Bei der Behandlung der idiopathischen Adoleszentenskoliose werden für die Spondylodese verschiedene Knochenmaterialien verwendet. Das autologe Knochenmaterial wird als der „Goldstandard“ bezeichnet. Da größere Mengen von Knochenmaterial für die Spondylodese nötig sind, erfolgt die Entnahme des autologen Knochens oft auch vom Beckenkamm. Dies kann zu erheblichen Komplikationen führen. Bei der Verwendung von allogenem Material besteht immer die Gefahr der viralen und bakteriellen Kontamination. Aufgrund dieser Probleme besteht ein Interesse an kompatiblen und osteokonduktiven Knochenersatzmaterialien. In dieser Studie soll untersucht werden, ob mit dem Knochenersatzmaterial beta-Tricalciumphosphat in Granulatform eine spinale Fusion erreicht werden kann. Dazu wurden 28 Patienten mit idiopathischer Adoleszentenskoliose nach der Methode von Cotrel-Dubousset operiert. Für die dorsale Spondylodese wurde bei 19 Patienten eine Mischung aus autologem/allogenem Knochen verwendet. 9 Patienten erhielten eine Mischung aus autologem Knochen und 25 g beta-Tricalciumphosphat in Granulatform. Als Verlaufskontrolle wurden zu verschiedenen Zeitpunkten klinische Untersuchungen durchgeführt und Röntgenbilder angefertigt. Zur Beurteilung der Knochendichte wurde bei allen Patienten nach ca. 11 Monaten eine Computertomographie durchgeführt. Eine Fusion der Segmente war bei beiden Gruppen anhand der Röntgenbilder nach ca. 6 Monaten vorhanden. Keine Pseudarthrosen wurden beobachtet. Die Knochendichte war durchschnittlich 430 mg/cm³ in der TCP Gruppe und 337 mg/cm³ in der Knochengruppe. Nach ca. 8 Monaten war das TCP auf den Röntgenbilder nicht mehr nachweisbar. Nach den Ergebnissen zu urteilen, ist beta-Tricalciumphosphat eine gute Alternative bei der operativen Behandlung der idiopathischen Adoleszentenskoliose, mit der ähnliche spinale Fusionsraten, wie mit autologem/allogenem Knochen erreicht werden können, besonders, wenn große Mengen an Knochen benötigt werden. / For correction of idiopathic adolescent scoliosis different bone materials are used to achieve spinal fusion. Autograft bone is known as the gold standard. Mostly large quantities of bone materials are needed for spinal fusion. Autograft bone is often taken from the iliac crest which can lead to severe problems. Using allografts there is always a risk of viral or bacterial contamination. Due to these problems the interest in compatible and osteconductive bone materials is rising. The aim of this study is to evaluate the ability of beta-tricalciumphosphat in granular form to achieve dorsal spondylodesis in adolescent idiopathic scoliosis. 28 patients underwent surgical correction by the method of Cotrel-Dubousset. Posterolateral grafting was performed using autograft/allograft bone for 29 patients and a mixture of autograft bone and 25 g of beta-tricalciumphosphate for 9 patients. As a follow-up clinical examination and X-rays were done at several dates. To measure the bone density CT-scans were taken about 11 month after surgery. According to the radiographs a solid fusion was shown after approximately 6 month in both groups. No pseudarthrosis was observed. Bone mineral density was about 430 mg/cm³ in the TCP group and 337 mg/cm³ in the bone group. After approximately 8 month the TCP was unverifiable in the X-rays. Based on the results of this study beta-tricalciumphosphate can be seen as an alternative in the surgical correction of idiopathic adolescent scoliosis. Similar spinal fusion rates compared with the use of autograft/allograft bone can be achieved, especially when huge quantities of bone are needed.

