Adolescent idiopathic scoliosis(AIS)is a complex three-dimensional deformity involving coronal,sagittal,and axial planes,with a prevalence that should not be overlooked.With advancements in technology and in-depth research,an increasing number of hospitals and physicians are exploring standardized diagnostic and treatment approaches for AIS.Comprehensive and in-depth understanding is required for AIS,including its etiology,screening and diagnosis,classification,assessment and examination,treatment options,exploration of current focus,and evaluation of quality of life.Such understanding ensures that the diagnostic and treatment are scientific,standardized,and timely.Based on the principles of evidence-based medicine,a consensus on the diagnosis and treatment of AIS is reached after multiple discussions among spinal surgery experts,aiming to provide reference and guidance for clinical practice.

Adolescent idiopathic scoliosis(AIS)is a complex spinal deformity that occurs in adolescents aged 10-18 years.It is more common in female adolescents.Despite extensive research,the precise pathological mechanisms underlying AIS are yet to be fully elucidated.Given its links to abnormal bone growth and reduced bone mineral density,the involvement of mesenchymal stem cells(MSCs)in bone metabolic disorders is considered a plausible contributing factor of AIS.This review summarizes the role of MSCs in the pathogenesis of AIS and provides a forward-looking perspective on the potential clinical application.

Objective To investigate the influence of basic condition,surgical strategy,and postoperative condition of adolescent idiopathic scoliosis(AIS)patients on the length of hospitalization.Methods A total of 145 AIS patients who underwent posterior spinal fusion and internal fixation in The First Affiliated Hospital of Naval Medical University(Second Military Medical University)from Jan.1,2014 to Dec.31,2023 with more than 2 years of follow-up were retrospectively enrolled.According to the surgical strategy,they were assigned to selective fusion group(n=50)and non-selective fusion group(n=95).AIS patients were assigned to intensive care unit(ICU)group(n=81)and non-ICU group(n=64)according to whether they were admitted to ICU.Parameters related to basic,surgical and postoperative conditions,hospital stay and postoperative hospital stay were analyzed.Multiple linear regression analysis was used to study the influencing factors of hospital stay and postoperative hospital stay.Results The number of surgical segments,surgical time,intraoperative blood loss,drainage volume on the 3rd day postoperatively,hospital stay,and postoperative hospital stay in the selective fusion group were significantly less than those in the non-selective fusion group(all P＜0.05).The patients in the ICU group were younger,had longer surgery time,had more intraoperative blood loss and blood transfusion,and had longer hospital stay and postoperative hospital stay compared with those in the non-ICU group(all P＜0.05).Correlation analysis showed that hospital stay and postoperative hospital stay were both positively correlated with ICU admission(r=0.179,0.240;both P＜0.05)and were both negatively correlated with selective fusion(r=-0.187,-0.242;both P＜0.05).Conclusion The hospital stay and postoperative hospital stay of AIS patients with non-selective fusion in posterior spinal fusion and internal fixation is longer than those of patients with selective fusion.Non-selective fusion and ICU admission may be factors contributing to the prolonged hospital stay and postoperative hospital stay in AIS patients.

Objective To compare the surgical outcomes of the sequence of screw and rod placement for Lenke type 5C adolescent idiopathic scoliosis(AIS).Methods Lenke type 5C AIS patients who underwent posterior orthopedic fusion and fixation in our hospital from Jan.2013 to Dec.2020 were recruited.Based on surgical sequences,22 cases were assigned to bilateral group(after bilateral screw placement,orthopedics was performed on the convex side and then on the concave side),and 20 cases were assigned to convex group(screws placed on the convex side and performed orthopedics,followed by the concave side).The operation-related indicators(including operation time),imaging parameters,quality of life scores were compared between the 2 groups before and 2 years after surgery.Complications of the 2 groups were analyzed.Results The operation time in the bilateral group was significantly longer than that in the convex group([232.8±13.1]min vs[198.4±16.5]min,P＜0.01).At the last follow-up 2 years after operation,the Cobb angle and its correction rate in the convex group were better than those in the bilateral group([8.0±2.3]° vs[9.9±3.2]°,P=0.03;[81.9±5.4]%vs[77.8±5.8]%,P=0.02).The rate of pedicle screw breach rate was 5.4%(17/312)in the bilateral group and 1.4%(4/280)in the convex group,with significant difference(P＜0.01).At the last follow-up 2 years after operation,the treatment satisfaction of quality of life assessment of the bilateral group was 4.61±1.38,and that of the convex group was 4.50±1.44,but there was no significant difference between the 2 groups(P＞0.05).There were no abnormal electrophysiological monitoring or operation-related complications in the 2 groups.Conclusion For Lenke type 5C AIS,the convex side of pedicle screw placement and orthopedics followed by concave side of pedicle screw placement and orthopedics can achieve better surgical effect.

