青少年特发性脊柱侧凸后路矫正的思考

青少年特发性脊柱侧凸的治疗,经历了辩证否定的发展过程,其中涉及一系列复杂矛盾的巧妙解决和对度的精确把握,哲学的思维方法有助于脊柱外科医生认识侧凸的本质,了解其演变规律,处理治疗过程出现的主要问题以及掌握矫正的关键技术。     

青少年特发性脊柱侧凸后路矫正的思考

青少年特发性脊柱侧凸的治疗,经历了辩证否定的发展过程,其中涉及一系列复杂矛盾的巧妙解决和对度的精确把握,哲学的思维方法有助于脊柱外科医生认识侧凸的本质,了解其演变规律,处理治疗过程出现的主要问题以及掌握矫正的关键技术.     

价值取向的代际效应及其与青少年心理和学校适应的关系

采用问卷法和教师评价法对上海、河南、山东、甘肃四地共1730名青少年及其父母进行调查,旨在考察价值取向的代际效应及其与青少年心理和学校适应的关系。结果发现：（1）父母集体价值取向均能正向预测青少年集体责任;父亲集体取向和母亲个体价值取向均能正向预测青少年同伴友情;父亲个体价值取向和母亲集体取向均能正向预测青少年超越进取;仅母亲个体取向正向预测青少年时尚潮流;（2）父母集体取向均能通过青少年集体责任对其心理适应产生积极影响;父母个体取向和母亲集体取向能通过青少年超越进取对其心理和学校适应产生积极影响;（3）母亲个体取向通过青少年同伴友情对其心理适应产生积极影响,对学校适应产生消极作用;母亲个体取向通过青少年时尚潮流对其心理和学校适应产生消极作用。这些结果证实了亲子之间存在价值取向的代际效应,并强调了代际效应对青少年的心理和学校适应的重要性。     

脑电双频指数（BIS）对脊柱侧凸矫正术中唤醒时间的影响

探讨脑电双频指数（bispectral index,BIS）监测不同镇静深度对脊柱侧凸矫正术中唤醒时间的影响,60例行脊柱侧凸矫正手术的患者随机分为三组,Ⅰ组BIS30～40,Ⅱ组BIS40～50和Ⅲ组BIS50～60,评价各组患者的唤醒时间及不良事件发生率。结果显示Ⅰ组唤醒时间为（18．13±2．3）min,明显长于Ⅱ组和Ⅲ组的唤醒时间。而当BIS为40～50时,患者术中的不良事件发生率明显低于另外两组。所以,使用BIS进行全麻镇静深度的监测,在唤醒前将镇静深度维持在BIS40～50是合适的。     

椎体成形术和球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩骨折的对比研究

为对比分析椎体成形术（PVP）与球囊扩张椎体后凸成形术（PKP）治疗骨质疏松性椎体压缩骨折的临床疗效。共治疗患者45例。PVP25例,PKP20例。所有患者术后疼痛均明显减轻或消失,PVP组与PKP组两组相比,术后的伤椎及相邻椎间隙高度、脊柱后凸Cobb角及ODI评分差异有统计学意义（P〈0．05）。PKP能够更好的恢复骨折椎体的高度,矫正脊柱后凸畸形,改善脊柱功能,明显减少骨水泥渗漏,临床效果较PVP更为满意。     

椎体成形术和球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩骨折的对比研究

为对比分析椎体成形术(PVP)与球囊扩张椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩骨折的临床疗效.共治疗患者45例.PVP25例,PKP20例.所有患者术后疼痛均明显减轻或消失,PVP组与PKP组两组相比,术后的伤椎及相邻椎间隙高度、脊柱后凸Cobb角及ODI评分差异有统计学意义(P<0.05).PKP能够更好的恢复骨折椎体的高度,矫正脊柱后凸畸形,改善脊柱功能,明显减少骨水泥渗漏,临床效果较PVP更为满意.     

