目的：探讨应用脊柱截骨矫形技术治疗成人复杂脊柱侧后凸矫形术的安全性,并评估其临床应用价值。方法：选择2011年9月~2012年9月期间应用截骨技术治疗的成人复杂脊柱侧后凸畸形患者进行前瞻性研究。所有入选患者均于手术前后及末次随访...目的：探讨应用脊柱截骨矫形技术治疗成人复杂脊柱侧后凸矫形术的安全性,并评估其临床应用价值。方法：选择2011年9月~2012年9月期间应用截骨技术治疗的成人复杂脊柱侧后凸畸形患者进行前瞻性研究。所有入选患者均于手术前后及末次随访时测量侧凸Cobb角、最大后凸Cobb角、冠状面平衡（distance between C7 plumbline and center sacral vertical line C7PL-CSVL）和矢状面平衡（sagittal vertical axis,SVA）等影像学相关参数。同时采用SF-36量表、疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、SRS-22量表等评估其临床疗效,并使用AISA评分法评价患者手术前后及末次随访时神经功能情况。结果：共17例患者最终纳入本次研究,其中男7例,女10例;年龄18~55岁（34.6±10.9）岁,术前侧凸Cobb角51°~97°（78.5°±13.1°）,后凸Cobb角50°~112°（71.8°±19.8°）,C7PL-CSVL为58.4±21.3mm,SVA为56.4±51.2mm。手术时间200~540min（406.1±82.2min）;术中出血量1000~12000ml（4088.9±2546.9ml）。术后侧凸Cobb角为37.7°±17.7°,后凸Cobb角为25.0°±16.4°,矫正率分别为51.9%±18.7%和67.2%±20.3%;C7PL-CSVL为18.0±9.4mm,SVA为27.6±16.9mm,均较术前明显改善。随访24.3±1.8个月,末次随访时侧、后凸Cobb角分别为39.5°±16.6°和26.2°±17.6°,C7PL-CSVL为22.1±15.4mm,SVA为30.4±17.1mm,随访期间无明显矫正丢失。术中监测均无诱发电位异常改变,无死亡、瘫痪等严重并发症,术后5例患者出现肢体远端一过性感觉功能减退,1例患者椎体前壁骨折,1例患者螺钉置钉不良,2例患者随访期间发生内固定并发症,总体并发症发生率为52.9%。术后和末次随访时的SF-36、VAS、ODI、SRS-22与术前比较均有明显改善,术后和末次随访时无显著性差异,ASIA运动和感觉评分与术前比较无显著性差异。结论：经后路脊柱截骨术治疗成人复杂脊柱侧后凸畸形矫正角度大,术后三维矫形效果满意,展开更多
Background Although previous reports had reported the use of temporary internal distraction as an aid to correct severe scoliosis,two-stage surgery strategy （less invasive internal distraction followed by posterior c...Background Although previous reports had reported the use of temporary internal distraction as an aid to correct severe scoliosis,two-stage surgery strategy （less invasive internal distraction followed by posterior correction and instrumentation） has never been reported in the treatment of patients with severe spinal deformity.This study aimed to report the results of the surgical treatment of severe scoliosis and kyphoscoliosis by two-stage and analyse the safety and efficacy of this surgical strategy in the treatment of severe spinal deformities.Methods A total of 15 patients with severe scoliosis,kyphoscoliosis or kyphosis who underwent two-stage surgeries （less invasive internal distraction followed by posterior correction and instrumentation） were studied based on hospital records.Pretreatment radiographs and radiographs taken after first surgery （internal distraction by two small incisions）,before second surgery （posterior correction,instrumentation and fusion）,one week after second surgery and final follow-up were measured.Subjects were analyzed by age,gender,major coronal curve magnitude,flexibility of major curve,major sagittal curve magnitude before first surgery,after first surgery,before second surgery,after second surgery and at final follow-up.Complications related to two-stage surgeries were noted in each case.Results The average major curve magnitude was 129.4° （range,95° to 175°）,reduced 58.9° or 45.4% after first stage surgery and reduced 30.6° or 24.6% after second stage surgery.The loss of correction during the interval between two surgeries was 7.1%.The total major coronal curve correction was 81.4°or 62.9%.At the final follow up,the average loss of correction of major coronal curve was 3.9° and the final average correction rate was 59.7%.The average major sagittal curve magnitude was 80.3° （range,30° to 170°）,and the total major sagittal curve correction was 48.2°.Loss of correction averaged 4.0° for major sagittal curve and the final correction averaged 4展开更多