Medical imaging plays an increasingly important role in modern healthcare. In medical imaging, it is often relevant to relate different images to each other, something which can prove challenging, since there rarely exists a pre-defined mapping between the pixels in different images. Hence, there is a need to find such a mapping/transformation, a procedure known as image registration. Over the years, image registration has been proved useful in a number of clinical situations. Despite this, current use of image registration in clinical practice is rather limited, typically only used for image fusion. The limited use is, to a large extent, caused by excessive computation times, lack of established validation methods/metrics and a general skepticism toward the trustworthiness of the estimated transformations in deformable image registration. This thesis aims to overcome some of the issues limiting the use of image registration, by proposing a set of technical contributions and two clinical applications targeted at improved clinical efficiency. The contributions are made in the context of a generic framework for non-parametric image registration and using an image registration method known as the Morphon.  In image registration, regularization of the estimated transformation forms an integral part in controlling the registration process, and in this thesis, two regularizers are proposed and their applicability demonstrated. Although the regularizers are similar in that they rely on local structure analysis, they differ in regard to implementation, where one is implemented as applying a set of filter kernels, and where the other is implemented as solving a global optimization problem. Furthermore, it is proposed to use a set of quadrature filters with parallel scales when estimating the phase-difference, driving the registration. A proposal that brings both accuracy and robustness to the registration process, as shown on a set of challenging image sequences. Computational complexity, in general, is addressed by porting the employed Morphon algorithm to the GPU, by which a performance improvement of 38-44x is achieved, when compared to a single-threaded CPU implementation. The suggested clinical applications are based upon the concept paint on priors, which was formulated in conjunction with the initial presentation of the Morphon, and which denotes the notion of assigning a model a set of properties (local operators), guiding the registration process. In this thesis, this is taken one step further, in which properties of a model are assigned to the patient data after completed registration. Based upon this, an application using the concept of anatomical transfer functions is presented, in which different organs can be visualized with separate transfer functions. This has been implemented for both 2D slice visualization and 3D volume rendering. A second application is proposed, in which landmarks, relevant for determining various measures describing the anatomy, are transferred to the patient data. In particular, this is applied to idiopathic scoliosis and used to obtain various measures relevant for assessing spinal deformity. In addition, a data analysis scheme is proposed, useful for quantifying the linear dependence between the different measures used to describe spinal deformities.

La scoliose idiopathique de l’adolescent (SIA) est la déformation la plus fréquente en orthopédie pédiatrique. C'est une maladie qui génère des déformations complexes du rachis, du thorax et du bassin affectant plus sévèrement et majoritairement les filles à la puberté. Malgré de nombreuses années de recherches approfondies dans le domaine de la SIA, la cause n'a toujours pas été résolue. OBJECTIFS : Il a été démontré qu’il existe une dysfonction de la signalisation de la mélatonine par les protéines G inhibitrices (Gi) dans les ostéoblastes isolés de patients atteints de SIA. Ceci a conduit à une stratification des patients en trois groupes fonctionnels. Le but de ce projet de maîtrise est d’établir les profils d’expression moléculaire correspondant à chacun des groupes fonctionnels. Les objectifs spécifiques sont d’identifier les gènes responsables de l’initiation de la SIA et du défaut différentiel observé dans la signalisation des récepteurs couplés aux protéines Gi. MÉTHODES : Des ARNs ont été préparés à partir d’ostéoblastes isolés de patients atteints de SIA sélectionnés pour chaque groupe fonctionnel et comparés aux ARNs obtenus d’ostéoblastes de sujets sains. En plus, des cellules sanguines (PBMCs) isolées d’une paire de jumelles monozygotes discordantes pour la scoliose ont été étudiées pour comparer leur profil d’expression génétique. Nous avons utilisé des biopuces à ADN contenant un ensemble de 54,000 sondes permettant l’analyse du niveau d’expression de plus de 47,000 transcrits représentant 30,000 gènes humains bien caractérisés (Affymetrix, GeneChip® Human gene 1.0 ST array). Les gènes retenus ont par la suite été validés par qPCR sur un plus grand nombre de patients afin de tester la spécificité des profils d’expression pour chaque groupe de patients à partir des cellules osseuses dérivées lors de la chirurgie. RÉSULTATS: Le profilage moléculaire proposé permettra d’établir les fondements moléculaires de la SIA selon le test fonctionnel développé par le Dr Moreau et son équipe et d’identifier de nouveaux gènes associés à la SIA. Ce projet a permis de mettre en évidence des gènes possiblement impliqués dans le défaut de signalisation associé aux protéines Gi communs aux trois groupes, ainsi que des gènes spécifiques à certains groupes, pouvant contribuer au développement de certaines co-morbidités et/ou au risque d’aggravation des déformations rachidiennes. L’étude préliminaire des jumelles monozygotes discordantes pour la scoliose a mis en évidence un nombre limité de gènes possiblement associés au défaut de signalisation observé chez la jumelle scoliotique, gènes