青少年特发性脊柱侧凸病因学研究进展

青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）是指青春期或骨骼成熟前发生的结构性脊柱侧弯畸形（在冠状面上Cobb角〉10°，且合并有脊柱的旋转），而无其他器质性疾病。AIS在小儿肌肉骨骼系统中是发病率较高的畸形之一，占整个脊柱侧凸的70％～80％。尽管脊柱侧凸临床上已治疗多年，但是发病机制尚不清楚。近年来就其遗传、生长发育、神经肌肉、激素、结缔组织等方向做了大量的研究，本文就其病因学研究进展予以综述。     

基因和发育在特发性脊柱侧凸病因学中的研究进展

青少年特发性脊柱侧凸（AIS）是一种好发于青春期的脊柱不对称性旋转病变，病因不详。如果要对其进行合理的预防和治疗，就必须对其病因学有明确的了解。但“特发性”的含义是指“病因不明确”，它不同于有明确病因的脊柱侧凸，如结缔组织性（如马凡综合征）、神经肌肉性（如脑瘫）和结构性（如先天性半椎体）脊柱侧凸等。因此，以往提出过很多有关特发性脊柱侧凸病因学的理论。近年来，特发性脊柱侧凸病因学的研究范围非常广泛，从动物模型、影像学、组织学、神经学、免疫荧光检查、生物力学、数学模型、基因学到分子生物学研究，特发性脊柱侧凸的临床模式和病因学方面取得了很大的进展。现就基因和发育方面的进展进行综述。     

Goldenhar综合征伴脊柱侧凸1例

Goldenhar综合征又名眼、耳、脊柱发育不良综合征,是一种少见的多发畸形,临床表现多样化,最初由Von Arlt于1845年首先描述,Goldenhar于1952年对此进行了详细描述并总结为综合征[1].Goldenhar综合征发生率为1/45 000-1/5 000,男女比例大致为3∶ 2,是一种在胚胎早期以眼、耳、颜面和脊柱发育异常为主的遗传学先天缺陷,也可伴其他器官和系统异常,如心、肝、肾、神经系统,其临床表现具有高度特异性.常见的体征包括：眼部异常、耳部畸形、脊柱畸形、颜面畸形及其他系统异常等.     

青少年特发性脊柱侧凸患者椎旁肌改变的研究进展

青少年特发性脊柱侧凸(adolescent idiopathic scol-iosis,AIS)是一种常见的脊柱畸形,在人群中发病率约为0.5%～1%,女性多于男性,在我国女性青少年中的发病率大约为3%～4%,其发病机理目前仍然不明确.与AIS病因学相关的假说包括基因遗传、神经系统平衡功能异常、神经内分泌异常以及躯干生长不平衡等.     

特发性脊柱侧凸褪黑素信号传导通路的研究进展及其临床意义

青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)是一个复杂的三维脊柱畸形,常累及青春期10～16岁的女孩.AIS的病因尚小清楚,近来褪黑素信号传导通路的深入研究使得褪黑素(melatonin)与侧凸之间的相关性再次成为AIS病因学研究的一个热点.     

青少年特发性脊柱侧凸的病因学研究现状和进展

青少年特发性脊柱侧凸是一种在未成年人中最常见的三维脊柱畸形,发生于11～18岁之间.青少年特发性脊柱侧凸被认为是影响青少年身心健康的重要疾病,近年来,中国国内各地医疗机构开始逐步落实青少年脊柱侧凸的防治工作.若能从源头抑制或阻止青少年特发性脊柱侧凸的发生发展,则可以更有效地减少该病对未成年人的影响,由此可见青少年特发性...     