Objective To explore the clinical effect of nursing guided by Neuman's systems model on adolescent idiopathic scoliosis surgery patients.Methods This study is a randomized controlled trial.A total of 120 patients with adolescent idiopathic scoliosis who underwent surgery in our hospital from Jan.to Dec.2023 were enrolled.According to the order of enrollment,they were randomly assigned to experimental group or control group,with 60 patients in each group.The control group received routine nursing,while the experimental group received nursing guided by Neuman's systems model.Independent-sample t test and χ2 test were used to compare the surgical efficacy,postoperative recovery,quality of life,and self-management ability of the 2 groups.Results Six months post-surgery,the main curve Cobb angle in the experimental group was significantly smaller than that in the control group([14.33±0.78]° vs[16.65±1.02]°,P＜0.001).The postoperative bedtime([4.78±1.32])d vs[6.13±1.26]d),incision healing time([13.43±3.29]d vs[15.32±5.23]d),and hospital stay([13.17±5.36]d vs[16.93±3.14]d)were all significantly shorter in the experimental group than those in the control group(all P＜0.05).The overall complication rate in the experimental group was significantly lower than that in the control group(5.00%[3/60]vs 21.67%[13/60],P=0.016).Six months post-surgery,the experimental group scored better in terms of physical functioning,bodily pain,general health,vitality,social functioning,role-emotional,and mental health compared to the control group(all P＜0.05).In terms of patient self-management,the experimental group also had significantly higher scores in common management(17.53±5.98 vs 13.34±7.32)and symptom management(30.95±8.12 vs 27.32±7.87)compared to the control group(both P＜0.05).Conclusion The nursing guided by Neuman's systems model for adolescent idiopathic scoliosis surgery patients can promote their postoperative recovery and improve their quality of life and self-management capabilities.

Objective To summarize the perioperative nursing experience of a child with Angelman syndrome(AS)complicated with moderate scoliosis undergoing posterior 3-dimensional osteotomy correction,fusion,and internal fixation under general anesthesia.Methods The clinical data of the child with AS and moderate scoliosis who underwent surgical treatment in our hospital on Aug.4,2023,were analyzed.A multidisciplinary team was established upon admission.Relevant literatures and evidences were reviewed to develop and implement a"1+X"nursing plan,which included 2 components:"1"(core perioperative nursing priorities for scoliosis)and"X"(multiple AS-related nursing issues and corresponding strategies).Results The surgery was successful,with stable postoperative conditions and significant improvement in spinal curvature.The child's height increased by 7 cm.Discharge occurred on postoperative day 10,with 100%follow-up compliance.The child regained preoperative independent walking ability during follow-up.Conclusion The"1+X"nursing protocol for AS complicated with scoliosis can effectively ensure perioperative safety and promote recovery,which providing insights for perioperative nursing care of other rare diseases complicated with scoliosis.

Low-intensity pulsed ultrasound(LIPUS)is a low-cost,non-invasive and safe treatment method mainly used for musculoskeletal diseases,especially for fractures and nonunion.This article reviews the therapeutic effects of LIPUS on various musculoskeletal and nervous system diseases and analyzes its mechanism and potential targets.It is found that besides fracture and nonunion,LIPUS also has clinical application prospect in treating osteoporosis,muscle injury,and motor nervous system diseases.

Objective To explore the value of methylation of SDC2 and SFRP2 genes promoter in fecal DNA for colorectal cancer ( CRC) screening. Methods All stool samples were enrolled from Changhai Hospital of Naval Medical University, the Tenth People' s Hospital of Tongji University and the Seventh Medical Center of Chinese People's Liberation Army General Hospital. A total of 500 stool samples collected from March 2018 to December 2018 were allocated to CRC group ( 132 CRCs ) , adenoma group ( 38 advanced adenomas), healthy group (152 healthy individuals), interferential group (178 cases of benign colorectal disease or other non-colorectal tumors) and negative group (330 cases composed of healthy group and interferential group ) . The promoter methylation of fecal SDC2 and SFRP2 genes was detected by methylation-specific PCR (MSP) and compared with single gene methylation and the fecal immunochemical tests ( FIT) to evaluate its sensitivity and specificity. Results The stool sample analysis showed that the sensitivity of combined detection of SDC2 and SFRP2 in CRC group was 97. 73％ ( 129/132 ) , which was significantly higher than those of the single gene SDC2 test [ 70. 45％ ( 93/132) , P=0. 000] , single SFRP2 test [81. 82％ (108/132), P=0. 000] and FIT [69. 70％ (92/132), P=0. 000]. In adenoma group, the sensitivity of combined detection of SDC2 and SFRP2 was 57. 89％ (22/38), which was significantly higher than those of the single gene SDC2 test [ 15. 79％ ( 6/38 ) , P= 0. 000 ] and FIT [ 21. 05％ ( 8/38 ) , P=0. 021] , with no significant difference compared with that of SFRP2 test [ 47. 37％ ( 18/38) , P=0. 358] . In healthy group, the specificity of combined detection of SDC2 and SFRP2 was 98. 68％ (150/152), with no significant difference compared with those of single gene SDC2 test [ 100. 00％( 152/152) , P=0. 156] , single SFRP2 test [98. 68％ (150/152), P=1. 000] or FIT [95. 39％ (145/152), P=0. 091]. Specificities of combined detection of two genes in interferential and negative groups were 90. 45％ ( 161/178) and 94. 24％( 311/330) , which were significantly higher than 73. 03％( 130/178, P=0. 000) and 83. 33％( 275/330, P=0. 000) of FIT, respectively. Conclusion The combined detection test of methylation of SDC2 and SFRP2 is superior to single gene test, whose sensitivity of CRC and aggressive adenoma and specificity of distinguishing benign and malignant lesions are higher than FIT, which has potential application value.