<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Scoliosis is a complex...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Scoliosis is a complex musculoskeletal torsional deformity of spine that includes: Lateral curvature in the anterior-posterior plane with a Cobb angle greater than 10 degrees, Angulation in the sagittal plane, or Rota</span><span style="font-family:Verdana;">tion in the transverse plane. Scoliosis classified into neuromuscular, idi</span><span style="font-family:Verdana;">opathic, or congenital. Radiological evaluation is done by plain radiography, computed tomography (CT), and magnetic resonance (MR). We aimed to eva</span><span style="font-family:Verdana;">luate patients with idiopathic kyphoscoliosis who underwent a freehand</span><span style="font-family:Verdana;"> posterior approach for scoliosis correction through transpedicular screws fixation. </span><b><span style="font-family:Verdana;">Setting:</span></b><span style="font-family:Verdana;"> Al-Azhar University Hospitals. </span><b><span style="font-family:Verdana;">Subjects and Methods:</span></b><span style="font-family:Verdana;"> Study was performed on 12 patients with idiopathic kyphoscoliosis who underwent a freehand posterior approach for scoliosis correction through transpedicular screws fixation in Al-Azhar University Hospitals between 2015 to 2018 & follow up for one year. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Early outcome showed improved Cobb’s angle and coronal balance significantly after surgery. Correction is 95% in 2 cases (17%), 80% correction in 8 cases (66%), 60% correction in 2 cases (17%). 2 </span><span style="font-family:Verdana;">cases have CSF leakage which improved with conservative treatment. Late</span><span style="font-family:Verdana;"> follow-up shows improvement of patient deformity and cosmetic appearance </span><span style="font-family:Verdana;">to the degree of patient satisfaction occur in 7 cases (58%) associated with</span><span style=展开更多
Background Surgery for severe kyphoscoliosis is frequently unsatisfying because of loss of correction, high rate of pseudarthrosis and neurological complications. Several authors reported that the anterior fusion with...Background Surgery for severe kyphoscoliosis is frequently unsatisfying because of loss of correction, high rate of pseudarthrosis and neurological complications. Several authors reported that the anterior fusion with strut grafts might improve the surgical outcome. This article describes and assesses the surgical strategies and the application of autogenous tibial strut in the treatment of severe kyphoscoliosis. Methods Severe kyphoscoliosis patients （n = 39 ） admitted from April 1998 to September 2003 formed the study group. Different surgical strategies had been used according to the flexibility, neurological function and curve level. All patients received staged anterior and posterior surgery with a tibial strut used in the anterior fusion. The patients were followed up for 9 months to 6 years （ mean 37 months）. Results The mean preoperative and postoperative kyphosis was 82° and 52° respectively, and the mean seoliosis was 84° and 44° respectively. Complications included pseudarthrosis （2 eases, one with graft fracture and the other with hook displacement） , posterior elements fractures （4） , pleura penetrations （3, in the plastic surgery of the thoracic cage） , dura tear （2） , exudative pleuritis （2, in the anterior surgery） , and tibia fracture of the harvesting site （ 1 ）. The mean loss of correction in coronal and sagittal plane was 6° and 7° respectively. Except for 1 ease, the patients with incomplete paraplegia showed improvements to varying extents. Conclusion Autogenous tibial strut can provide excellent support to the kyphoscoliotic spine： it reduces pseudarthrodic rate, loss of correction and complications of graft harvest, it also prevents the occurrence of neurological impairment.展开更多
目的探讨经颅电刺激运动诱发电位(transcranial electric motor evoked potentials,TCeMEP)和体感诱发电位(somatosensory evoked potentials,SSEP)监测在脊柱侧凸翻修截骨手术中的应用价值。方法回顾性分析2011年3月至2016年3月于我科...目的探讨经颅电刺激运动诱发电位(transcranial electric motor evoked potentials,TCeMEP)和体感诱发电位(somatosensory evoked potentials,SSEP)监测在脊柱侧凸翻修截骨手术中的应用价值。方法回顾性分析2011年3月至2016年3月于我科全麻下行脊柱侧凸翻修截骨术的患者176例,均行SSEP监测,其中134例同时应用TCeMEP监测。分别统计单独SSEP、单独TCeMEP及TCeMEP联合SSEP监测的真阳性率、假阳性率、真阴性率、假阴性率、阳性预测值、阴性预测值、敏感性及特异性。结果单独SSEP成功监测162例(92.0%),TCeMEP成功监测109例(81.3%)。134例应用TCeMEP联合SSEP监测患者,有124例(92.5%)采用任意一种监测方式成功监测。162例成功监测的患者中共有14例报警,报警率为8.6%(14/162)。最终残留神经损伤患者3例,占1.9%(3/162)。统计单独SSEP监测组的敏感性和特异性分别为72.7%和98.7%,单独TcMEP组为90.9%和98.0%,而联合TcMEP及SSEP监测组的敏感性为最高100%,特异性为98.2%。联合TcMEP及SSEP监测组阳性及阴性预测值为85.7%和100%,高于单独SSEP组(80.0%和98.0%)及单独TcMEP组(83.3%和99.0%)。结论脊柱侧凸翻修截骨术手术操作复杂,联合TcMEP及SSEP监测较单一监测能更早地发现神经损害,降低手术风险。我们建议对于脊柱侧凸翻修截骨患者应常规应用TcMEP及SSEP进行联合监测。展开更多
