目的:观察在青少年脊柱侧凸患者中术前实施综合性呼吸操锻炼的临床效果方法:选取46例伴有不同程度肺功能障碍的青少年脊柱侧弯患者作为研究对象,对其自入院后第一天即开始实施综合性呼吸操锻炼,观察术前肺功能的变化情况及术后肺部并发症的发生情况。结果:锻炼后患者肺活量(VC)、肺容量(TLC)、用力肺活量(FVC)、最大通气量(MVV),等肺功能指标较锻炼前有明显改善,差异具有统计学意义(Plt;0.05);术后血氧饱和度gt;95%;无肺部并发症发生。结论:入院后即进行综合性呼吸操锻炼能在近期有效改善患者肺功能,提高患者对脊柱矫形手术的耐受力,对预防和减少术后肺部感染以及呼吸功能不全的发生有积极作用。
Spina bifida and tethered spinal cord are congenital diseases that can lead to severe disability. At present, most doctors in relevant specialties in China still have insufficient understanding of spina bifida, resulting in high incidence and aggravation of its complications. To provide guidance for the diagnosis and treatment of spina bifida and tethered spinal cord in China, experts from neurosurgery, urology, orthopedics, spine surgery, and rehabilitation departments who have experiences in the diagnosis and treatment of spina bifida discussed and summarized their experiences, and referred to the relevant literature on the diagnosis and treatment of spina bifida at home and abroad. Expert consensus was formed in the following aspects: concept, classification, and pathological changes of spina bifida; diagnosis; treatment process and operation timing; principles and methods of treatment; rehabilitation; and follow up. This expert consensus can provide reference for relevant care providers of spina bifida in China.
ObjectiveTo compare the effectiveness of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with bilateral decompression via unilateral approach and bilateral decompression via bilateral approaches in the treatment of single-segment lumbar spinal stenosis.MethodsBetween February 2015 and January 2017, 70 cases of single-segment lumbar spinal stenosis were treated with MIS-TLIF. The bilateral decompression via unilateral approach (group U) was performed in 36 cases and bilateral decompression via bilateral approaches (group B) in 34 cases. There was no significant difference in age, gender, body mass index, disease duration, distribution of responsibility segments, preoperative visual analogue scale (VAS) score of low back pain and leg pain and Oswestry disability index (ODI) score (P>0.05). The operation time, intraoperative blood loss, hospitalization stay after operation, complications related to operation, incidence of asymptomatic lateral root symptoms, VAS scores of low back pain and leg pain, and ODI score before and after operation were compared between the two groups. X-ray film and CT scan at 12 months after operation were used to assessted the intervertebral bony fusion.ResultsThe operation time and intraoperative blood loss in group U were significantly less than those in group B (P<0.05). There was no significant difference in hospitalization stay after operation between the two groups (t=–0.311, P=0.757). During the operation, 1 case in group U and 2 cases in group B had dural tear. No screw placement related nerve injury or asymptomatic lateral root symptoms occurred after operation. The patients were followed up 24 to 38 months, with an average of 32.8 months in group U and 35.5 months in group B. The VAS scores of low back pain and leg pain at 2 days, 3, 6, and 12 months after operation were significantly lower than that before operation in the two groups (P<0.05), and there was no significant difference between the two groups (P>0.05). The ODI scores at 3, 6 and 12 months after operation were significantly lower than that before operation in the two groups (P<0.05), and there was no significant difference between the two groups (P>0.05). Radiographic examination showed interbody fusion at 12 months after operation in the two groups.ConclusionMIS-TLIF is safe and effective in the treatment of single-segment lumbar spinal stenosis with bilateral decompression via unilateral approach and bilateral decompression via bilateral approaches. Bilateral decompression via unilateral approach takes less operation time and has less intraoperative blood loss.
