Objective Currently, there are few researches on lordosis associated with scol iosis. To explore the effects of nickel-titanium memory alloy staple (Staple) on the growth of thoracic lordosis by observing the histological changes of cartilage cells in the osteoepiphysis of the thoracic vertebrates in goats. Methods Eighteen 2-3 months old female goats, weighing 8-12 kg, were randomly divided into long staple group (n=6), short staple group (n=6), and blank control group (n=6). Long staple (7 mm) and short staple (4 mm) were implanted into T6-11 segments of goats in long and short staplegroups by anterior approach, respectively. The blank control group was not treated. The X-ray examination was performedpre-operatively and at 3 months post-operatively to observe the changes of Cobb angle. Then the growth plates and inferior facet processes of the apex vertebral body were harvested to observe the histological grades of cartilage by HE staining, and to observe prol iferation and apoptosis of chondrocytes through immunohistochemistry double label ing staining with poly-ADPribose- polymerase-p85 and prol iferating cell nuclear antigen. Results At 3 months after operation, the T6-11 Cobb angles were significantly higher than those of pre-operation in short staple group and long staple group, which were significantly higher than those in blank control group (P lt; 0.05), but there was no significant difference between short staple group and long staple group (P gt; 0.05). The results of HE staining and immunohistochemistry double staining showed that the number of chondrocytes were reduced obviously with irregular columnar arrangement and increased volume ratio of surrounding extracellular matrix in prol iferative zone and hypertrophic zone of growth plate and inferior articular process in both long and short staple groups, and this tendency was more noticeable in long staple group. There were significant differences in the grades of prol iferation viabil ity of chondrocytes between 2 staple groups and blank control group (P lt; 0.05), but there was no significant difference tewteen long staple group and short staple group (P gt; 0.05). The prol iferation viabil ities of chondrocytes in growth plate and inferior articular process were significantly higher in blank control group than in 2 staple groups (P lt; 0.01), but there was no significant difference between long staple group and short staple group (P gt; 0.05). Conclusion The histological evidences prove that the Staple implantation by anterior approach can reduce prol iferation viabil ity of chondrocytes in growth plate and inferior articular process of the thoracic vertebrates in goats, which conduces the growth direction of thoracic vertebrates to kyphosis.
【Abstract】 Objective To summarize the current development of the correction of severe and rigid scol iosis. Methods Recent l iterature concerning the correction of severe and rigid scol iosis at home and abroad was extensively reviewed, and current developments of the correction of severe and rigid scol iosis were summarized. Results The correction of severe and rigid scol iosis shows developments as follows: the application of Halo-gravity traction increase and Halo-femoral traction is applied in posterior correction surgery. Fixation and correction technique with all pedicle screws was gradually popularized. The applications of posterior vertebral column resection, one-stage anterior and posterior surgery, and posterior-only correction surgery increase. Conclusion The developments of all kinds of correction techniques improve the correction effects of severe and rigid scol iosis. Now there is no standardized treatment protocol for severe and rigid scol iosis. Greater development can be expected in the future.
Objective To further investigate the possible mechanism of the correction of scol iosis with Staple by quantifying the effect of Staple on growth rate of vertebral growth plates in goat scol iosis. Methods Experimental scol iosis was created in 10 juvenile female goats by using unilateral pedicle screws asymmetric tethering. After 8-10 weeks, goats were divided randomly into Staple treated group (n=5) and control group (n=5). All tethers were removed in both groups and Staplegroup underwent anterior vertebral stapl ing with 4-5 shape memory alloy Staples along the convexity of the maximal curvature after posterior tether being removed. All goats were observed for an additional 8-13 weeks, the Cobb angle were measured to observe the correction of scol iosis. The fluorochromes Oxytetracycl ine and Calcein were administered respectively 18 and 3 days before death to label the ossifying front under the growth plates. Superior intervertebral disc of apical vertebra and two adjacent growth plates were completely harvested in all goats. All specimens were embedded with polymethyl methacrylate and sl iced undecalcified. The growth rates of the vertebral growth plates were calculated by measuring the distance between the two fluorescent l ines with fluorescence microscope. Results Nine (5 in Staple treated group and 4 in control group) of 10 tethered goats had progressive scol iotic curves of significant magnitude after 8-10 weeks of tethering. In Staple treated group, the Cobb angles were (34.8 ± 12.4)° at the instant after treatment , and (15.6 ± 11.7)° 8-13 weeks after treatment; showing statistically significant difference (P lt; 0.05). In the control group, the Cobb angles were (49.3 ± 18.0)° at the instant after treatment, and(49.0 ± 17.6)° 8-13 weeks after treatment; showing no statistically significant difference (P gt; 0.05). In Staple treated group, the growth rate of growth plate in the concavity (3.27 ± 0.96) μm/d was higher than that in convexity (1.84 ± 0.52) μm/d (P lt; 0.05), while the growth rate of the concavity did not differ significantly from that of the convexity in control group (P gt; 0.05). Conclusion Staple can significantly alter the growth rates of two sides of vertebrae in scol iosis with the growth rate of concavity exceeding the one of convexity, which results in correction of deformity.
