不同剂量褪黑素对双足直立鼠脊柱侧凸发生率的影响及脊柱侧凸临床治疗相关研究
发布时间：2018-09-06 18:02
【摘要】：第1章褪黑素水平与脊柱侧凸的发病机制相关研究第1节不同剂量褪黑素对C57BL/6J双足直立小鼠模型脊柱侧凸发生率的影响目的：内源性褪黑素(melatonin, MT)缺乏被认为是青少年特发性脊柱侧凸(Adolescent idiopathic scoliosis, AIS)最重要的发病机制之一。既往研究报道低褪黑素C57BL/6J双足直立鼠脊柱侧凸的发生率较高,同时对该动物模型早期持续外源性腹腔注射生理剂量的褪黑素可阻止脊柱侧凸的发生和发展。但是目前尚无研究证实该效应是否与所注射褪黑素的剂量相关。因此,本研究旨在探究早期外源性补充不同剂量褪黑素是否会影响C57BL/6J双足直立小鼠脊柱侧凸的发生率。方法：选取三周龄C57BL/6J雌性SPF级小鼠105只,随机选取75只施行双上肢及鼠尾切除术建立双足直立小鼠模型,然后行直立体态的诱导。将四足鼠随机分为两组：组A：15只,每日腹腔注射0.1ml 10%酒精/生理盐水；组B：15只,每日注射0.1ml褪黑素溶液,剂量为8mg/kg。双足鼠随机分为5组：组C：15只,每日腹腔注射0.1ml 10%酒精/生理盐水；组D、E、F、G:每组15只,每日注射O.1ml褪黑素溶液,剂量分别为4mg/k、8 mg/kg、16mg/kg、32 mg/kg。 20周后麻醉下对所有小鼠行全脊柱X线正位片检查,测量Cobb角,Cobb角10。定义为脊柱侧凸。记录并比较各组脊柱侧凸的发生率。结果：20周后,全脊柱X线正位片显示双足鼠中共有19只(19/75,25.3%)发生脊柱侧凸,其中未注射褪黑素的C组有14只(14/15,93.3%)小鼠发生脊柱侧凸,注射生理量褪黑素的E组有3只(3/15,20%)发生了脊柱侧凸,D、F组各有1只(1/15,6.7%)发生脊柱侧凸。四足鼠中仅A组有2只(2/15,13.3%)发生了脊柱侧凸。C组小鼠的脊柱侧凸发生率显著高于其余各组。然而注射不同剂量褪黑素的D、E、F、G组间小鼠脊柱侧凸的发生率无显著差异(P0.05)。结论：褪黑素缺乏在C57BL/6J双足直立小鼠脊柱侧凸的发生发展中起着重要的作用,早期腹腔注射褪黑素可显著降低该模型脊柱侧凸的发生率,且这种效应不依赖于褪黑素的剂量。第2章脊柱侧凸的临床治疗相关研究第1节 锁骨胸廓交角差对Lenke 1型青少年特发性脊柱侧凸患者后路矫形术后双肩平衡的预测作用目的：探讨锁骨胸廓交角差(Clavicle chest cage angle difference, CCAD)是否可用于Lenke 1型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis, AIS)患者后路矫形术后双肩影像学、美学平衡及患者和术者满意度的预测。方法：回顾性分析2008年3月至2011年8月在我院行选择性后路矫形内固定术、有完整影像学资料的Lenke 1型女性青少年特发性脊柱侧凸患者44例,平均年龄15.1±1.7岁。CCAD为站立位全脊柱正位片上左侧锁骨胸廓的夹角(CC A)与右侧CCA的差值。双肩高度差(SHD)为站立位全脊柱正位片上左侧肩锁关节正上方软组织影与相应右侧软组织影高度的差值。分别测量患者术前、术后及两年后随访时的CCAD及双肩高度差SHD。末次随访双肩高度差SHD≥1cm的患者归入双肩失衡组；SHD1cm为双肩平衡组。在患者末次随访时的背部外观照上测量其内肩高度差(inner shoulder height, SHi)及外肩高度差(outer shoulder height, SHo)。末次随访SHi1cm、SHo1cm分别定义为内肩、外肩平衡,SHi≥1cm SHo≥1cm分别定义为内肩、外肩失衡。通过两个问卷分别评估患者的满意度及术者的满意度。利用ROC曲线分析预测末次随访患者双肩平衡状态及患者和术者的满意度的术前CCAD诊断值。结果：末次随访时共18例患者双肩失衡,26例双肩平衡。双肩失衡组术前CCAD显著高于双肩平衡组(8.1±3.9。vs.3.3±1.8。,P0.001)。根据患者美学外观照,末次随访内肩平衡组和内肩失衡组的术前CCAD无统计学差异,外肩平衡组和外肩失衡组术前CCAD亦无显著差异。根据患者和术者的满意度,不满意组的患者术前CCAD显著高于满意组。ROC曲线分析术前CCAD预测术后双肩影像学失衡、患者不满意及术者不满意的诊断值均为5.5。。结论：CCAD可用于预测Lenke 1型青少年特发性脊柱侧凸患者术后双肩影像学平衡及患者和术者的满意度,但是由于双肩美学参数和影像学参数存在不一致,CCAD不能用于预测Lenke1型青少年特发性脊柱侧凸患者术后双肩美学平衡。第2节Lenke 1型青少年特发性脊柱侧凸前路矫形术后胸椎后凸角改变与脊柱后份生长的相关性研究目的：评估Lenke 1型青少年特发性脊柱侧凸患者前路矫形手术术后脊柱前柱和后份生长的情况,进一步探究术后胸椎后凸角改变的原因。方法：选取2002年6月至2006年11月间在我院接受前路选择性胸弯固定治疗的青少年特发性脊柱侧凸患者40例,平均年龄14.1±1.7岁。根据其术前Risser征分为3组：A组,Risser 0; B组,Risser 1-3;C组,Risser 4～5。在术前、术后早期(术后3-6月)以及末次随访时的站立位全脊柱正侧位X线片上测量以下参数：冠状面上测量胸弯、腰弯Cobb角；矢状面上测量：胸椎后凸角(thoracic kyphosis, TK), T5-12各椎体前壁高度(VBHa)、后壁高度(VBHp)、椎弓根高度(PH)及椎弓根间隙高度(IPH)并分别其T5-12的总和SVBHa、 SVBHp、SPH及SIPH。结果：三组患者例数分别为：A组：7例；B组：14例；C组19例。患者术前、术后、末次随访胸椎后凸角分别为10.4。±12.2。,15.1。土8.6。,18.1。±6.5。。末次随访胸椎后凸角相比术后3月有增大的趋势,但差异不显著。三组中A、B两组胸椎后凸角较术后3月分别增大了8.3。、2.2。。A组中SVBHp/SVBHa及(SIPH+SPH)/SVBHa、B组中(SIPH+SPH)/SVBHa在末次随访时较术后3月显著增加,而B组SVBHp/SVBHa、C组病例SVBHp/SVBHa及(SIPH+SPH)/SVBHa末次随访与术后3月相比无显著差异。结论：胸弯青少年特发性脊柱侧凸患者前路胸椎矫形术后有前柱生长停滞,后份继续生长的现象,从而导致术后随访过程中胸椎后凸在一定时间内持续增大。第3节Lenke 5型AIS患者前路与后路矫形术后矢状面形态的比较分析目的分析Lenke5型青少年特发性脊柱侧凸(AIS)患者前路/后路矫形术后脊柱矢状面形态的变化,探讨比较不同入路对脊柱矢状面形态的影响。