| Object:1.To investigate the morphological characteristic of thoracic and lumbar pedicles of adolescent idiopathic scoliosis,explore the relationship between the changes of pedicle morphology and abnormal severity and provide some advice for clinical treatment.2. To retrospectively analysis the clinical data and the effectiveness of the thoracolumbosacral orthosis (TLSO used to treat adolescent idiopathic scoliosis in the census of some areas in Yunnan province.Provide some advices for the census of AIS and clinical treatment.Methods:1.31adolescent idiopathic scoliosis patients aged10-19and received CT examination since discovered in this study from April2010to January2014.Most of the patients had received operation.11cases were males and20cases were females.Their cobb angle were from24.4degrees to114.4degrees,22cases cobb angle were smaller than80degrees and other9cases cobb Angle were larger than80degrees.CT scanning was used to investigate the parameters of pedicle morphology which include transverse pedicle length(TPL), transverse pedicle diameter(TPD), the angle between bilateral pedicles(ABP), transverse pedicle angle(TPA), he angle between pedicle and coronal plane(APC), the sagittal diameter of the spinal-canal(SDS). the coronal diameter of the spinal-canal(CDS).SPSS19.0software was performed to the following statistical analysis:(1)Compare bilateral pedicle morphology parameters of31patients by paired sample t test.(2)Compare the pedicle morphology parameters of the cases whose cobb angle is greater than80degrees with those whose cobb angle is smaller than80degrees by independent sample T test.(3)Explore the correlation between the cobb angle and pedicle morphology parameters by pearson correlation analysis.(4)Explore the risk factors of the curve progression by logistic regression analysis.2.132patients, aged10-19and suffered with Lenke1type,Lenke3type, Lenke5type and Lenke6type idiopathic scoliosis, were treated with regular brace by TLSO more than2years.They got exact diagnosis in the census of some areas in Yunnan procince.15males and117females were included in this group. In which,10cases, whose cobb angle greater than45degrees, volunteered to choose conservative brace treatment because of economic reason and surgery fear etc. All patients were treated with a regular TLSO brace for16hour and an average period over2years, during this time, patient was followed-up for every3month.The SPSS19.0soft was used for Statistical analysis.Results1. The results of paired sample t test showed:the TPL of vertebral sections from T8to L2,the TPD of T1, T3, T4, T10, T12, L5.the APC of T3, T4, T5,T9and the TPA of T11,T12were significantly different between concave side and convex side.Especially the TPL of vertebral sections from T9to T12had highly significant difference(P<0.01). The results of independent sample t test showed:the TPA of T7,T9,T10,the bilateral pedicle length differences of L1,L2,the bilateral pedicle diameter differences of L2,L5and the CDS of T7,T9were significantly different between the severe patients and mild-to-moderate patients.The average pedicle length in severe group was shorter than mild-to-moderate group.Significant correlations were found between CDS of T7,T8and cobb angle.The same results were found in the pedicle length differences of T12,L1,L2,the pedicle diameter differences of L5, the APC differences of T2, T6, T9, L4and the TPA differences of T3, T7, T9, T10, L5.Gender and apical region were shown to be the Significant risk factors for severe AIS by logistic regression analysis.2. For92.4%AIS were observed effective result of stopping or slowing down the curve progression. But3patients were noted with obvious curve progression over5degree and3of them stoped the treatment of TLSO because the development of Cobb angle were more than45°.No significance difference of correction was found in Lenke6type while Lenke1type,Lenke3type, Lenke5type got the opposite result. The effectiveness of TLSO treatment to stop or slow down the curve progression are not affected by age, gender and the difference of Lenke classification.Conclusion:1. Bilateral pedicle morphology were changed obvious asymmetric in AIS,especially in apical region.Significant differences of the changes of pedicle morphology were found in the comparison of severe patients and mild-to-moderate patients.The changes of pedicle morphology were most commonly occurs in T7and T9,followed by T8and T10..ALL these vertebras were located in the most common apical vertebra region.It showed that apical vertebra often occurs in the vertebra whose pedicle morphology can easily changed.In addition,the positive correlation between the changes of pedicle morphology and cobb angle means the differences of morphological characteristic were more significantly as the AIS more severe. The Asymmetric development Adverse effect on the progression of AIS.While the apical vertebra located in T7-T9,the patients have a high risk of deformity progression.Because of the changes of pedicle morphology were most commonly occurs in T7-T10and the patients have a high risk of deformity progression while the apical vertebra located in T7-T9. Early detection, early treatment and Observe the patients condition is necessary in the clinical work. The success rate of surgery will be improving after you have a strong understanding of the morphological characteristics of pedicle and choose an appropriate nailing way preoperation.2.12-16years old adolescents should be the focus survey objects because72.9%of the AIS patients visit the doctor for the first time in this age.Regular TLSO brace can effectivelyslow down or stop curve progression of adolescent idiopathic scoliosis. Regular TLSO brace can effectively reduce the Cobb angle of Lenkel type,Lenke3 type and Lenke5type,but the effective is not obvious in Lenke6type.With the treatment of TLSO to stop or slow down the curve progression are not affected by age,gender and the difference of Lenke classification. |
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