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。
Objective To evaluate pulmonary function changes in patients with severe scol iosis undergoing anterior release, posterior segmental fixation and fusion, and convex thoracoplasty by resecting a short length of rib. Methods FromJanuary 2006 to July 2007, 16 patients with severe scol iosis were treated with anterior release, posterior segmental fixation and fusion, and convex thoracoplasty by resecting a short length of rib. There were 6 males and 10 females with an average age of 16.9 years (range, 10-24 years). There were 1 case of Lenke 1 curve, 9 cases of Lenke 2 curve, and 6 cases of Lenke 4 curve. The preoperative Cobb angle was (104.8 ± 10.9)° and the preoperative thoracic kyphotic angle was (30.0 ± 4.2)°. The preoperative height of “razor back” deformity was (5.9 ± 1.2) cm. Before operation, the actual value of forced vital capacity (FVC) was (2.04 ± 0.63) L and that of forced expiratory volume in 1 second (FEV1.0) was (1.72 ± 0.62) L. The percentage of actual values to expected ones in FVC was 70% ± 16%, and that in FEV1.0 was 67% ± 15%. All patients had pulmonary function tests before operation and 3, 6, 12, 24 months after operation. Results All wounds healed by first intention. The Cobb angle at 24-month follow-up was (53.4 ± 18.6)° and the correction rate was 49.0% ± 15.3%. The thoracic kyphotic angle at 24-month follow-up was (34.0 ± 2.4)° and the correction rate was 13.3% ± 2.2%. The height of “razor back” deformity at 24-month follow-up was (2.2 ± 0.8) cm. Compared with preoperative level, all these data showed significant differences (P lt; 0.05). At 3 and 6 months, the actual values of FVC and FEV1.0 decl ined, but no significant difference was found (P gt; 0.05). At 12 and 24 months, the actual values of FVC andFEV1.0 were close to the preoperative level (P gt; 0.05). The percentages of actual values to expected ones in FVC and FEV1.0 indicate continued improvement in pulmonary function from the postoperative 3 to 24 months follow-up. Compared with preoperative level, the percentages of actual values in FVC decl ined 19% 3 months postoperatively (P lt; 0.05) and 12% 6 months postoperatively (P lt; 0.05). The percentages of actual values to expected ones in FEV1.0 decl ined 16% 3 months postoperatively (P lt; 0.05), and 10% 6 months postoperatively (P lt; 0.05). The percentages of actual values to expected ones in FVC and FEV1.0 were close to the preoperative level 12 and 24 months after operation (P gt; 0.05). Conclusion In severe scol iosis patients who are treated with anterior release, posterior segmental fixation and fusion, and convex thoracoplasty by resecting a short length of rib, pulmonary function decreases obviously 3-6 months after operation. And it returns to the operative baseline 12-24 months after operation.
ObjectiveTo review the recent progress in research on the role of estrogen and estrogen receptor on the onset and progression of adolescent idiopathic scoliosis (AIS). MethodsThe recently published clinical and experimental 1iterature at home and abroad on abnormality of estrogen and its receptor in AIS was reviewed and summarized. ResultsThere are many abnormal changes of estrogen and estrogen receptor in most AIS patients, including higher serum estrogen concentration, unusual cellular response to estrogen, late age at menarche, and gene polymorphisms of estrogen receptor, which are closely associated with AIS predisposition, curve severity, and scoliosis progression. ConclusionEstrogen and its receptor participate in the onset and progression of AIS by certain mechanisms, but exact mechanism remains indefinite, which needs further research to better define the role of estrogen and its receptor in AIS.
Objective To elucidate the new development and effects of three-dimensional correction techniques of idiopathic scol iosis (IS). Methods The related home and abroad l iterature concerning three-dimensional correction techniques of IS was extensively reviewed. Results With more and more attention to three-dimensional correction of IS, all kinds of surgery and developed techniques of correction are applied to the correction of IS. The effects of three-dimensional correction of IS are satisfied. Conclusion With more knowledge about IS and more developed theory of correction, more safe and effective techniques of correction is therefore the hot spot for future study.