方法2005年1月至2010年12月在我科行胸腰/腰椎矫形术且有完整随访资料(随访12年)的Lenke5型AIS患者共49例,其中,前路手术组(A组)23例,后路手术组(B组)26例。对这两组患者术前、术后早期、术后1年及末次随访的胸腰/腰弯Cobb角、胸弯Cobb角,胸椎后凸角(TK)、腰椎前凸角(LL)和内固定近端交界角(PJA)等指标进行测量并进行统计学分析。结果A、B两组的手术年龄、Risser征、术前代偿胸弯、胸腰/腰弯Cobb角、主弯累及节段等一般资料均无统计学差异(P0.05)。A、B两组术前矢状面参数：TK:15.1° vs.15.6°、 LL:-51.9° vs.-50.3°、PJA:4.7°、vs.4.0°,也均未表现出统计学差异(P0.05)。A组与B组融合节段相似,术后及随访两组继发胸弯和主胸腰/腰弯矫形效果也均类似(P0.05)。术后矢状面参数：A组TK较术前增加0.80,B组TK增幅较大(4.80),B组TK显著高于A组(P0.05)；A组LL减小6.60,B组LL减小1°；A组PJA稍有增加(0.2。),B组PJA增加2.9。,两组间LL及PJA均未见显著性差异(P0.05)。A组平均随访2.8±0.9年,B组平均随访2.3±0.5年。A、B两组TK、LL和PJA在术后1年及末次随访均较术后有小幅增加,B组TK值显著高于A组(P0.05),其余参数两组间未见统计学差异(P0.05)。结论Lenke5型AIS行选择性胸腰腰弯矫形内固定术时,前路与后路手术均可获得良好的冠状面矫形效果。矢状面上：后路较前路对胸椎后凸恢复更好,因此,后路手术对矢状面形态重建的效果较前路手术好。第4节 严重脊柱畸形患者术前Halo重力牵引后骨密度变化及其相关因素分析目的：对于严重的脊柱畸形,Halo重力牵引是目前应用最广泛的术前治疗手段之一,然而其对于患者骨密度的影响目前尚未见报道。因此本研究以接受术前Halo重力牵引的严重脊柱畸形患者为研究对象,分析其牵引后的骨密度(bone mineral density, BMD)变化情况及相关影响因素。方法：前瞻性收集了在南京鼓楼医院脊柱外科接受至少2月术前Halo重力牵引治疗的严重脊柱畸形患者。牵引前和牵引结束后脊柱矫形手术前通过双能X线吸收测量法(dual energy X-ray absorptiometry, DEXA)测定并记录患者腰椎(L2-L4)和非优势侧股骨颈骨密度。记录患者的牵引时间、最大牵引重量、牵引前后主弯Cobb角以及患者年龄、性别、病因等基本信息。通过配对t检验比较牵引前和牵引结束后患者的骨密度。通过卡方检验比较牵引前后研究人群中骨质疏松的发生率。利用独立t检验、单因素方差分析和Pearson相关性分析探究与患者骨密度变化的相关因素。结果：一共入选20例病例,平均年龄16.3±7.6岁。平均牵引时间为77.9±13.0天,平均最大牵引重量为体重的39.9%±11.1%。与牵引前相比,牵引结束后17例(85%)患者的腰椎骨密度和18例(90%)患者的非优势侧股骨颈骨密度都发生了显著降低。牵引结束后75%的患者有骨质疏松,其发生率高于牵引前(35%),且差异具有统计学意义(P0.05)。通过Pearson相关性分析发现骨密度降低值仅与牵引时间长短具有相关性(股骨颈：r=0.581,P=0.012；腰椎：r=0.558,P=0.020)。结论：接受2月以上术前Halo重力牵引的严重脊柱畸形患者的腰椎和非优势侧股骨颈骨密度牵引结束后可发生显著减少,其减少值与牵引的时间长短相关,临床应用Halo重力牵引时应避免牵引时间过长以防止牵引后骨质疏松的发生。
[Abstract]:Chapter 1 Melatonin levels and the pathogenesis of scoliosis. Section 1 Effects of different doses of melatonin on the incidence of scoliosis in C57BL/6J biped erect mice. Objective: Endogenous melatonin (MT) deficiency is considered to be the most important factor in adolescent idiopathic scoliosis (AIS). Previous studies have reported that low melatonin C57BL/6J has a high incidence of scoliosis in bipedal erect mice. At the same time, continuous and exogenous intraperitoneal injection of melatonin can prevent the occurrence and development of scoliosis. Therefore, the purpose of this study was to explore whether early exogenous melatonin supplementation at different doses could affect the incidence of scoliosis in C57BL/6J bipedal erect mice. Methods: 105 three-week-old female SPF mice were randomly selected and 75 mice were operated on to establish bipedal erect mice models. Quadruped rats were randomly divided into two groups: group A: 15 rats were injected with 0.1ml 10% alcohol/normal saline daily, group B: 15 rats were injected with 0.1ml melatonin solution daily at the dose of 8mg/kg. Biped rats were randomly divided into five groups: group C: 15 rats were injected with 0.1ml 10% alcohol/normal saline daily, group D, E, F, G: 15 rats in each group were injected with O.1m daily. L Melatonin solution, dosage of 4 mg/k, 8 mg/kg, 16 mg/kg, 32 mg/kg. 20 weeks