基于病区特征的神经肌肉脊柱畸形的额状和矢状形态

Q4 Medicine Coluna/ Columna Pub Date : 2022-01-01 DOI:10.1590/s1808-185120222104262160
Egor U. Filatov, O. M. Sergeenko, D. Savin, P. Ochirova, S. Ryabykh
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引用次数: 0

摘要

【摘要】目的:揭示脊柱畸形的额状和矢状面形态与神经肌肉分科的关系,为手术和预后规划提供依据。脊柱畸形的特征因病理不同而不同。在脑瘫、肌肉萎缩症和脊髓性肌萎缩症中,畸形的具体特征写得很少,尤其是矢状面。方法:评价标准为患者年龄、性别、出血量、住院时间、畸形曲线测量、胸腰椎后凸(Cobb角)、骨盆与水平线的倾斜度、曲线矫正率。术前出院前(术后21天)和术后1年测量Cobb角。结果:71例神经肌肉疾病所致脊柱畸形患者分为4组:肌营养不良(MD)、脊髓性肌萎缩(SMA)、杜氏肌营养不良(DMD)和脑瘫(CP)。额平面最典型的畸形为c型胸腰椎侧凸伴骨盆旋转;根据脊柱侧凸的程度,椎体的旋转增加。腰椎前凸在PD患者中很常见,而胸后凸减小甚至胸前凸在DMD患者中更常见。所有组脊柱侧凸均有中度矫正。根据FIM,功能状态没有明显改善。结论:刚性前凸是神经肌肉畸形患者脊柱畸形的主要问题。通过标准操作的椎弓根螺钉结构和骨盆螺钉固定,可以很好地纠正NMS的脊柱侧凸和骨盆倾斜。证据水平IV;较低质量的前瞻性研究。
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FRONTAL AND SAGITTAL PATTERNS OF NEUROMUSCULAR SPINAL DEFORMITIES BASED ON NOSOLOGICAL PROFILE
ABSTRACT Objective: Reveal frontal and sagittal patterns of spinal deformity depending on neuromuscular nosology for surgery and outcome planning. The characteristics of spinal deformity vary according to the pathology. In cerebral palsy, muscular dystrophies, and spinal muscular atrophy, specific features of deformities are poorly written, especially in the sagittal profile. Methods: The evaluation criteria were age, gender of the patients, the volume of blood loss, duration of hospitalization, measurement of the deformity curve, thoracic and lumbar kyphosis (Cobb angle), pelvic obliquity concerning the horizontal line, the percentage of curve correction. Cobb angle was measured preoperatively before hospital discharge (up to 21 days postoperatively) and one year after surgery. Results: The cohort of 71 patients with spinal deformities due to neuromuscular diseases included four groups: muscular dystrophy (MD), spinal muscular atrophy (SMA), Duchenne muscular dystrophy (DMD), and cerebral palsy (CP). The most characteristic deformity in the frontal plane was C-shaped thoracolumbar scoliosis with rotation of the pelvis; rotation of the vertebrae increased according to the magnitude of scoliosis. Lumbar hyperlordosis was common in patients with PD, whereas decreased thoracic kyphosis or even thoracic lordosis occurs more frequently in patients with DMD. Moderate correction of scoliosis was observed in all groups. There was no significant improvement in functional status, according to the FIM. Conclusion: The findings showed that rigid hyperlordosis is the main problem of spinal deformities in neuromuscular patients. Scoliosis and pelvic obliquity can be well corrected in NMS by pedicle screw construction with standard maneuvers and pelvic screw fixation. Level of Evidence IV; Lesser quality prospective study.
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来源期刊
Coluna/ Columna
Coluna/ Columna Medicine-Surgery
CiteScore
0.40
自引率
0.00%
发文量
32
审稿时长
10 weeks
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