Objective To investigate the short-term effectiveness of the anterior and middle columns in thoracolumbar tuberculosis reconstructed with whole autogenous spinous process-laminar bone through posterior approach. Methods The retrospective study included 78 patients with thoracolumbar tuberculosis who underwent posterior approach surgery and anterior and middle column bone graft reconstruction between January 2012 and May 2023. Based on the type of autogenous bone graft used, patients were divided into group A (whole autogenous spinous process-laminar bone graft, 38 cases) and group B (autogenous structural iliac bone graft, 40 cases). There was no significant difference of baseline data, such as age, gender, disease duration, involved segment of spinal tuberculosis, and preoperative erythrocyte sedimentation rate (ESR), C reactive protein (CRP), Oswestry disability index (ODI), visual analogue scale (VAS) score, the American Spinal Injury Association (ASIA) grade, segmental kyphotic angle, and intervertebral height between the two groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospital stays, ESR, CRP, VAS score, ODI, bone fusion time, ASIA grade for neurological status valuation, postoperative complications, change of segmental kyphotic angle, change of intervertebral height were recorded and compared between the two groups. Results The operation time in group A was significantly shorter than that in group B (P<0.05); there was no significant difference in intraoperative blood loss, postoperative drainage, and hospital stays between the two groups (P>0.05). All patients in the two groups were followed up 14-110 months (mean, 64.1 months); there was no significant difference in the follow-up time between the two groups (P>0.05). The ESR, CRP, ODI, and VAS score at each time point after operation in both groups significantly improved when compared with those before operation, and further improved with the extension of time, the differences were significant (P<0.05). There was no significant difference between the two groups (P>0.05) except that the VAS score of group A was significantly better than that of group B at 3 days after operation (P<0.05). There was no significant difference in fusion time between the two groups (P>0.05). The neurological function of most patients improved after operation, and there was no significant difference in ASIA grade between the two groups at last follow-up (P>0.05). There was no significant difference in segmental kyphosis angle and intervertebral height between the two groups at each time point (P>0.05), and no significant difference in segmental kyphosis angle, intervertebral height correction and loss were found between the two groups (P>0.05). In group A, there was 1 case of incision fat liquefaction and 1 case of incision infection; in group B, there was 1 case of deep venous thrombosis, 2 cases of pleural effusion, and 10 cases of pain in bone harvesting area; in both groups, there were 2 cases of gout caused by hyperuricemia. There was a significant difference in the incidence of pain in bone harvesting area between the two groups (P<0.05), and there was no significant difference in the incidence of other complications between the two groups (P>0.05). ConclusionWhole autogenous spinous process-laminar bone grafting is equivalent to structural iliac bone graft in reconstruction of the anterior and middle columns in thoracolumbar tuberculosis through posterior approach, effectively supporting the stability of the anterior and middle columns of the spine, while resulting in shorter operation time and less postoperative pain in bone harvesting area.
To investigate the effects of postoperative fusion implantation on the mesoscopic biomechanical properties of vertebrae and bone tissue osteogenesis in idiopathic scoliosis, a macroscopic finite element model of the postoperative fusion device was developed, and a mesoscopic model of the bone unit was developed using the Saint Venant sub-model approach. To simulate human physiological conditions, the differences in biomechanical properties between macroscopic cortical bone and mesoscopic bone units under the same boundary conditions were studied, and the effects of fusion implantation on bone tissue growth at the mesoscopic scale were analyzed. The results showed that the stresses in the mesoscopic structure of the lumbar spine increased compared to the macroscopic structure, and the mesoscopic stress in this case is 2.606 to 5.958 times of the macroscopic stress; the stresses in the upper bone unit of the fusion device were greater than those in the lower part; the average stresses in the upper vertebral body end surfaces were ranked in the order of right, left, posterior and anterior; the stresses in the lower vertebral body were ranked in the order of left, posterior, right and anterior; and rotation was the condition with the greatest stress value in the bone unit. It is hypothesized that bone tissue osteogenesis is better on the upper face of the fusion than on the lower face, and that bone tissue growth rate on the upper face is in the order of right, left, posterior, and anterior; while on the lower face, it is in the order of left, posterior, right, and anterior; and that patients’ constant rotational movements after surgery is conducive to bone growth. The results of the study may provide a theoretical basis for the design of surgical protocols and optimization of fusion devices for idiopathic scoliosis.
OBJECTIVE: Both primary and metastatic tumor of spine can influence spinal stability, spinal cord and nerves. The principles of dealing spinal tumor are resection of tumor decompression on spinal cord and reconstruction of spinal stability. METHODS: Since Aug. 1993 to Oct. 1996, 15 cases with spinal tumor were treated, including 4 primary spinal tumor and 11 metastatic tumor. Tumor foci were mainly in thoracic and lumbar spine. Graded by Frankel classification of spinal injuries, there were 1 case of grade A, 1 of grade B, 3 of grade C, 5 of grade D and 5 of grade E. Tumors of upper lumbar spine and thoracic spine were resected through anterior approach. Posterior approach also was adopted once posterior column was affected. Tumors of lower lumbar spine were resected by two-staged operation: firstly, operation through posterior approach to reconstruct spinal stability: secondly, operation through anterior approach. After resection of tumor, the spines were fixed by Kaneda instrument, Steffee plate or Kirschner pins. To fuse the spine, bone grafting was used in benign tumor and bone cement used in malignant tumor. RESULTS: Except one patient died from arrest of bone marrow, the others were followed up for 3 to 20 months. Postoperatively, 11 patients could sit up on one foot with the help of body supporter, and 9 patients could walk in two weeks under careful monitoring. There was no exacerbation of symptom and failure of fixation. The function of spinal cord was improved: 1 case from grade B to grade E, 1 from A to C, 2 from C to E and 4 from D to E. CONCLUSION: The spine can be reconstructed for weight bearing early by internal fixation. The symptom can be relieved and the nervous function can be improved by resection of tumor and decompression.