脑电双频指数(BIS)对脊柱侧凸矫正术中唤醒时间的影响

探讨脑电双频指数(bispeetral index,BIS)监测不同镇静深度对脊柱侧凸矫正术中唤醒时间的影响,60例行眷拄侧凸矫正手术的患者随机分为三组,1组BIS 30～40,Ⅱ组BIS 40～50和Ⅲ组BIS 50～60,评价各组患者的唤醒时间及不良事件发生率.结果显示I组唤醒时间为(18.13+2.3)min,明显长于Ⅱ组和Ⅲ组的唤醒时间.而当BIS为40～50时,患者术中的不良事件发生率明显低于另外两组.所以,使用BIS进行全麻镇静深度的监测,在唤醒前将镇静深度维持在BIS40～50是合适的.     

青少年家庭功能与心理复原力的关系：一个有调节的中介模型

为探讨家庭功能、自我控制与青少年心理复原力的关系及其作用机制,采用家庭功能评定量表、自我控制量表、心理复原力量表对浙江省、山东省、河北省957名中学生进行调查。结果发现：（1）家庭功能对青少年心理复原力具有显著正向预测作用。（2）自我控制在家庭功能和青少年心理复原力之间起到部分中介作用。（3）家庭功能对青少年心理复原力中介过程的前半段路径受到性别调节,相比于女生,男生群体的家庭功能对自我控制的影响更为显著。     

脊柱创伤与慢性脊柱疾病患者心理状况调查和干预

脊柱疾病患者的病程较长,长时间的患病带来心身的极大损耗。我们对入住我科的脊柱疾病患者使用焦虑自评量表（SAS）和抑郁自评量表（SDS）进行自我测评,调查脊柱疾病患者心理状况,并对脊柱创伤和慢性脊柱疾病患者的心理状况进行比较,为实施干预措施提供依据。     

青少年脊柱侧弯的临床诊治进展

青少年特发性脊柱侧弯（AIS）既对患儿及家庭所造成的痛苦,也对患者家庭和国家财政都造成沉重的经济负担,引发各国及各级政府的高度关注。但是,随着对AIS了解的深入,质疑和犹豫也逐渐产生。本文回顾当前关于AIS的临床和基础研究结果,发现其中许多研究结论都充满了临床悖论。本文还通过总结作者单位的临床经验,提出的AIS诊治新原则。该原则利用脊柱对于AIS的充分代偿能力,改变聚焦于纠正脊柱畸形的传统理念,尽量维护脊柱的代偿平衡,同时避免对AIS患儿的歧视性宣传,避免诱导其发生心理自卑感。通过借鉴“代偿稳定、阴阳自和”等中医哲学理念可以在AIS等脊柱损伤退变性疾病的临床诊治过程中为患者争取最为实效的临床利益。     

Lumbar spine coordination during axial trunk rotation in adolescents with and without right thoracic idiopathic scoliosis

Adolescent idiopathic scoliosis (AIS) is a complex deformity that often leads to loss of coordination and dynamic posture. However, there is a lack of understanding on inter-segmental coordination in AIS. The purpose of this study was to compare spinal range of motion (ROM), as well as the relations to coupling angles (CA) in the spinal region during trunk rotation, between AIS and control subjects. There were 14 subjects with right thoracic AIS and 18 control subjects who participated in the study. All subjects were asked to perform five repeated axial trunk rotations in standing while holding a bar. The outcome measures included ROM at the first thoracic spinous process (T1), the seventh thoracic spinous process (T7), the twelfth thoracic spinous process (T12), and the first sacrum spinous tubercle (S1) by the motion capture system. The CA in each spinal region (trunk, lumbar spine, and lower and upper thoraces) were analyzed while considering age and body mass index (BMI). The Cobb angle demonstrated positive moderate relationships with ROM at T7 (r = 0.62, p = 0.04) and the CA in the upper thorax (r = 0.69, p = 0.02) in the AIS group. There was no CA difference at the spinous processes between groups; however, the lumbar spine ROM significantly decreased in the AIS group (t = 2.40, p = 0.02). The BMI demonstrated moderate relationships on the lumbar spine (r = −0.67, p = 0.02) in the AIS group and the lower thorax (r = 0.59, p = 0.01) in the control group. The lumbar spine was significantly dissociated in the AIS group during trunk rotation, although the Cobb angle demonstrated positive relationships with ROM at T7. Collectively, the inter-segmental CA indicated that the AIS group compensated more independently to the right thoracic convexity.Mini abstractThe coordinated trunk rotations in the adolescent idiopathic scoliosis (AIS) group were compared with the control subjects. The lumbar spine motion was dissociated with the thorax in the AIS group and was negatively correlated with body mass index. Clinicians need to consider thorax convexity and dissociated lumbar motion for compensatory and rehabilitation strategies.     