Objective To discuss operative strategies of posterior deformity vertebra resection and instrumentation fixation in the treatment of congenital scol iosis or kyphoscol iosis in child and adolescent patients, and to evaluate the surgicalresults. Methods From May 2003 to December 2007, 28 patients with congenital scol iosis or kyphoscol iosis were treatedwith one stage posterior deformity vertebra resection. There were 11 males and 17 females with an average age of 9.6 years (1.5-17.0 years). The locations were thoracic vertebra in 13 cases, thoracolumbar vertebra in 10 cases, and lumbar vertebra in 5 cases. All the patients underwent one stage posterior deformity vertebra resection, fusion and correction with pedicle instrumentation. According to different types of deformities, the patients underwent three different surgeries: hemivertebra resection (13 patients), hemivertebra resection combined contralateral unsegmental resection (7 patients), and total vertebral column resection (8 patients). Based on short or long segmental pedicle instrumentation, deformities were corrected and fixed, in 7 patients with short segmental fixation (group A), in 13 patients with long segmental fixation with hemivertebra resection or combined contralateral unsegmental resection (group B), and in 8 patients with long segmental fixation with total vertebral column resection (group C). The operative duration and the volume of blood loss were recorded, and the correction rate was calculated through measurement of Cobb angles of scol iosis and kyphosis before and after operation. Results The operation time of groups A, B, and C was (98 ± 17), (234 ± 42), and (383 ± 67) minutes, respectively, and the blood loss during operation was (330 ± 66), (1 540 ± 120), and (4 760 ± 135) mL, respectively; showing significant differences among three groups (P lt; 0.05). All patients achieved one-stage heal ing of incision. No deep infection, respiratory failure or deep vein thrombosis occurred. One patient had the signs of ischemical reperfusion injury of spinal cord 6 hours after operation and recovered after 2 weeks of relative therapy in group C; no neurological compl ication occurred in other patients. The mean follow-up period was 32.8 months (24-72 months). Intervertebral rigid fusion was identified from radiological data 6 months after operation according to contiguous callus crossed intervertebral gap and maintenance of correction results. No instrumentation failure occurred. There were significant differences in the Cobb angle between before and after operations (P lt; 0.01). There were significant differences in the corrective rate of scol iosis between groups A, B and group C (P lt; 0.05). Meanwhile, there were significant differences in the corrective rate of kyphosis between groups A, C and group B (P lt; 0.05). Conclusion One-stage posterior deformity vertebra resection has a good capabil ity of correcting congenital scol iosis or kyphoscol iosis on coronal and sagittal plane rel ied on removal deformity origin. It is important to select appropriated strategies on deformity resection and segmental fixation according to different ages and deformity situations of patient.
Objective To analyze the correlation between the polymorphism on interleukin 6 (IL-6) gene promoter region-174 locus and adolescent idiopathic scoliosis (AIS), including the susceptibility, the bracing effectiveness, and the possible mechanism. Methods The 182 AIS patients and 210 healthy controls who met the inclusion criteria between January 2013 and January 2016 were collected as research objects. The genotype of IL-6 gene promoter region-174 locus, the serum IL-6, the bone mineral density (BMD) of femoral neck and vertebrae (L1–4), and the bone metabolism parameters, including bone alkaline phosphatase (BALP), bone gla protein (BGP), tartrate resistant acid phosphatase 5b (TRACP-5b), urine Ca, and urine Ca/Cr, were detected. All research objects were divided into the AIS group and the control group according to whether they had AIS, the GG, CG, CC groups according to their genotype, and progression-free group and progression group according to the therapeutic effectiveness of 1-year bracing treatment. Statistical analysis for the indexes were conducted respectively. Results There were significant differences in AIS history, BMD of femoral neck and lumbar vertebrae between the AIS group and control group (P<0.05). According to the therapeutic effecitveness of 1-year bracing treatment, 182 AIS patients were divided into progression-free group in 110 cases and progression group in 72 cases. The results of single factor analysis showed that there were significant differences in the genotype and allele distribution of IL-6 gene promoter region-174 locus, BMD of femoral neck and lumbar vertebrae, IL-6, TRACP-5b, urine Ca, and urine Ca/Cr between the progression-free group and progression group (P<0.05). The results of multivariable analysis showed that the BMD of lumbar vertebrae, TRACP-5b, and urine Ca were the influencing factors of bracing efficacy (P<0.05). According to the results of genotype detection, all research objects were divided into GG group in 264 cases, CG group in 104 cases, and CC group in 24 cases. The IL-6, TRACP-5b, urine Ca, and urine Ca/Cr of GG type carriers were higher and BMD of femoral neck and lumbar vertebrae were lower when compared with the CG and CC type carriers (P<0.05). The BMD of lumbar vertebrae of CG type carriers was lower than that of CC type carriers (P<0.05). Conclusion The polymorphism of IL-6 genepromoter region-174 locus wasn’t correlated with the AIS susceptibility, but it was correlated (not independently correlated) with the scoliosis progression under bracing treatment, and the risk for G-carried patients was higher. The mechanism may be that the polymorphism affected the IL-6 expression level and eventually affected the BMD of AIS patients through the bone metabolism.