dont l’expression pourrait être influencée par des modifications d’ordre épigénétique liées à l’environnement. CONCLUSION: Les données obtenues par des approches de transcriptomiques dans le cadre de ce projet soutiennent notre méthode de stratification fonctionnelle des patients SIA et ont conduit à l’identification de nouveaux gènes associés à la SIA. Ces résultats jettent un éclairage nouveau sur la SIA et contribuent à une meilleure compréhension des mécanismes et facteurs impliqués dans l’étiologie de la SIA. À cet égard, nos résultats permettront éventuellement d’identifier des cibles thérapeutiques potentielles et des traitements personnalisés compte tenu des profils moléculaires distincts observés pour chaque groupe de patients. / The adolescent idiopathic scoliosis (AIS) is the most common deformity in paediatric orthopaedics. It is a disease that generates complex deformations of the spine, thorax and pelvis and severely affecting mainly girls at puberty. Despite many years extensive research into the field of AIS, the cause of this disorder has still not been resolved. OBJECTIFS: We have demonstrated a differential melatonin signaling dysfunction through G inhibitory (Gi) proteins in osteoblasts isolated from AIS patients. This led to a stratification of AIS patients into three distinct functional groups. The goal of this project is to establish molecular expression profiles corresponding to each functional group. The specific objective is to identify genes responsible for the initiation of the AIS and the differential dysfunction in the signaling of Gi protein-coupled receptors. METHODES: Osteoblasts isolated from AIS patients of each functional subgroup were selected and compared to osteoblasts obtained from healthy controls. In addition, blood cells (PBMCs) isolated from a pair of monozygotic discordant twins of scoliosis was studied to compare their gene expression profiles. We used DNA chips with 54,000 probe sets that allow analysis of expression level of over 47,000 transcripts and variants from over 30,000 well-characterized human genes (Affymetrix, GeneChip® Human gene 1.0 ST array). The identified genes were subsequently validated by qPCR in a larger number of patients in order to test the specificity of expression profiles for each group of patients using bone cells derived during surgery. RESULTS: The molecular profiling will establish the molecular basis of AIS according to the functional test developed by Moreau et al., and identify new genes associate with AIS. This project may allow us to identify genes involved in the dysfunction of Gi protein signaling which present in all three groups of patients. Also genes associated specifically with a particular group, can contribute to the development of certain AIS co-morbidities and/or to a risk of aggravation of spine deformities. The preliminary study of monozygotic discordant twins of scoliosis revealed a limited number of genes potentially associated with the signaling defect observed in the scoliotic twin, the gene expression could be influenced by epigenetic changes related to the environment. CONCLUSION: The data obtained by transcriptomic approaches further support our functional method of AIS patients’ stratification, also allowed the identification of novel genes associated with AIS. Such results would provide us a better understanding of the mechanisms and factors involved in the etiology of AIS. In this regard, our results would help to identify potential and specific therapeutic targets and personalized treatments based on the distinct molecular profiles observed in each patient group.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) surgery is the most common reason for elective pediatric orthopaedic surgery. Minimization of adverse events is an important goal. Institute of Medicine (IOM) outlined 6 facets of healthcare quality improvement within the acronym STEEEP. Two of these facets, Safety and Timeliness for AIS surgery in Canada, are examined in this thesis. METHODS: A three - part study, using clinical records at the largest Canadian pediatric hospital and CIHI national administrative data, determined i) the relationship between surgical wait times and rates of adverse events, along with determination of an empirically derived access target, ii) accuracy of ICD-10 coding of surgical AIS cases along with an optimal search strategy to identify surgical AIS cases, and iii) the volume – outcome relationships for scoliosis surgery using hierarchical and conventional single level multi-variate regression analysis. RESULTS: Access target of 3 months minimized the adverse events related to waiting. Optimal search strategy for AIS surgical cases using ICD-10 coding required combination of codes as each code in isolation was inaccurate due to limitations in coding definitions. There was no significant volume – outcome relationship using appropriate modeling strategies. CONCLUSIONS: Ensuring timeliness of surgical treatment of less than 3 months is important in surgical cases of AIS given the potential for curve progression in higher risk individuals who are skeletally immature with large magnitude curves at time of surgical consent. At the administrative database level, knowledge of coding accuracy and optimal search strategies are needed to capture a complete cohort for analysis. In AIS, several ICD-10 codes need to be combined. AIS surgery cases captured through this optimal search strategy, revealed no significant volume-outcome relationships with appropriate modeling. Based on these results, minimum volume thresholds and regionalization of care for AIS surgery does not appear to be justified. However, a larger sample size was needed to determine whether there was a clinically significant difference in wound infection and blood transfusion rates. Furthermore, clinical variables, not part of an administrative database such as curve pattern were not included.

