This method has the advantages of high mechanical strength, strong vertebral height maintenance, high bone healing rate and few complications, which will be the ideal choice in the treatment of thoracolumbar burst fracture.
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BACKGROUND: Conventional anterior debridement and bone graft fusion for lumbar spinal tuberculosis have a great trauma, and bring more complications. The double titanium mesh support bone graft combined with posterior pedicle internal fixation reconstruction can significantly improve the prognosis of lumbar spinal tuberculosis. There is no clinical study to compare the efficacy between the two surgical methods. OBJECTIVE: To compare the efficacy of lumbar spinal tuberculosis via anterior double titanium mesh support bone graft combined with posterior pedicle internal fixation and conventional anterior debridement and bone graft fusion. METHODS: Case history data of 40 patients with lumbar spinal tuberculosis were retrospectively collected from the Department of Spinal Surgery, Mianyang Central Hospital, Southwest Medical University from May 2015 to March 2018. The patients were divided into experimental group and control group (n=20) according to the operation. Patients in the experimental group were treated with the anterior double titanium mesh support bone graft combined with the posterior pedicle screw fixation reconstruction. Patients in the control group were treated with anterior debridement and bone graft fusion. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. RESULTS AND CONCLUTION: (1) Lumbar spinal tuberculosis could be effectively treated with both surgical methods. (2) Compared with the control group, the operation time was shorter; the intraoperative blood loss was less; and the bone graft fusion was faster in the experimental group. (3) With prolongation of the postoperative time, the erythrocyte sedimentation rate and the sagittal Cobb angle of the lesion segment gradually decreased in the two groups. The erythrocyte sedimentation rate and the sagittal Cobb angle of the lesion segment in the experimental group were slightly lower than those in the control group. (4) After treatment, the classification of the American Spinal Cord Injury Association was improved in some patients. (5) The incidence of adverse reactions in the experimental group was lower than that of the control group. (6) The results suggest that double titanium mesh support bone graft combined with posterior pedicle internal fixation reconstruction can effectively improve the stability of the diseased vertebrae, and the treatment effect on lumbar spinal tuberculosis is better than conventional anterior lesion removal and bone graft fusion internal fixation.
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BACKGROUND: Previous studies show that the amount and diffusion degree of bone cement In vertebroplasty have some Influence on the postoperative recovery of patients with osteoporotic vertebral compression fracture, but there are few reports about the correlation between the amount and diffusion degree of bone cement In vertebroplasty and the recovery of vertebral body. OBJECTIVE: To Investigate the relationships between the effect of percutaneous vertebroplasty on osteoporotic vertebral compression fractures and the Injection amount and dispersion degree of bone cement. METHODS: Totally 102 osteoporotic vertebral compression fracture patients (109 vertebrae) who received treatment in the Sanya Hospital of Traditional Chinese Medicine from January 2017 to August 2018, including 42 males and 60 females at the age of 52-76 years, were retrospectively analyzed. All patients received percutaneous vertebroplasty. According to the Injection amount of bone cement, they were divided into two groups: observation group 1 (Injection > 4 mL, n=57) and control group 1 (injection ≤ 4 mL, n=45). According to the degree of dispersion of bone cement, they were divided into two groups: observation group 2 (filling rate > 15%, n=61) and control group 2 (filling rate > 15%, n=41). Visual analogue scale score, Oswestry disability index, anterior vertebral height, Cobb angle, and the occurrence of cement leakage were observed before and after surgery. The correlations of the Injection amount and dispersion degree of bone cement with the height of vertebral body recovered were analyzed. This study was approved by the Medical Ethics Committee of Sanya Hospital of Traditional Chinese Medicine. RESULTS AND CONCLUSION: (1) The visual analogue scale score and Oswestry dysfunction index of patients in the observation group 1 and control group 1 at 3 days after operation were decreased compared with before operation (P 0.05). There was no significant difference in the incidence of cement leakage between observation group 2 and control group 2 (P > 0.05). (4) The height of vertebral body recovery was positively correlated with the Injection amount and dispersion degree of bone cement (P < 0.05). (5) The results suggest that increases of the Injection amount and dispersion degree of bone cement properly can alleviate the pain, improve the mobility, correct the deformity of vertebral posterior concave, and restore the height of vertebral body of osteoporotic vertebral compression fracture patients. The Injection amount and dispersion degree of bone cement are positively correlated with the recovery height of vertebral body.