after anesthesia, all the mice were examined with whole spine X-ray. Cobb angle and Cobb angle were measured. Scoliosis was defined as scoliosis. The incidence of scoliosis in each group was recorded and compared. Scoliosis occurred in 3%. Scoliosis occurred in 14 mice (14/15,93.3%) in group C without melatonin injection. Scoliosis occurred in 3 mice (3/15,20%) in group E with melatonin injection. Scoliosis occurred in 1 in group D and 1 in group F (1/15,6.7%) respectively. However, there was no significant difference in the incidence of scoliosis between groups D, E, F and G (P 0.05). Conclusion: Melatonin deficiency plays an important role in the development of scoliosis in C57BL/6J bipedal orthostatic mice. Early intraperitoneal injection of melatonin can significantly reduce the incidence of scoliosis in this model. The incidence of columnar scoliosis and the effect does not depend on the dose of melatonin. Chapter 2 Clinical treatment of scoliosis Whether CCAD can be used to predict shoulder imaging, aesthetic balance and patient and surgeon satisfaction after posterior correction in adolescent idiopathic scoliosis (AIS) patients with Lenke type 1. Methods: A retrospective analysis was performed in our hospital from March 2008 to August 2011. Complete imaging data of 44 female adolescents with idiopathic scoliosis of Lenke type 1, with an average age of 15.1 (+ 1.7 years). CCAD was the difference between the left clavicular thoracic angle (CC A) and the right CC A on the upright radiograph of the whole spine. The shoulder height difference (SHD) was the soft tissue image and phase above the left acromioclavicular joint on the upright radiograph of the whole spine. CCAD and SHD were measured before surgery, after surgery and two years after follow-up. Patients with SHD (>1 cm) at the last follow-up were classified as shoulder imbalance group and SHD (>1 cm) as shoulder balance group. At the last follow-up, SHi 1 cm, SHo 1 cm were defined as inner shoulder and outer shoulder balance, SHi (> 1 cm) was defined as inner shoulder and outer shoulder imbalance, and SHi (> 1 cm) was defined as outer shoulder imbalance. Results: At the last follow-up, 18 patients had bilateral shoulder imbalance and 26 had bilateral shoulder balance. The preoperative CCAD of the patients with bilateral shoulder imbalance was significantly higher than that of the patients with bilateral shoulder imbalance (8.1 +3.9.vs. 3.3 +1.8, P 0.001). According to the satisfaction of patients and surgeons, the preoperative CCAD of patients with dissatisfaction group was significantly higher than that of patients with satisfaction group. ROC curve analysis showed that preoperative CCAD predicted postoperative shoulder imaging imbalance. The diagnostic values of patients with dissatisfaction and surgeons'dissatisfaction were both 5.5.. CCAD can not be used to predict postoperative shoulder aesthetic