特发性脊柱则凸脊髓异常的MRI评价

脊柱侧凸是一种常见的脊柱畸形 ,其中特发性脊柱侧凸约占 70 % ,其在儿童青少年中的发病率约为 1%～3%。随着影像学检查的深入 ,尤其是ＭＲＩ在特发性脊柱侧凸中的应用 ,越来越多的脊髓异常被发现 ,其意义尚待进一步探讨。1　特发性脊柱侧凸的脊髓异常脊柱侧凸脊髓异常的发生率与侧凸类型密切相关 :①不加区分的各种侧凸脊髓异常的发生率由于病例选择的随意性 ,差别明显 ,报道为 18.7%～5 3%。②先天性脊柱侧凸的脊髓异常发生率较高 ,所见报道为 38%、40 %、5 8%。③其他所谓“异常侧凸”的脊髓异常发生率较高 :胸椎左侧凸脊髓异常发生率通…     

生长发育异常和青少年特发性脊柱侧凸

青少年特发性脊柱侧弯(AdolescentIdiopathicScoliosis ,以下简称AIS)是以脊柱在冠状面上的侧凸、矢状面上的胸椎后凸减少甚至前凸和脊椎在水平面上的旋转为特征的三维畸形,它是最常见的青少年脊柱畸形之一。如果将诊断标准定为Cobb角大于10°,其发病率是3%左右[1] ,邱勇等[1] 发现AIS占整个脊柱侧凸病因学诊断的80 %。目前AIS的发病机理以及进展机制还不明确,有各种不同的假设。由于AIS的发生发展和脊柱生长有着密切的联系,本文拟就AIS患者生长发育的相关研究进行综述。1AIS的生长发育AIS的出现及加重均在青春期生长发育的高峰期…     

鼠类脊柱侧凸动物模型研究进展

脊柱侧凸是指脊柱椎体向侧方移位并伴有椎体旋转的三维结构性畸形.国际脊柱侧凸研究协会定义脊柱侧凸为测量全脊柱正侧位X线片Cobb角＞10°[1].据统计,全球青少年脊柱侧凸的发病率为1％?3％[2].该疾病的发生可涉及多种因素,相关的病因学机制及遗传背景尚未明确.为研究该疾病的具体发病机制而进行人类随机对照试验不符合相关...     

神经系统异常在青少年特发性脊柱侧凸发病学中的作用

青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)是最常见的脊柱畸形,占全部脊柱侧凸的74.7%,以女性多见[1]。目前AIS的病因学存在多种假说,包括遗传、骨骼发育异常、内分泌及代谢系统异常、神经系统异常以及结缔组织异常等[2-3]。近年的研究表明,AIS患者的神经系统存在异常表现,提示神经系统异常可能在AIS的发生发展中起着重要作用。本文将对既往AIS患者神经系统异常的相关文献进行综述。     

Idiopathic scoliosis: etiological concepts and hypotheses

Scoliosis is diagnosed as idiopathic in 70 % of structural deformities affecting the spine in children and adolescents, probably reflecting our current misunderstanding of this disease. By definition, a structural scoliosis should be the result of some primary disorder. The goal of this article is to give a comprehensive overview of the currently proposed etiological concepts in idiopathic scoliosis regarding genetics, molecular biology, biomechanics, and neurology, with particular emphasis on adolescent idiopathic scoliosis (AIS). Despite the fact that numerous potential etiologies for idiopathic scoliosis have been formulated, the primary etiology of AIS remains unknown. Beyond etiology, identification of prognostic factors of AIS progression would probably be more relevant in our daily practice, with the hope of reducing repetitive exposure to radiation, unnecessary brace treatments, psychological implications, and costs-of-care related to follow-up in low-risk patients.     

Scoliosis: the bent spine

Scoliosis, a permanent abnormal curvature of the spine to the side, is divided into four forms: idiopathic (infantile, juvenile and adolescent, accounting for 80% of cases), neurogenic, congenital and adult scoliosis. Most patients with adolescent idiopathic scoliosis initially have mainly cosmetic problems. However, neurogenic, congenital and adult scoliosis can lead to severe clinical symptoms. The leading symptom is back pain caused by secondary changes. In recent years the Lenke classification has been proven to be a reliable tool for disease classification. Non-progressive scoliosis is usually treated conservatively. In the case of Cobb angles of greater than 50°, surgical therapy is recommended in patients presenting before adulthood. Technical improvements in implants and the optimisation of surgical methods have set a trend in the direction of surgical therapy.     