OBJECTIVE: To explore a new surgical treatment of old atlantoaxial dislocation. METHODS: 5 patients aged 12 to 45 years, who suffered from old atlantoaxial dislocation for 1 to 4.5 years, received the new surgical treatment by the transoccipitocervical posterolateral approach, and expansion of the foramen magnum, odontectomy and bony fusion of the occipitoatlantoid region were performed. Neurological examinations and CT scan were undertaken after operation. RESULTS: All 5 patients survived. Sensory function recovered almost completely and motor function was better more than 1 degree. CT scan showed the diameter of the spinal canal restored well. CONCLUSION: The transoccipitocervical posterolateral approach is an ideal and safe pathway to reach the site of old atlantoaxial dislocation and the operating field is exposed completely. Anterior-posterior decompression and occipitocervical spinal fusion can be performed simultaneously
目的 探讨前路小切口顶椎切除联合后路矫形手术治疗重度僵硬性脊柱侧凸的可行性及疗效。 方法 2009 年7月－2010年9月，采用前路小切口顶椎切除联合后路矫形手术治疗重度僵硬性脊柱侧凸18例。其中男9例，女9例，年龄10～24岁，平均14.5岁。其中15 例特发性脊柱侧凸（Lenke 2型6例，Lenke 3型1例，Lenke 4型8例），2 例脊髓空洞合并脊柱侧凸，1 例Chiari畸形合并脊柱侧凸。术前剃刀背高度（6.8 ± 2.3）cm，主胸弯Cobb角（99.6 ±10.0）°，主胸弯顶椎偏距（7.3 ± 1.3）cm。 结果 前路手术切口10～13 cm，平均（11.4 ± 1.0）cm；前路手术时间170～300 min，平均（215.3 ± 36.8）min；失血量300～1 300 mL，平均（662.5 ± 274.8） mL。所有患者随访25～39个月，平均30.7个月。末次随访时，剃刀背高度（1.0 ± 0.6）cm，矫正率86.7%；主胸弯Cobb角（31.4 ± 11.4）°，矫正率68.7%；主胸弯顶椎偏距（2.2 ± 0.9） cm，矫正率69.6%。上胸弯、胸腰弯/腰弯的Cobb 角及顶椎偏距亦明显矫正，冠状面及矢状面平衡与术前相比，差异无统计学意义（P＞0.05）。未发生神经系统并发症，1例患者在前路手术后入ICU行呼吸支持治疗12 h，1例患者出现椎弓根螺钉穿透椎弓根上壁，2例患者出现钛网位置不佳，随访未见钛网位置改变。 结论 采用前路小切口顶椎切除联合后路矫形治疗重度僵硬性脊柱侧凸安全可行，矫形效果满意。
ObjectiveTo systematically review the effect of Schroth therapy on adolescent idiopathic scoliosis. MethodsThe PubMed, EBSCO, Embase, Cochrane Library, Web of Science, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) related to the objectives from inception to November 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. ResultsA total of 14 RCTs involving 589 patients were included. The results of meta-analysis showed that Schroth therapy significantly reduced patients' Cobb angle (MD=−3.21, 95%CI −3.87 to −2.55, P<0.01) and angle of trunk rotation (ATR) (MD=−2.39, 95%CI −3.07 to −1.71, P<0.01), and improved SRS-22 quality of life score (MD=0.16, 95%CI 0.01 to 0.30, P=0.04) compared with the control group. Subgroup analysis results showed that Schroth therapy had a better effect on improving the quality of life in moderate patients. Schroth therapy for 1.5-3 months, 5-7 times therapy a week, and a single 30 minute and 40-60 minutes therapy showed better improvement in patients' quality of life. Conclusion Current evidence shows that Schroth therapy can effectively improve Cobb angle, ATR, and quality of life in adolescents with idiopathic scoliosis. The improvement effect on quality of life is influenced by the intervention period, frequency, and duration of each intervention.
Objective To investigate the efficacy of freeze-driedcancellous allograft in the treatment of spinal tuberculosis. Methods From January 1999 to August 2004, there were 31 cases of spinal tuberculosis who underwent surgery. The freeze-dried cancellous allograft was used as grafting material in all the cases.The cancellous allograft was packed in a titanium mesh cage or an artificial vertebrae, and then used as a strut graft anteriorly to implant into the bone defect after the redical debridement, and the instrumentation was done. Results Twenty-three cases were followed up 1.5 years to 5 years (3.7 years on average), and bonyfusion was achieved in 21 cases 6 months later. In 2 cases ceasing antituberculous therapy after 2 months of operation, the local recurrence was obvious. The loosened screw was noticed in one of these two cases, who had tuberculosis in lumbar spine. When antituberculous therapy continued, the bony fusion was observed in these two cases 12 months later. No further position change of the instrument wasnoticed in the patient carrying loosened screw, but the kyphosis of the thoracolumbar spine aggravated. Conclusion Freeze-dried cancellous allograft could be usedin the treatment of spinal tuberculosis. To achieve good results of allograft incorporation and remodeling, the rigid instrumentation should be performed, postoperative antituberculous therapy is also important.