Raktiniai žodžiai: laikysena, skoliozė, raumenų tonusas, kineziterapija. Tyrimo objektas: 10-16 metų (5,6,7,8 klasių) vaikų, sergančių cerebriniu paralyžiumi laikysenos sutrikimai ir korekcija. Tyrimo problema: Netaisyklinga laikysena, ydinga laikysena, skoliozė – vis dažniau skambančios frazės ugdymo įstaigose šiomis dienomis. Šiame kompiuterių ir technikos amžiuje laikysenos sutrikimai yra labai dažnas reiškinys mokinių tarpe. Vaikams, sergantiems cerebriniu paralyžiumi, ši problema yra ypač aktuali, nes jų kūno laikyseną labai įtakoja jų specifinis raumenų tonusas, sąnarių kontraktūros, jau nekalbant apie nepritaikytus mokyklinius suolus ir laiką, praleistą prie kompiuterio. Jų kūno laikyseną reikia nuolat prižiūrėti, intensyvinti mankštas, taikyti įvairius metodus, naujoves, kad pasiekti pačią optimaliausia formą. Darbo tikslas: Išsiaiškinti, ar pakito tiriamųjų laikysena bei raumenų jėga ir tonusas, pritaikius judesių korekcijos užsiėmimų programą. Tyrimo uždaviniai: 1. Apibendrinti literatūrą apie vaikų laikysenos sutrikimus, vaikų, sergančių cerebriniu paralyžiumi raumenų tonuso ypatumus. 2. Įvertinti cerebriniu paralyžiumi sergančių vaikų laikyseną, sąnarių amplitudes, raumenų tonusą bei jėgą prieš judesių korekcijos užsiėmimų programos sudarymą. 3. Ištyrus sudaryti judesių korekcijos užsiėmimų bendrą programą (bendrą ir jei reikia individualią); 4. Įvertinti cerebriniu paralyžiumi sergančių vaikų laikyseną, raumenų tonusą bei jėgą judesių korekcijos užsiėmimų... [toliau žr. visą tekstą] / Key words: posture, scoliosis, muscular tonicity, kinezitherapy. The object of research: posture disorder and correction of 10-16 year (5th, 6th, 7th and 8th forms) children having cerebral paralysis. The problem of research: Incorrect posture, perverse posture and scoliosis are phrases heard and pronounced more and more often at educational institutions nowadays. In the computer and machine age posture disorder is a very common phenomenon among schoolchildren. The problem is especially relevant for children having cerebral paralysis as their body posture is extremely influenced by specific muscular tonicity and articular contractor not to mention unfitted school desks and time spent in front of the computer. In order to achieve the most optimum physical form these children’s body posture must always be under observation, exercises should be intensified and various methods and innovations applied. The purpose of research: To ascertain if children’s in the study posture and muscular power and tonicity have changed since the application of the programme of activities of movement correction. The objectives of research: 1. To summarize literature on the disorder of children’s posture and peculiarities of muscular tonicity of children having cerebral paralysis. 2. To evaluate posture, articular amplitude, muscular tonicity and power of children having cerebral paralysis before formation of the programme of activities of movement correction. 3. To form a general programme of... [to full text]

No description available.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) surgery is the most common reason for elective pediatric orthopaedic surgery. Minimization of adverse events is an important goal. Institute of Medicine (IOM) outlined 6 facets of healthcare quality improvement within the acronym STEEEP. Two of these facets, Safety and Timeliness for AIS surgery in Canada, are examined in this thesis. METHODS: A three - part study, using clinical records at the largest Canadian pediatric hospital and CIHI national administrative data, determined i) the relationship between surgical wait times and rates of adverse events, along with determination of an empirically derived access target, ii) accuracy of ICD-10 coding of surgical AIS cases along with an optimal search strategy to identify surgical AIS cases, and iii) the volume – outcome relationships for scoliosis surgery using hierarchical and conventional single level multi-variate regression analysis. RESULTS: Access target of 3 months minimized the adverse events related to waiting. Optimal search strategy for AIS surgical cases using ICD-10 coding required combination of codes as each code in isolation was inaccurate due to limitations in coding definitions. There was no significant volume – outcome relationship using appropriate modeling strategies. CONCLUSIONS: Ensuring timeliness of surgical treatment of less than 3 months is important in surgical cases of AIS given the potential for curve progression in higher risk individuals who are skeletally immature with large magnitude curves at time of surgical consent. At the administrative database level, knowledge of coding accuracy and optimal search strategies are needed to capture a complete cohort for analysis. In AIS, several ICD-10 codes need to be combined. AIS surgery cases captured through this optimal search strategy, revealed no significant volume-outcome relationships with appropriate modeling. Based on these results, minimum volume thresholds and regionalization of care for AIS surgery does not appear to be justified. However, a larger sample size was needed to determine whether there was a clinically significant difference in wound infection and blood transfusion rates. Furthermore, clinical variables, not part of an administrative database such as curve pattern were not included.

Tyrimo objektas: sergančiųjų skolioze nuomonė apie gyvenseną, fizinį aktyvumą ir gydymą sanatorijos sąlygomis. Tyrimo subjektas: Šiaulių sanatorinės mokyklos mokiniai. Hipotezė: mokinių, sergančių įvairaus laipsnio skolioze, gydymo sanatorinėmis sąlygomis fizinė veikla ir gydymo procedūrų įvairovė, jų taikymo dažnis, nežiūrint kai kurių gyvensenos pokyčių, teigiamai veikia mokinių sveikatą. Tyrimo tikslas: ištirti, mokinių, sergančių skolioze gyvensenos įvairovę, nuomonę apie fizinę veiklą, gydymo procedūras ir pamokas. Tyrimo uždaviniai: 1. Sergančių skolioze mokinių demografinė charakteristika sanatorinėje mokykloje. 2. Priežastys, dėl ko mokiniai patiria gyvenimo sunkumus sanatorinėje mokykloje. 3. Sanatorinės mokyklos mokinių nuomonė apie gydymo procedūras ir pamokas. 4. Sanatorinės mokyklos mokinių fizino aktyvumo vertinimas. Išvados: 1. Sanatorijoje yra daugiau mergaičių nei berniukų. Daugiau vyresnio nei jaunesnio amžiaus mokinių. Mokiniai mokykloje mokosi tol, kol pasiekia teigiamų gydymo rezultatų, didžioji dalis mokosi pirmus arba antrus metus. Dauguma sanatorijos mokinių serga I ir II laipsnio skolioze. Jaunesniųjų sanatorijoje daugiausia su skolioze II°, o vyresniųjų skolioze I°. 2. Sanatorijos mokiniai susiduria su įvairiais sunkumais. Dažniausios patiriamų sunkumų priežastys - tėvų ir namų ilgesys, nuvargimas gulimoje padėtyje mokantis. 3. Daugumai mokinių visos procedūros patinka, bet malonumą kartais vertino prieštaringai, pavyzdžiui: gydomasis plaukimas... [toliau žr. visą tekstą] / Research object: students with scoliosis opinion about quality of life, physical activity and treatment of sanatorium conditions. Research subject: students in Siauliai sanatorium school. Hypothesis: students with differents degrees of scoliosis treatment in sanatorium conditions physical activity and treatments procedures applying, the frequency, some of the quality of life changes that positively affects students health. Research aim: students with scoliosis explore diversity to quality of life, opinion about physical activity, treatment procedures and lessons. Research tasks: 1. Students with scoliosis demographic characteristics in sanatorium school. 2. Students difficulties experiencing life in sanatorium school. 3. Students opinion about treatments procedures and lessons in sanatorium school. 4. Students physical activity evaluation in sanatorium school. Conclusions: 1. School studys and lives more girls than boys in sanatorium. Also, more older than younger age students. The students learns until they reach the positive treatment results most of them studys during the first or second year. Most students in sanatorium school sick I and II degree scoliosis. The youngest students in sanatorium school mostly with scoliosis II° and the oldest mostly with scoliosis I°. 2. Sanatorium school students comes up with differents of difficulties. The most rising difficulties among the students - yearning for parents and home, tiredness in learning lying position. 3. Most students... [to full text]