Patients’ and Parents’ Perceptions of Appearance in Scoliosis Treated with a Brace: A Cross-Sectional Analysis

The perspective of trunk deformity is a matter of special concern for adolescent idiopathic scoliosis (AIS) patients. No research group has ever reported interviewing patients and their parents regarding differences in perception of body appearance in the course of Cheneau brace treatment. We aimed to investigate the level of agreement in the field of concerns and perceptions of spinal appearance in relation to brace- and scoliosis-related data between parents and female patients with AIS, treated with a Cheneau brace, by means of the Spinal Appearance Questionnaire-pl (SAQ-pl). In this cross-sectional study forty-one pairs of parents and female patients with AIS were asked to separately complete the Polish versions of the Spinal Appearance Questionnaire-pl patient form (SAQ-pl patient form) and the SAQ-pl parent form. Age of patients was 13.60 years SD 1.60 (range 10–17). Patients scored 2.70 (SD 0.60) and parents scored 2.70 SD 0.60 in the total score of the SAQ-pl. The study groups do not differ significantly in regards to the SAQ-pl results. The percentage of consistent answers on SAQ-pl items ranges from 34.10 % (item 20) to 78 % (item 8). Height, age and brace-wearing time per day, were significantly related to the differences in the patient-parent General perception of body shape (r _s  = ?0.51, r _s  = ?0.34, r _s  = 0.36, respectively). Parents and female patients with AIS have similar concerns and perceptions of spinal appearance. The discrepancies in General perception of spinal appearance between parents and AIS females decrease with age of patient. Parental emotional support may contribute to minimizing the risk factors of psychological impairment, especially in late adolescents with AIS.     

Learning to stand tall: Idiopathic scoliosis,behavioral electronics,and technologically-assisted patient participation in treatment,c. 1969–1992

Drawing on the archives of American learning psychologist Neal E. Miller, this article investigates the role of instrumentation in the expansion and diversification of the behavior therapy domain from the late 1960s to the early 1990s. Through the case of Miller's research on the use of biofeedback to treat idiopathic scoliosis, it argues that the post-World War II adoption of electronic technology by behavioral psychologists contributed to extending their subject matter to include physiological processes and somatic conditions. It also enabled a technologically-instrumented move outside the laboratory through the development of portable ambulatory treatment devices. Using the example of the Posture-Training Device that Miller and his collaborators invented for the behavioral treatment of idiopathic scoliosis, this paper considers how electromechanical psychological instrumentation illustrated a larger and ambiguous strategic shift in behavior therapy from an orientation toward external control to one of self-control.     

Systemic Family Therapy Competences in Child and Adolescent Mental Health Care

This article is based on a doctoral research project aiming to identify a comprehensive and detailed outline of the systemic therapist competences in child and adolescent mental health care in Norway. Because of the growing demands to offer specialized services within child and adolescent mental health care, I intended the identified competences to target the psychosocial difficulties that are categorized as associated abnormal psychosocial situations (axis 5) in the multiaxial diagnostic system (WHO, Multiaxial classification of child and adolescent psychiatric disorders. The ICD-10 classification of mental and behavioural disorders in children and adolescents. Cambridge University Press, Cambridge, 1996). The project is based on twelve qualitative in-depth interviews with six experienced systemic family therapists, and fieldwork observations of the therapists (participants) in practice. The qualitative methodology is based on Grounded Theory and five overarching categories were identified through the analysis: (1): the importance of ethical and contextual awareness in systemic therapy; (2) the systemic therapist’s stance; (3) therapeutic processes; (4) therapeutic practices; and (5) session-specific features. Challenges, such as limiting the systemic approach to five overarching competences, are discussed alongside this strengths and limitations of the study. The detailed outline of systemic therapist competences is intended to offer a framework for delivering flexible, yet specialized systemic therapy in the context of child and adolescent mental health care. This research may therefore facilitate a “bridge-building process” between mental health’s biomedical focus and postmodern systemic ideas.     