OBJECTIVETo evaluate the role and value of Changhai fulcrum bending radiograph(CH-FBR) in curve flexibility assessment of adolescent idiopathic scoliosis(AIS) patients.

METHODSThirty-seven AIS patients treated between June 2012 and August 2013 were enrolled, including 31 female and 6 male patients whose age ranged from 10 to 19 years, averaged of 15.0 years. The assessment of radiographs included preoperative standing posterior-anterior radiograph, supine side-bending radiograph, traditional fulcrum bending radiograph, Changhai fulcrum bending radiograph and postoperative standing posterior-anterior radiograph. Postoperatively, radiographs were assessed at one week. The CH-FBR was performed at the lowest height and the optimized height which means the weight on the fulcrum touch the maximum. All measurements of angle were made with use of the Cobb method. The flexibility of the curve as well as the correction rate and fulcrum bending correction index (FBCI) were calculated for all patients. The maximum height of CH-FBR, basic weight and maximum weight were measured for all AIS. Paired t-tests were used to assess differences between preoperative and postoperative curves within group samples. The Pearson correlation coefficients were calculated using bivariate analysis between CH-FBR flexibility rate and correction rate, the maximum height of CH-FBR and maximum weight, the height changes of CH-FBR and weight changes.

RESULTSA total of 46 curves were involved in this study, including 28 thoracic and 18 thoracolumbar/lumbar curves. Preoperatively, the mean Cobb angle of the 46 structural curves was 47° ± 11°. Postoperatively, the mean Cobb angle was 11° ± 5°. Cobb's angle in supine side-bending(t = 7.2, P = 0.001), traditional fulcrum bending (t = 7.1, P = 0.001) and lowest height of Changhai fulcrum bending (t = 6.5, P = 0.001) were significantly different from the postoperative Cobb angle; Cobb's angle in traditional FBR (t = 11.0, P = 0.001) and lowest height of Changhai fulcrum bending (t = 13.6, P = 0.001) were significantly different from the optimized height CH-FBR Cobb angle. There was no significant difference found between traditional FBR Cobb angle and lowest height CH-FBR Cobb angle (t = 2.0, P = 0.051), optimized height CH-FBR Cobb angle and postoperative Cobb angle (t = 0.9, P = 0.36), lowest height CH-FBR Cobb angle and traditional FBR Cobb angle(t = 2.0, P = 0.051). The maximum height of CH-FBR, basic weight and maximum weight were (29.6 ± 1.4)cm,(20 ± 6)kg, and (40 ± 6) kg. Preoperatively, the mean Cobb angle of the 28 structural curves(main thoracic curves) was 46° ± 11°. Postoperatively, the mean Cobb angle was 12° ± 6°. Preoperatively, the mean Cobb angle of the 18 structural curves(thoracolumbar/lumbar curves) was 49° ± 12°. Postoperatively, the mean Cobb angle was 10° ± 5°. The results were same in 28 structural curves, 18 structural curves as well as 46 curves. Correlation analysis of 46 curves indicated that the maximum height of CH-FBR positively correlated with maximum weight (r = 0.69, r(2) = 0.47, P = 0.001), the height changes of CH-FBR positively correlated with weight changes on CH-FBR (r = 0.62, r(2) = 0.38, P = 0.001).

CONCLUSIONSCH-FBR is a more reliable and effective method than traditional FBR and supine side-bending for curve flexibility evaluation in AIS patients. Moreover, compared to the traditional FBR and side-bending radiograph, the flexibility suggested by the optimized height CH-FBR more closely approximates the postoperative result made by pedicle screws fixation and fusion.

Adolescent ; Child ; Female ; Humans ; Male ; Prospective Studies ; Radiography ; Range of Motion, Articular ; Scoliosis ; diagnostic imaging ; surgery ; Young Adult

20?) or vertebral semiluxation and vertebral pathological fracture group (n=14),which was treated with full laminectomy and limited correction with pedicle screw/rod internal fixation system by augmentation and restoration with bone cement in the screw tract; mild coronal plane deformity (Cobb’s angle