文摘目的：探讨应用脊柱截骨矫形技术治疗成人复杂脊柱侧后凸矫形术的安全性,并评估其临床应用价值。方法：选择2011年9月~2012年9月期间应用截骨技术治疗的成人复杂脊柱侧后凸畸形患者进行前瞻性研究。所有入选患者均于手术前后及末次随访时测量侧凸Cobb角、最大后凸Cobb角、冠状面平衡（distance between C7 plumbline and center sacral vertical line C7PL-CSVL）和矢状面平衡（sagittal vertical axis,SVA）等影像学相关参数。同时采用SF-36量表、疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、SRS-22量表等评估其临床疗效,并使用AISA评分法评价患者手术前后及末次随访时神经功能情况。结果：共17例患者最终纳入本次研究,其中男7例,女10例;年龄18~55岁（34.6±10.9）岁,术前侧凸Cobb角51°~97°（78.5°±13.1°）,后凸Cobb角50°~112°（71.8°±19.8°）,C7PL-CSVL为58.4±21.3mm,SVA为56.4±51.2mm。手术时间200~540min（406.1±82.2min）;术中出血量1000~12000ml（4088.9±2546.9ml）。术后侧凸Cobb角为37.7°±17.7°,后凸Cobb角为25.0°±16.4°,矫正率分别为51.9%±18.7%和67.2%±20.3%;C7PL-CSVL为18.0±9.4mm,SVA为27.6±16.9mm,均较术前明显改善。随访24.3±1.8个月,末次随访时侧、后凸Cobb角分别为39.5°±16.6°和26.2°±17.6°,C7PL-CSVL为22.1±15.4mm,SVA为30.4±17.1mm,随访期间无明显矫正丢失。术中监测均无诱发电位异常改变,无死亡、瘫痪等严重并发症,术后5例患者出现肢体远端一过性感觉功能减退,1例患者椎体前壁骨折,1例患者螺钉置钉不良,2例患者随访期间发生内固定并发症,总体并发症发生率为52.9%。术后和末次随访时的SF-36、VAS、ODI、SRS-22与术前比较均有明显改善,术后和末次随访时无显著性差异,ASIA运动和感觉评分与术前比较无显著性差异。结论：经后路脊柱截骨术治疗成人复杂脊柱侧后凸畸形矫正角度大,术后三维矫形效果满意,
文摘Background Although previous reports had reported the use of temporary internal distraction as an aid to correct severe scoliosis,two-stage surgery strategy （less invasive internal distraction followed by posterior correction and instrumentation） has never been reported in the treatment of patients with severe spinal deformity.This study aimed to report the results of the surgical treatment of severe scoliosis and kyphoscoliosis by two-stage and analyse the safety and efficacy of this surgical strategy in the treatment of severe spinal deformities.Methods A total of 15 patients with severe scoliosis,kyphoscoliosis or kyphosis who underwent two-stage surgeries （less invasive internal distraction followed by posterior correction and instrumentation） were studied based on hospital records.Pretreatment radiographs and radiographs taken after first surgery （internal distraction by two small incisions）,before second surgery （posterior correction,instrumentation and fusion）,one week after second surgery and final follow-up were measured.Subjects were analyzed by age,gender,major coronal curve magnitude,flexibility of major curve,major sagittal curve magnitude before first surgery,after first surgery,before second surgery,after second surgery and at final follow-up.Complications related to two-stage surgeries were noted in each case.Results The average major curve magnitude was 129.4° （range,95° to 175°）,reduced 58.9° or 45.4% after first stage surgery and reduced 30.6° or 24.6% after second stage surgery.The loss of correction during the interval between two surgeries was 7.1%.The total major coronal curve correction was 81.4°or 62.9%.At the final follow up,the average loss of correction of major coronal curve was 3.9° and the final average correction rate was 59.7%.The average major sagittal curve magnitude was 80.3° （range,30° to 170°）,and the total major sagittal curve correction was 48.2°.Loss of correction averaged 4.0° for major sagittal curve and the final correction averaged 4