Inledning: Postoperativ smärta hos barn är fortfarande ett problem trots förbättrade arbetsrutiner och smärtbehandling. Smärtskattning på barn och speciellt barn med kognitiva nedsättningar kräver att sjuksköterskorna har kunskap om tillgängliga smärtskattningsinstrument. På så vis ges alla barn möjlighet att smärtskattas. Syfte: Att undersöka hur ofta sjuksköterskor smärtskattar barn som opereras för skolios postoperativt. Design: En retrospektiv studie. Metod: Journalgranskningen genomfördes på Universitetssjukhuset i Linköping. Alla barn som under 2008-2009 opererats för Idiopatisk eller Neuromuskulär skolios, var mellan 0-18 år och fanns med i journaldatasystemet inkluderades i studien. Resultat: Barn med Idiopatisk skolios smärtskattades oftare än barn med Neuromuskulär skolios. Barn som inte förstod instruktion smärtskattades inte lika ofta som de barn som förstod instruktion. Flickor smärtskattades oftare än pojkar inom gruppen som förstod instruktion. Konklusion: Det fanns en signifikant skillnad i frekvens smärtskattning mellan Idiopatisk skolios och Neuromuskulär skolios, utöver detta gjordes fyndet att flickor smärtskattades högre än pojkar. För att alla skall få möjlighet till lika god omvårdnad krävs att det finns tillgång till olika smärtskattningsinstrument. / Background: Despite improved guidelines and treatment of children, postoperative pain is still a problem. Painassessment in children and specially children with cognitive disibilities demands knowledge in existing pain measurement tools for nurses. Then all children have the opportunity to express their pain. Aim: To find out if there is a difference in the frequency of assessment in postoperative pain in children after surgery for scoliosis. Design: A retrospective study. Methods: The study was performed in Linköping University hospital. Children admitted 2008-2009 for Idiopatic scoliosis or Neuromuscular scoliosis surgery, in age 0-18 years and available via the data journal were included in the study. Results: Children with Idiopatic scoliosis had a higher freqvence of painassessment compared with Neuromuscular scoliosis. Children who didn´t understood verbal information had less frequence of painassesment compered with those who understood verbal information. Girls were assessed for pain significant more often as compared to boys in the group who understood verbal information. Conclusion: There was differences between children who were able to express themselves and those who weren´t in painassessment, but also gender matters and to ensure all children’s right to similar care it´s of importance to access different pain measurement tools.

Surgical correction of scoliosis is a complicated mechanical process. Understanding the loads applied to the spine and providing immediate feedback to surgeons during scoliosis surgery will prevent overloading, improve surgical outcome and patient safety. Long-term development of residual forces in the spinal instrument after surgery with the continual curvature changes over time has been unknown. The goal of this research work was to develop a wireless implantable sensor platform to investigate the loads during and after surgery. This thesis describes research leading to the design of a sensor platform that uses both 403 MHz and 2.45 GHz for wireless communication, and reports the resolution and accuracy of the built-in temperature sensor, the A/D accuracy of the sensing platform, the power consumption at different operation modes, the range of the wireless communication and the discharge characteristics of a potential capacitive power module. / Biomedical Engineering