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BACKGROUND: The clinical application of zoledronic acid in the treatment of osteoporosis lacks systematic scientific evaluation and evidence-based basis. Therefore, the clinical efficacy of zoledronic acid combined with percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture is still uncertain. OBJECTIVE: To systematically evaluate the efficacy of zoledronic acid combined with percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture. METHODS: A computer search of all randomized controlled studies and clinical trials of zolidronic acid combined with percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fracture published in CNKI, Wanfang, VIP, CBM, PubMed and Cochrane prior to September 2019 was performed. The experimental group was treated with zoledronic acid and percutaneous kyphoplasty, while the control group was treated with percutaneous kyphoplasty. Literature screening and data extraction were conducted by the two researchers independently. The quality of the included randomized controlled trials was evaluated one by one according to the Cochrane collaboration standards. Meta-analysis was performed on RevMan 5.3 for those that met the inclusion criteria. RESULTS AND CONCLUSION: (1) Five randomized controlled trials were included, including 175 in the experimental group and 184 in the control group. (2) Meta-analysis results showed that the bone mineral density was higher in the experimental group than in the control group [MD=0.12, 95%CI(0.08, 0.17), P < 0.000 01]. The visual analogue scale score was lower in the experimental group than that of the control group 6 and 12 months after treatment [MD=0.46, 95%CI(0.18, 0.75), P=0.002; MD=0.85, 95%CI(0.20, 1.50), P=0.01]. At 1 year after treatment, Oswestry disability index was lower in the experimental group than in the control group [MD=6.59, 95%CI(4.77，8.41), P < 0.000 01]. Bone cement leakage rate and recurrence rate of vertebral fractures were lower in the experimental group than in the control group [OR=0.22, 95%CI(0.08, 0.59), P=0.003; OR=0.18, 95%CI(0.07, 0.50), P=0.000 8]. Vertebral height recovery and kyphotic Cobb angle were not significantly different between the two groups [MD=0.65, 95%CI(-0.27, 1.56), P=0.16; MD=-0.60, 95%CI(-2.45, 1.25), P=0.53]. (3) Results showed that compared with percutaneous kyphoplasty alone, zoledronic acid combined with percutaneous kyphoplasty has significant advantages in improving bone mineral density, reducing the recurrence rate of vertebral fracture, improving the long-term clinical symptoms of patients, preventing the bone cement leakage, but a large number of high-quality multi-center randomized controlled studies are still needed to provide more sufficient evidence in the later stage.
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OBJECTIVE@#To analyze the effectiveness and safety of one stage three column osteotomy in treatment of scoliosis with split spinal cord malformation.@*METHODS@#The clinical data of 41 patients with scoliosis and split spinal cord malformation underwent one-stage three-column osteotomy from January 2015 to December 2017 were retrospectively analyzed. There were 17 males and 24 females with average age of (25.14±4.51) years old and the average weight of (65.14±9.11) kg. According to the classification of longitudinal spina bifida, 15 cases of Pang typeⅠwere group A and 26 cases of Pang typeⅡwere group B. The general situations of two groups were recorded ; preoperative and postoperative Cobb angle were observed and the correction rate of Cobb angle of coronal plane was calculated ; the coronal and sagittal torso offset distances were compared between two groups and the trunk balance was evaluated ; the complication of two groups was recorded.@*RESULTS@#All 41 patients were followed up for more than 12 months. The operation time, intraoperative blood loss, and perioperative blood transfusion volume in group A were (610.14±115.02) min, (4 001.12±1 014.33) ml, (3 951.14±1 021.55) ml, respectively, and group B were (520.12±101.14) min, (2 701.57±1 021.45) ml, (2 565.77±880.47) ml, the difference between the two groups was statistically significant (0.05). There was no significant difference in postoperative coronary Cobb angle and correction rate between two groups (>0.05). Immediately after surgery and 12 months after surgery, there was no significant difference in the trunk displacement distance of coronal view and sagittal view between two groups (>0.05). Six patients in group A had complications, which was higher than that in group B of 1 case (=4.885, < 0.05).@*CONCLUSION@#One-stage three-column osteotomy in treatment of scoliosis with split spinal cord malformation has high correction rate and good balance of the trunk. However, for patients with typeⅠsplit spinal cord malformation, they will face longer operation time, more intraoperative bleeding volume, large amount of perioperative blood transfusion and higher risk of complications, and the safety is not as good as that of typeⅡpatients. Therefore, in the actual treatment of scoliosis, especially for those with typeⅠsplit spinal cord malformation, a more reasonable surgical plan should be developed in combination with the actual situations of the patients, so as to improve the safety of the operation.