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Scoliosis is a complex musculoskeletal torsional deformity of spine that includes: Lateral curvature in the anterior-posterior plane with a Cobb angle greater than 10 degrees, Angulation in the sagittal plane, or Rota</span><span style="font-family:Verdana;">tion in the transverse plane. Scoliosis classified into neuromuscular, idi</span><span style="font-family:Verdana;">opathic, or congenital. Radiological evaluation is done by plain radiography, computed tomography (CT), and magnetic resonance (MR). We aimed to eva</span><span style="font-family:Verdana;">luate patients with idiopathic kyphoscoliosis who underwent a freehand</span><span style="font-family:Verdana;"> posterior approach for scoliosis correction through transpedicular screws fixation. </span><b><span style="font-family:Verdana;">Setting:</span></b><span style="font-family:Verdana;"> Al-Azhar University Hospitals. </span><b><span style="font-family:Verdana;">Subjects and Methods:</span></b><span style="font-family:Verdana;"> Study was performed on 12 patients with idiopathic kyphoscoliosis who underwent a freehand posterior approach for scoliosis correction through transpedicular screws fixation in Al-Azhar University Hospitals between 2015 to 2018 & follow up for one year. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Early outcome showed improved Cobb’s angle and coronal balance significantly after surgery. Correction is 95% in 2 cases (17%), 80% correction in 8 cases (66%), 60% correction in 2 cases (17%). 2 </span><span style="font-family:Verdana;">cases have CSF leakage which improved with conservative treatment. Late</span><span style="font-family:Verdana;"> follow-up shows improvement of patient deformity and cosmetic appearance </span><span style="font-family:Verdana;">to the degree of patient satisfaction occur in 7 cases (58%) associated with</span><span style=
文摘Background Surgery for severe kyphoscoliosis is frequently unsatisfying because of loss of correction, high rate of pseudarthrosis and neurological complications. Several authors reported that the anterior fusion with strut grafts might improve the surgical outcome. This article describes and assesses the surgical strategies and the application of autogenous tibial strut in the treatment of severe kyphoscoliosis. Methods Severe kyphoscoliosis patients （n = 39 ） admitted from April 1998 to September 2003 formed the study group. Different surgical strategies had been used according to the flexibility, neurological function and curve level. All patients received staged anterior and posterior surgery with a tibial strut used in the anterior fusion. The patients were followed up for 9 months to 6 years （ mean 37 months）. Results The mean preoperative and postoperative kyphosis was 82° and 52° respectively, and the mean seoliosis was 84° and 44° respectively. Complications included pseudarthrosis （2 eases, one with graft fracture and the other with hook displacement） , posterior elements fractures （4） , pleura penetrations （3, in the plastic surgery of the thoracic cage） , dura tear （2） , exudative pleuritis （2, in the anterior surgery） , and tibia fracture of the harvesting site （ 1 ）. The mean loss of correction in coronal and sagittal plane was 6° and 7° respectively. Except for 1 ease, the patients with incomplete paraplegia showed improvements to varying extents. Conclusion Autogenous tibial strut can provide excellent support to the kyphoscoliotic spine： it reduces pseudarthrodic rate, loss of correction and complications of graft harvest, it also prevents the occurrence of neurological impairment.
文摘目的探讨经颅电刺激运动诱发电位(transcranial electric motor evoked potentials,TCeMEP)和体感诱发电位(somatosensory evoked potentials,SSEP)监测在脊柱侧凸翻修截骨手术中的应用价值。方法回顾性分析2011年3月至2016年3月于我科全麻下行脊柱侧凸翻修截骨术的患者176例,均行SSEP监测,其中134例同时应用TCeMEP监测。分别统计单独SSEP、单独TCeMEP及TCeMEP联合SSEP监测的真阳性率、假阳性率、真阴性率、假阴性率、阳性预测值、阴性预测值、敏感性及特异性。结果单独SSEP成功监测162例(92.0%),TCeMEP成功监测109例(81.3%)。134例应用TCeMEP联合SSEP监测患者,有124例(92.5%)采用任意一种监测方式成功监测。162例成功监测的患者中共有14例报警,报警率为8.6%(14/162)。最终残留神经损伤患者3例,占1.9%(3/162)。统计单独SSEP监测组的敏感性和特异性分别为72.7%和98.7%,单独TcMEP组为90.9%和98.0%,而联合TcMEP及SSEP监测组的敏感性为最高100%,特异性为98.2%。联合TcMEP及SSEP监测组阳性及阴性预测值为85.7%和100%,高于单独SSEP组(80.0%和98.0%)及单独TcMEP组(83.3%和99.0%)。结论脊柱侧凸翻修截骨术手术操作复杂,联合TcMEP及SSEP监测较单一监测能更早地发现神经损害,降低手术风险。我们建议对于脊柱侧凸翻修截骨患者应常规应用TcMEP及SSEP进行联合监测。