balance in adolescent idiopathic scoliosis Lenke type 1. Lenke type 1 adolescents Objective: To evaluate the anterior and posterior spinal growth in adolescent idiopathic scoliosis Lenke type 1 patients after anterior spinal surgery, and to explore the causes of postoperative thoracic kyphosis. From November 2006 to November 2006, 40 adolescent patients with idiopathic scoliosis who underwent anterior selective thoracic curvature fixation were divided into three groups according to their preoperative Risser signs: group A, Risser 0; group B, Risser 1-3; group C, Risser 4-5. The total standing spine was preoperatively, early postoperatively (3-6 months) and at the last follow-up. The following parameters were measured on axial and lateral X-ray films: thoracic kyphosis (TK), anterior wall height (VBHa), posterior wall height (VBHp), pedicle height (PH) and intervertebral space height (IPH) on coronal plane and sagittal plane, and the sum of T5-12 and SVBHp, SPH and SIPH. Results: The number of patients in the three groups were: group A: 7 cases; group B: 14 cases; group C: 19 cases. The thoracic kyphosis angle of the patients in group A and B were 10.4. + 12.2., 15.1. soil 8.6., 18.1. + 6.5.. The thoracic kyphosis angle of the patients in the last follow-up was increased, but the difference was not significant. SVBHp/SVBHa and (SIPH+SPH)/SVBHa in group A and (SIPH+SPH)/SVBHa in group B increased significantly at the last follow-up compared with 3 months after surgery, while SVBHp/SVBHa in group B, SVBHp/SVBHa in group C and (SIPH+SPH)/SVBHa in the last follow-up showed no significant difference compared with 3 months after surgery. Section 3 Comparison of sagittal morphology between anterior and posterior approaches in patients with Lenke 5 AIS Objective To analyze anterior/posterior approaches in adolescent idiopathic scoliosis (AIS) patients with Lenke 5. Methods From January 2005 to December 2010, 49 patients with Lenke type 5 AIS underwent thoracolumbar/lumbar orthopedics with complete follow-up data (12 years follow-up), including 23 patients in anterior approach group (group A) and 26 patients in posterior approach group (group B). The Cobb angle, Cobb angle, TK angle, LL angle and PJA angle of thoracolumbar lordosis were measured and analyzed statistically. Results The operative age, Risser sign, preoperative compensatory thoracolumbar bend, Cobb angle of thoracolumbar/lumbar bend, and main bend involvement in group A and B were analyzed statistically. There was no significant difference in the sagittal plane parameters between group A and group B (P 0.05). The sagittal plane parameters of group B: TK: 15.1 degrees vs. 15.6 degrees, LL: - 51.9 degrees vs. - 50.3 degrees, PJA: 4.7 degrees, vs. 4.0 degrees, and there was no significant difference between group A and group B (P 0.05). Postoperative sagittal parameters: TK in group A increased by 0.80, TK