Online mental health resources for adolescents: Overview of research and theory

Adolescents use the Internet at higher rates than any other age group. The Internet therefore offers an obvious opportunity for the provision of mental health information for them. Little is known, however, about adolescent behaviour online, especially access of age‐appropriate mental health resources. This review of the published literature examines theoretical and research studies to develop an understanding of adolescent mental health‐seeking behaviour on the Internet. It is clear that adolescents do seek health information online, but little is known about its content, nature or mode of delivery. There appears to be no research specific to mental health resources for adolescents online.     

A qualitative evaluation of a mental health literacy intervention for parents delivered through community sport clubs

Intervention studies have rarely targeted parent mental health literacy despite its importance for adolescent mental health. This qualitative study evaluated the experiences of parents (n = 352) who participated in the Ahead of the Game mental health literacy workshop delivered through community sport clubs. Moreover, the study aimed to investigate the relevance, retention and use of intervention content by parents, assess the acceptability and feasibility of delivering mental health education through community sport clubs, and identify strategies for increased engagement. In total, 17 parents (13 mothers, four fathers) participated in semi-structured interviews up to one month after the workshop. Reflexive thematic analysis revealed that parents perceived mental health education as important and valuable, and believed the community sport club was an appropriate setting to discuss adolescent mental health. Parents reported increased awareness and knowledge of mental health disorders and help-seeking options, and increased confidence and preparedness to communicate and assist someone experiencing a mental health issue. The workshop stimulated conversation about mental health between parents and their children, and between parents within and outside the sport club community. Parents used information and resources provided in the workshop to help those in their networks and reflected back on the workshop when noticing changes in their adolescent’s behavior. Potential additions to the workshop (as suggested by parents) included increased discussion among parents as well as opportunities for further information sessions or tailored online material. Future research might look to engage more fathers, actively encourage parents to aid in the recruitment of others, and investigate long-term adolescent mental health outcomes.     

The Relation Between Parental Mental Illness and Adolescent Mental Health: The Role of Family Factors

Children of parents with a mental illness are often found to be at high risk of developing psychological problems themselves. Little is known about the role of family factors in the relation between parental and adolescent mental health. The current study focused on parent–child interaction and family environment. This cross-sectional questionnaire study included 124 families with a mentally ill parent and 127 families without a mentally ill parent who at the time of the study had children aged 11–16 years old. Parents completed questionnaires about their mental health, parent–child interaction (i.e., parental monitoring and parental support), and family environment (i.e., cohesion, expressiveness, and conflict). Adolescents reported their internalizing and externalizing problems. Path analyses were used to examine the direct associations between parental mental illness and adolescent problems as well as the indirect relations via parent–child interaction and family environment. The results showed that interaction between parents with a mental illness and their child was significantly worse compared to parents without a mental illness. The family environment of parents with mental illness was also more negative. Mentally ill parents monitored their adolescents less, which in turn related to more externalizing problems of the adolescents. No factors mediated the relation between parental mental health and adolescent internalizing problems. Moreover, no direct effects of parental support, family cohesion, and family expressiveness with externalizing problems were found. These findings imply that parental monitoring should get a specific focus of attention in existing interventions designed to prevent adolescents with a mentally ill parent from developing problems.     

Storytelling: An enjoyable and effective therapeutic tool

Storytelling has great potential for stimulating insight and behavior change, particularly when client and clinician seem to have reached an impasse, as is frequently the case with adolescent clients. The storytelling process provides a viable alternative to the traditional therapeutic communication style in which the client is the only storyteller. It provides a means to circumvent client resistance and present new concepts and paradigms for healthy behavior. This paper provides a practical guide for the use of therapeutic metaphors and storytelling as an intervention technique, provides examples of successful interventions made through the storytelling process with both adolescent and adult clients, and outlines suggestions for the effective use of storytelling as a therapeutic tool.Joyce Divinyi, MS, a licensed professional counselor, is a consultant with The Wellness Connection, Peachtree City, Georgia, providing wellness education and mental health training programs and individual and family counseling services. She was formerly the executive director of a residential treatment program for adolescent girls. Reprint requests should be sent to the author at The Wellness Connection, 125 Highgreen Ridge, Peachtree City, GA 30269.