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Objective: This study aimed to investigate the age at which scoliosis progresses to a severe condition and identify the factors related to severe scoliosis in patients with cerebral palsy.Patients and Methods: This retrospective study included 51 patients aged ≥15 years. The Cobb angle was measured over time using radiographs. Patients were divided into the following groups according to their final Cobb angle: <60°, 60°–100°, and ≥100°. The age at which the Cobb angle was ≥20° in the patients was compared among the groups. Moreover, the age at which a significant difference in the Cobb angle occurred in the groups was considered the age at which the scoliosis worsened. Association of the final Cobb angle with factors such as the location of curve, Gross Motor Functional Classification System (GMFCS), capability of turning over, orthosis use, hip dislocation, tracheotomy, and gastric fistula was examined.Results: The mean age at which the Cobb angle was ≥20° was significantly lower in the ≥100° group. From 9 years of age, a significant difference was noted in the Cobb angle between the <60° group and ≥100° group. Between 13–19 years, a significant difference in the Cobb angle was observed among the three groups. Furthermore, GMFCS, capability of turning over, hip dislocation, and gastric fistula were the factors showing a significant difference among the three groups.Conclusion: Scoliosis progressed to the severe form (Cobb angle ≥100°) at 9 years of age. Moreover, scoliosis is aggravated during the growth period. Severe cerebral palsy with low motor function levels and problems with internal functions was considered the cause of scoliosis deterioration.
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In order to conduct surface monitoring of the three-dimensional spine morphology of the human body in daily life, a spine morphology measuring method using "single camera, multi-view" to construct stereo vision is proposed. The images of the back of the human body with landmarks of spinous process are captured from multiple angles by moving a single camera, and based on the "Zhang Zhengyou calibration method" and the triangulation principle of binocular stereo vision, the spatial conversion matrices corresponding to each other between all images and the 3D coordinates of the landmarks are calculated. Then the spine evaluation angle used to evaluate the spine morphology is further calculated. The tests' results showed that the spine evaluation angle error of this method is within ±3°, and the correlation between the results and the X-ray film Cobb angles is 0.871. The visual detection algorithm used in this paper is non-radioactive, and because only one camera is used in the measurement process and there is no need to pre-set the camera's shooting pose, the operation is simple. The research results of this article can be used in a mobile phone-based intelligent detection system, which will be suitable for the group survey of scoliosis in communities, schools, families and other occasions, as well as for the long-term follow-up of confirmed patients. This will provide a reference for doctors to diagnose the condition, predict the development trend of the condition, and formulate treatment plans.
Subject(s)
Humans , Algorithms , Calibration , Imaging, Three-Dimensional , Scoliosis/diagnostic imaging , Spine/diagnostic imaging , TechnologyABSTRACT
Objective To compare the effects of transpedicular grafting of vertebral pedicle screw and strode over fractured vertebra of vertebral pedicle screw in the treatment of thoracolumbar fractures.Methods From January 2015 to December 2016,84 cases of thoracolumbar fractures in Weihai Central Hospital were randomly divided into two groups according to the digital table,with 42 cases in each group.The control group received strode over fractured vertebra of vertebral pedicle screw,and the study group received transpedicular grafting of vertebral pedicle screw.The patients were followed up for 12 months.The bleeding loss,operation time,postoperative drainage,fracture healing time,hospitalization days and anterior compression ratio of vertebral body,kyphosis Cobb angle before and after treatment and postoperative complications were compared between the two groups.Results There were no statistically significant differences in postoperative drainage volume,fracture healing time and hospitalization days between the two groups (t =1.38,1.79,1.20,all P ＞ 0.05),but the intraoperative bleeding volume [(183.85 ± 13.88) mL] and operation time[(119.74 ± 14.85) min] in the study group were significantly higher than those in the control group[(137.97 ±14.24) mL,(99.46 ± 13.42) min] (t =14.95,6.57,all P ＜ 0.01).Compared with the control group,the compression ratio of the anterior vertebral body in the study group was significantly increased after operation [(92.15 ± 8.70) ％vs.(83.75 ± 7.04)％] (t =4.86,P ＜ 0.01),and the kyphotic Cobb angle in the study group and the control group were significantly decreased compared with those before operation [(10.15 ± 2.47) °,(14.53 ± 4.85) °],and the postoperative kyphotic Cobb angle in the study group was significantly lower than that in the control group (t =5.21,P ＜0.01).The incidence rate of postoperative complications in the study group was 4.76％,which showed no statistically significant difference compared with the control group (14.29％,x2 =2.21,P =0.14).Conclusion Transpedicular grafting of vertebral pedicle screw is superior to strode over fractured vertebra of vertebral pedicle screw in promoting reduction,correcting posterior process deformity and reconstructing vertebral height in patients with thoracolumbar fractures,and it does not cause serious complications,so it has good clinical value.