in group B increased significantly (4.80), TK in group B was significantly higher than that in group A (P 0.05); LL in group A decreased by 6.60, LL in group B decreased by 1 degree; PJA in group A increased slightly (0.2.) and PJA in group B increased by 2.9. (P 0.05). There was no significant difference in LL and PJA between the two groups (P 0.05). The average follow-up time in group A was 2.8 [0.9 years], and the average follow-up time in group B was 2.3 [.5 years, B] TK, LL and PJA in both groups increased slightly at 1 year and the last follow-up. TK in group B was significantly higher than that in group A (P 0.05). There was no significant difference in other parameters between the two groups (P 0.05). Conclusion Both anterior and posterior approaches can achieve good coronal orthopedic results in Lenke 5 AIS patients undergoing selective thoracolumbar curvature and internal fixation. Posterior approach is better than anterior approach in restoring thoracic kyphosis, so posterior approach is better than anterior approach in reconstructing the sagittal plane. One of the treatment methods, however, the effect on bone mineral density (BMD) of patients with severe spinal deformity after preoperative Halo gravity traction has not been reported so far. Dual energy X-ray absorptiometry (DEXA) was used to measure and record the bone mineral density of the lumbar spine (L2-L4) and the non-dominant femoral neck before and after traction. Time, maximum traction weight, main bend Cobb angle before and after traction, patient's age, sex, etiology and other basic information. Bone mineral density was compared before and after traction by paired t test. The incidence of osteoporosis was compared by chi-square test before and after traction. The incidence of osteoporosis was analyzed by independent t test, one-way ANOVA and Pearson test. Result: A total of 20 patients, with an average age of 16.3 (+ 7.6 years), were enrolled in the study. The average traction time was 77.9 (+ 13.0 days) and the average maximum traction weight was 39.9% (+ 11.1%) of body weight. Compared with pre-traction, the lumbar vertebral bone mineral density of 17 patients (85%) and 18 patients (90%) were not excellent after traction. After traction, 75% of the patients had osteoporosis. The incidence of osteoporosis was higher than that before traction (35%) and the difference was statistically significant (P 58, P = 0.020). Conclusion: The bone mineral density of the lumbar spine and the femoral neck of the non-dominant side of the patients with severe spinal deformity who received Halo gravity traction more than 2 months before the operation can be significantly reduced after the traction. The reduction value is related to the length of the traction. The long traction time should be avoided in the clinical application of Halo gravity traction to prevent osteoporosis after the traction. Happen.
