| Background and objectivePhysical and mental health of juvenile was deeply affected by idiopathic scoliosis. Aggravated malformation, which was paralleled with age, induced deformity of appearance, dysfunction of heart and lung, and seriously impacted on the future of the workforce capacity and quality of life. Special and systematical treatment of spinal deformities not only improve and strengthen juveniles' health, but also enhance quality of nation and promote national economic development. Although treatment of idiopathic scoliosis had been explored over 100 years, it was still regarded as a problem in correction of spinal deformity for its complex pathogenesis. To reduce the invalidity, variety of methods of treatment had been suggested and applied in domestic and international. Some satisfactory and positive treatment methods had been summarized as follows: early treatment, effective control and effective orthopaedic surgery. Progression of idiopathic scoliosis correlated to sex, Cobb's angle, maturity of bone and other related factors. At present, many kinds of preoperative radiography methods had been designed and used clinically. But there was not a special method which could accurately forecast correction ratio. To find a more accurate preoperative forecasting method for clinical treatment, three preoperative radiography methods had been applied in forecasting the correction ratio of juveniles'patients who were treated with pedicle screw fixation systems.When Cobb angle 10°~ 40°, non-surgical treatment, such as brace treatment must be carried out. At present, brace treatment was generally regarded as effective non-surgical treatment. Although as a complementary treatment, effect of treatment with other non-surgical methods was not widely accepted. Objective of brace treatment were as follows: correct or control curved spine, improve balance and appearance, prevent deformity progression, and enhance spinal stability. The method would bring great social effect if it was widely adopted in early stage. Such as prompt correction in time for those suffering from scoliosis, controlling of bending in the mild range, reducing disabilities. To explore indications and contraindications of brace treatment for adolescent idiopathic scoliosis and to evaluate its clinical effect, large numbers of samples need to be summarized, Currently, treatment of adolescent idiopathic scoliosis with thermosetting plastic brace (TPB) had not been reported. To observe clinical results, 106 cases with adolescent idiopathic scoliosis were normative treated with thermosetting plastic brace (TPB) .Orthopaedic correction and fusion should be applied when Cobb angle was more than 40°. whether to correct or how to correct depended on skeletal age, development, type of scoliosis, structural characteristics, spinal rotation, number of involved vertebrae, distance between middle line and apical vertebra, malformation of appearance, imbalance of trunk. and other factors. So far, 3-D correction were deeply developed in domestic and abroad. Infixating instrumentations are still being developed continuously. It is necessary for patients to design a new kind of sliding pedicle screw fixation system. Correcting spinal deformity and not restraining spinal growth could be the characteristic of the idealist instrumentation. At present, scoliosis clinically corrected with pedicle screw fixation system. Locking state between pedicles and rods usually restrained spinal growth, more seriously induced shot trunks and crankshaft phenomena. To this end, we analyzed characteristic of the previous instrumentation and designed a sliding pedicle screw system (Sliding Instrumentation of Pedicle Screw System, SIPSS), which could reduce or avoid complications stated above. The author also compared biomechanical index between traditional pedicle screw system and the SIPSS.There are still many problems in treatment of idiopathic idiopathic scoliosis. So we devote ourselves on this topic.Research Method1. sixty-three cases of adolescent idiopathic scoliosis(AIS) with 79 structural curves were studied, Preoperative X-films of standing , gravity-suspendig traction , supine bending and fulcrum bending were compared with postoperative standing X-films one week after surgery, Cobb angle of all X-films were measured and statistical significance was evaluated.2. All 106 immatured skeleton patients suffered from adolescent idiopathic scoliosis with no history of prior treatment . They were treated with Thermosetting plastic brace. 21 cases were male and 85 cases were female with the mean age being 13.1 years(range from 8 to 19 years). 49 cases had single thoracic curve, 8 cases had double thoracic curve, 37 cases had thoracic and lumbar double major curve, 12 cases had either single thoraco-lumbar or single lumbar curve. The mean primary curve was 29.5°(range, 20°~42°). Risser sign was 0°in 51 cases, I°in 33 cases, II°in 19 cases, andШ°in 3 cases. The standing AP X-ray films were obtained at intervals of 3 to 6 months.3. Sliding pattern was designed between pedicle screws and rods to accommodate spinal growth. 12 new spinal columns of pigs were random divided into 2 groups (sliding group and locking group). Testing biomechanical methods was used to analyze corresponding results.Research Result1. In structural thoracic group and lumbar group the mean Cobb angle was 40°and 21°in gravity-suspendig traction X-film, 41°and 23°in supine bending X-film, 35°and 19°in fulcrum bending X-film, 36°and 18°in postoperative standing X-film respectively. In severe group and moderate group the mean Cobb angle was 52°and 23°in gravity-suspendig traction X-film, 53°and 24°in supine bending X-film, 47°and 20°in fulcrum bending X-film, 44°and 19°in postoperative standing X-film respectively. In rigid group and flexible group the mean Cobb angle was 51°and 22°in gravity-suspendig traction X-film, 52°and 22°in supine bending X-film, 48°and 18°in fulcrum bending X-film, 45°and 17°in postoperative standing X-film respectively. In anterior approach group and posterior approach group the mean Cobb angle was 47°and 15°in gravity-suspendig traction X-film, 49°and 16°in supine bending X-film, 43°and 11°in fulcrum bending X-film, 42°and 10°in postoperative standing X-film respectively. Above all Cobb angle are mean numerical value,The mean follow-up period was 1.5years (range:1years~3years).2. 79 cases (74.5%) with the brace showed a good effectiveness, 27 cases (25.5%) were judged as curve progression ,All patients with a follow-up of 24 to 72 months (mean, 36 months). The difference of the initial brace correction rate was significant(P<0.05) between flexible scoliosis and rigid scoliosis.The lower the Cobb's angle , the higher the brace correction rate . The initial brace correcting effectiveness in patients with a Cobb's angle between 20°to 30°were higher than with a Cobb's angle between 30°to 40°(P<0.05).3. samples of sliding group and locking group were tested in sagittal and coronal plane bending and axial compression. No statistical difference (P>0.05) was detected in main stress, deviation of apical vertebrae and strength of fixation.Conclusion1. The fulcrum bending X-films are more predicting of correctability of AIS patients than the gravity-suspendig traction and supine bending X-films, It can provide reference for chosing anterior or posterior approach and chosing fusion levels.2. Thermosetting plastic brace had a good treatment effectiveness, flexible scoliosis and lower Cobb's angle , correcting result is better.The focrum bending film can predict correcting effectiveness.3. Compared with traditional pedicle screw system, same stability could be got in correction with sliding instrumentation of pedicle screw system.
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