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STUDY DESIGN: Retrospective analysis OBJECTIVES: To evaluate preoperative factors related with spinal canal expansion after posterior decompression for the treatment of multilevel cervical myelopathy. SUMMARY OF LITERATURE REVIEW: Data about preoperative factors related with spinal canal expansion after posterior cervical decompression surgery are inconsistent. MATERIALS AND METHODS: We reviewed 67 patients with cervical myelopathy who underwent posterior laminectomy or laminoplasty. Radiologically, we evaluated the C2-7 Cobb angle and range of motion using X-rays from the preoperative assessment and final follow-up. Expansion of the spinal canal at 6 weeks postoperatively was evaluated using magnetic resonance imaging and compared with the preoperative values. The preoperative factors of age, sex, number of operated levels, operation method, and radiological parameters were investigated as factors potentially related to postoperative spinal canal expansion using multivariate regression and correlation analyses. The clinical outcome was analyzed by the Neck Disability Index (NDI) and Japanese Orthopaedic Association (JOA) scores. RESULTS: The postoperative spinal canal expansion was 4.76 mm in sagittal images and 4.31 mm in axial images, with higher values observed in males and cases of severe preoperative cord compression. A lordotic preoperative Cobb angle was related to postoperative spinal canal expansion and JOA score improvement, but without statistical significance. The clinical outcomes of NDI (18.3→14.8) and JOA scores (10.81→14.6) showed improvement, but were not significantly related with any preoperative factors. CONCLUSIONS: The amount of preoperative spinal canal stenosis was associated with postoperative spinal canal expansion after posterior decompression in multilevel cervical myelopathy. The preoperative Cobb angle was not related to postoperative spinal canal expansion or clinical improvement.
Subject(s)
Humans , Male , Asian People , Constriction, Pathologic , Decompression , Follow-Up Studies , Laminectomy , Laminoplasty , Magnetic Resonance Imaging , Methods , Neck , Range of Motion, Articular , Retrospective Studies , Spinal Canal , Spinal Cord DiseasesABSTRACT
PURPOSE: This study examined the effects of the fascial distortion model (FDM) method on Cobb's angle. METHODS: Fourteen subjects participated in this study. The idiopathic scoliosis group performed FDM treatments eight times in four weeks. A Shapiro-Wilks test was used to verify the normality of a group of idiopathic scoliosis patients. A paired t-test was performed to determine the satisfaction with the normality. RESULTS: The difference in Cobb's angle was reduced significantly (p<0.05) by an average of 5.72°±2.24 from 15.51°±1.81 before the experiment. CONCLUSION: This study found that the use of the FDM method was effective in improving the Cobb's angle. The application of a FDM treatment appears to stabilize the fascia with decreased ability to adapt physiologically. The application of the CD and TB method of FDM treatment improved the asymmetry spine by dispersing moisture in fascia and improving the contraction and relaxation ability. The results suggest that the Cobb's angle is reduced when FDM is applied, thereby preventing the progression of curvature and avoiding psychological and physical problems that can arise from improving patients with scoliosis.
Subject(s)
Adolescent , Humans , Fascia , Methods , Relaxation , Scoliosis , SpineABSTRACT
BACKGROUND: Although secondary cervicothoracic scoliosis frequently occurs in patients with congenital muscular torticollis (CMT), the relationship between scoliosis and CMT has not been evaluated. This study aims to evaluate the effects of surgical release of sternocleidomastoid (SCM) muscle on secondary cervicothoracic scoliosis in patients with CMT and determine factors affecting the improvement of scoliosis after surgical release of SCM muscle. METHODS: Eighty-seven of the 106 patients, confirmed as having secondary cervicothoracic scoliosis with CMT with a minimum 1-year follow-up, were included in this study. Preoperative and last follow-up radiologic outcomes were assessed for the cervicomandibular angle (CMA), Cobb angle of the cervicothoracic scoliosis, and direction of convexity in the scoliosis curve. Patients were divided into two groups to assess the improvement of Cobb angle according to residual growth potential; age ≤ 15 years and > 15 years. The improvement of Cobb angle after surgical release was compared in the two groups. Correlation analysis and multivariable regression analysis were performed to determine the factors affecting the improvement of scoliosis. RESULTS: All the radiologic parameters, such as the Cobb angle and CMA, improved significantly after surgical release (p 15 years (p < 0.001). The improvement of Cobb angle was significantly correlated with age (r = −0.474, p < 0.001) and the preoperative Cobb angle (r = 0.221, p = 0.036). In multivariable regression analysis, age and preoperative Cobb angle were shown to be predisposing factors affecting the improvement of scoliosis. CONCLUSIONS: The results showed that SCM release can be a beneficial treatment for secondary cervicothoracic scoliosis. The improvement of scoliosis was greater when the SCM release was performed before the patient reached the end of growth.