【学位授予单位】：南京大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R682.3
本文编号：2227107
[Abstract]:Chapter 1 Melatonin levels and the pathogenesis of scoliosis. Section 1 Effects of different doses of melatonin on the incidence of scoliosis in C57BL/6J biped erect mice. Objective: Endogenous melatonin (MT) deficiency is considered to be the most important factor in adolescent idiopathic scoliosis (AIS). Previous studies have reported that low melatonin C57BL/6J has a high incidence of scoliosis in bipedal erect mice. At the same time, continuous and exogenous intraperitoneal injection of melatonin can prevent the occurrence and development of scoliosis. Therefore, the purpose of this study was to explore whether early exogenous melatonin supplementation at different doses could affect the incidence of scoliosis in C57BL/6J bipedal erect mice. Methods: 105 three-week-old female SPF mice were randomly selected and 75 mice were operated on to establish bipedal erect mice models. Quadruped rats were randomly divided into two groups: group A: 15 rats were injected with 0.1ml 10% alcohol/normal saline daily, group B: 15 rats were injected with 0.1ml melatonin solution daily at the dose of 8mg/kg. Biped rats were randomly divided into five groups: group C: 15 rats were injected with 0.1ml 10% alcohol/normal saline daily, group D, E, F, G: 15 rats in each group were injected with O.1m daily. L Melatonin solution, dosage of 4 mg/k, 8 mg/kg, 16 mg/kg, 32 mg/kg. 20 weeks after anesthesia, all the mice were examined with whole spine X-ray. Cobb angle and Cobb angle were measured. Scoliosis was defined as scoliosis. The incidence of scoliosis in each group was recorded and compared. Scoliosis occurred in 3%. Scoliosis occurred in 14 mice (14/15,93.3%) in group C without melatonin injection. Scoliosis occurred in 3 mice (3/15,20%) in group E with melatonin injection. Scoliosis occurred in 1 in group D and 1 in group F (1/15,6.7%) respectively. However, there was no significant difference in the incidence of scoliosis between groups D, E, F and G (P 0.05). Conclusion: Melatonin deficiency plays an important role in the development of scoliosis in C57BL/6J bipedal orthostatic mice. Early intraperitoneal injection of melatonin can significantly reduce the incidence of scoliosis in this model. The incidence of columnar scoliosis and the effect does not depend on the dose of melatonin. Chapter 2 Clinical treatment of scoliosis Whether CCAD can be used to predict shoulder imaging, aesthetic balance and patient and surgeon satisfaction after posterior correction in adolescent idiopathic scoliosis (AIS) patients with Lenke type 1. Methods: A retrospective analysis was performed in our hospital from March 2008 to August 2011. Complete imaging data of 44 female adolescents with idiopathic scoliosis of Lenke type 1, with an average age of 15.1 (+ 1.7 years). CCAD was the difference between the left clavicular thoracic angle (CC A) and the right CC A on the upright radiograph of the whole spine. The shoulder height difference (SHD) was the soft tissue image and phase above the left acromioclavicular joint on the upright radiograph of the whole spine. CCAD and SHD were measured before surgery, after surgery and two years after follow-up. Patients with SHD (>1 cm) at the last follow-up were classified as shoulder imbalance group and SHD (>1 cm) as shoulder balance group. At the last follow-up, SHi 1 cm, SHo 1 cm were defined as inner shoulder and outer shoulder balance, SHi (> 1 cm) was defined as inner shoulder and outer shoulder imbalance, and SHi (> 1 cm) was defined as outer shoulder imbalance. Results: At the last follow-up, 18 patients had bilateral shoulder imbalance and 26 had bilateral shoulder balance. The preoperative CCAD of the patients with bilateral shoulder imbalance was significantly higher than that of the patients with bilateral shoulder imbalance (8.1 +3.9.vs. 3.3 +1.8, P 0.001). According to the satisfaction of patients and surgeons, the preoperative CCAD of patients with dissatisfaction group was significantly higher than that of patients with satisfaction group. ROC curve analysis showed that preoperative CCAD predicted postoperative shoulder imaging imbalance. The diagnostic values of patients with dissatisfaction and surgeons'dissatisfaction were both 5.5.. CCAD can not be used to predict postoperative shoulder aesthetic balance in adolescent idiopathic scoliosis Lenke type 1. Lenke type 1 adolescents Objective: To evaluate the anterior and posterior spinal growth in adolescent idiopathic scoliosis Lenke type 1 patients after anterior spinal surgery, and to explore the causes of postoperative thoracic kyphosis. From November 2006 to November 2006, 40 adolescent patients with idiopathic scoliosis who underwent anterior selective thoracic curvature fixation were divided into three groups according to their preoperative Risser signs: group A, Risser 0; group B, Risser 1-3; group C, Risser 4-5. The total standing spine was preoperatively, early postoperatively (3-6 months) and at the last follow-up. The following parameters were measured on axial and lateral X-ray films: thoracic kyphosis (TK), anterior wall height (VBHa), posterior wall height (VBHp), pedicle height (PH) and intervertebral space height (IPH) on coronal plane and sagittal plane, and the sum of T5-12 and SVBHp, SPH and SIPH. Results: The number of patients in the three groups were: group A: 7 cases; group B: 14 cases; group C: 19 cases. The thoracic kyphosis angle of the patients in group A and B were 10.4. + 12.2., 15.1. soil 8.6., 18.1. + 6.5.. The thoracic kyphosis angle of the patients in the last follow-up was increased, but the difference was not significant. SVBHp/SVBHa and (SIPH+SPH)/SVBHa in group A and (SIPH+SPH)/SVBHa in group B increased significantly at the last follow-up compared with 3 months after surgery, while SVBHp/SVBHa in group B, SVBHp/SVBHa in group C and (SIPH+SPH)/SVBHa in the last follow-up showed no significant difference compared with 3 months after surgery. Section 3 Comparison of sagittal morphology between anterior and posterior approaches in patients with Lenke 5 AIS Objective To analyze anterior/posterior approaches in adolescent idiopathic scoliosis (AIS) patients with Lenke 5. Methods From January 2005 to December 2010, 49 patients with Lenke type 5 AIS underwent thoracolumbar/lumbar orthopedics with complete follow-up data (12 years follow-up), including 23 patients in anterior approach group (group A) and 26 patients in posterior approach group (group B). The Cobb angle, Cobb angle, TK angle, LL angle and PJA angle of thoracolumbar lordosis were measured and analyzed statistically. Results The operative age, Risser sign, preoperative compensatory thoracolumbar bend, Cobb angle of thoracolumbar/lumbar bend, and main bend involvement in group A and B were analyzed statistically. There was no significant difference in the sagittal plane parameters between group A and group B (P 0.05). The sagittal plane parameters of group B: TK: 15.1 degrees vs. 15.6 degrees, LL: - 51.9 degrees vs. - 50.3 degrees, PJA: 4.7 degrees, vs. 4.0 degrees, and there was no significant difference between group A and group B (P 0.05). Postoperative sagittal parameters: TK in group A increased by 0.80, TK in group B increased significantly (4.80), TK in group B was significantly higher than that in group A (P 0.05); LL in group A decreased by 6.60, LL in group B decreased by 1 degree; PJA in group A increased slightly (0.2.) and PJA in group B increased by 2.9. (P 0.05). There was no significant difference in LL and PJA between the two groups (P 0.05). The average follow-up time in group A was 2.8 [0.9 years], and the average follow-up time in group B was 2.3 [.5 years, B] TK, LL and PJA in both groups increased slightly at 1 year and the last follow-up. TK in group B was significantly higher than that in group A (P 0.05). There was no significant difference in other parameters between the two groups (P 0.05). Conclusion Both anterior and posterior approaches can achieve good coronal orthopedic results in Lenke 5 AIS patients undergoing selective thoracolumbar curvature and internal fixation. Posterior approach is better than anterior approach in restoring thoracic kyphosis, so posterior approach is better than anterior approach in reconstructing the sagittal plane. One of the treatment methods, however, the effect on bone mineral density (BMD) of patients with severe spinal deformity after preoperative Halo gravity traction has not been reported so far. Dual energy X-ray absorptiometry (DEXA) was used to measure and record the bone mineral density of the lumbar spine (L2-L4) and the non-dominant femoral neck before and after traction. Time, maximum traction weight, main bend Cobb angle before and after traction, patient's age, sex, etiology and other basic information. Bone mineral density was compared before and after traction by paired t test. The incidence of osteoporosis was compared by chi-square test before and after traction. The incidence of osteoporosis was analyzed by independent t test, one-way ANOVA and Pearson test. Result: A total of 20 patients, with an average age of 16.3 (+ 7.6 years), were enrolled in the study. The average traction time was 77.9 (+ 13.0 days) and the average maximum traction weight was 39.9% (+ 11.1%) of body weight. Compared with pre-traction, the lumbar vertebral bone mineral density of 17 patients (85%) and 18 patients (90%) were not excellent after traction. After traction, 75% of the patients had osteoporosis. The incidence of osteoporosis was higher than that before traction (35%) and the difference was statistically significant (P 58, P = 0.020). Conclusion: The bone mineral density of the lumbar spine and the femoral neck of the non-dominant side of the patients with severe spinal deformity who received Halo gravity traction more than 2 months before the operation can be significantly reduced after the traction. The reduction value is related to the length of the traction. The long traction time should be avoided in the clinical application of Halo gravity traction to prevent osteoporosis after the traction. Happen.
【学位授予单位】：南京大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R682.3
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