The importance of sagittal alignment in patients with adolescent idiopathic scoliosis and early onset scoliosis: A review on preoperative versus postoperative changes

Scoliosis is a three-dimensional spine deformity that in pediatric patients can progressively worsen to cause esthetic issues in adolescent idiopathic scoliosis (AIS) and lung complications in early-onset scoliosis (EOS). Previous emphasis was placed on only correcting coronal plane deformity, but recent research has demonstrated the importance of correcting sagittal plane alignment as well. Failure to do so can lead to adjacent segment disease or abnormal global sagittal balance which negatively affects quality of life. This review article summarizes current concepts of sagittal spine alignment in terms of radiographic parameters, outcomes, and complications when surgically treating patients with AIS and EOS.     

青少年脊柱侧弯的研究进展

【摘要】〓脊柱侧弯类型包括功能性脊柱侧弯及结构性脊柱侧弯。特发性脊柱侧弯属结构性脊柱侧弯,约占全部脊柱侧弯80%左右,是临床中最常见的结构性脊柱侧弯。青少年特发性脊柱侧弯(AIS)影响了约0.5%~3%的学生,由于中国的教育发展,中小学生的学习压力不断增加,相信AIS发病率可能进一步升高。脊柱侧弯的预后关键在于早期发现,早期干预。早期发现的最有效途径应该是普查,且早期畸形不明显亦无脊柱结构的变化,易于矫正。     

Abnormalities of the lumbar spine in the coronal plane on plain abdominal radiographs

The main objective of this study is to determine the prevalence of coronal abnormalities of the lumbar spine in a large population of patients with respect to their age and sex. Lumbar degenerative disease is associated with degenerative scoliosis. Degenerative scoliosis and lateral listhesis are important features to identify before decompressive surgery as deformity may not be seen on magnetic resonance imaging scans. Scoliosis and lateral listhesis may be important in the development of symptoms especially in an ageing population. All abdominal and plain kidney–ureter–bladder radiographs performed over a 10-month period were reviewed. 2,765 radiographs were assessed for scoliosis (Cobb angle greater then 10°), lateral listhesis and evidence of osteoarthritis. The prevalence of scoliosis, lateral listhesis and osteoarthritis of the lumbar spine increased with age. Scoliosis and lateral listhesis were significantly more prevalent in women. Deformity starts to occur after the age of 50 and steadily increases with age. By the ninth decade nearly a quarter of patients have evidence of scoliosis and lateral listhesis. As the adult lumbar spine ages, the prevalence of lateral listhesis and degenerative scoliosis increases. It is important to appreciate these coronal abnormalities in patients undergoing decompressive surgery for spinal stenosis. This increase in deformity may have a greater impact as the population continues to age.     

Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City, Japan

There have been a few studies regarding detail of back pain in adolescents with idiopathic scoliosis (IS) as prevalence, location, and severity. The condition of back pain in adolescents with IS was clarified based on a cross-sectional study using a questionnaire survey, targeting a total of 43,630 pupils, including all elementary school pupils from the fourth to sixth grade (21,893 pupils) and all junior high pupils from the first to third year (21,737 pupils) in Niigata City (population of 785,067), Japan. 32,134 pupils were determined to have valid responses (valid response rate: 73.7%). In Niigata City, pupils from the fourth grade of elementary school to the third year of junior high school are screened for scoliosis every year. This screening system involves a three-step survey, and the third step of the survey is an imaging and medical examination at the Niigata University Hospital. In this study, the pupils who answered in the questionnaire that they had been advised to visit Niigata University Hospital after the school screening were defined as Scoliosis group (51 pupils; 0.159%) and the others were defined as No scoliosis group (32,083 pupils). The point and lifetime prevalence of back pain, the duration, the recurrence, the severity and the location of back pain were compared between these groups. The severity of back pain was divided into three levels (level 1 no limitation in any activity; level 2 necessary to refrain from participating in sports and physical activities, and level 3 necessary to be absent from school). The point prevalence was 11.4% in No scoliosis group, and 27.5% in Scoliosis group. The lifetime prevalence was 32.9% in No scoliosis group, and 58.8% in Scoliosis group. According to the gender- and school-grade-adjusted odds ratios (OR), Scoliosis group showed a more than twofold elevated odds of back pain compared to No scoliosis group irrespective of the point or lifetime prevalence of back pain (OR, 2.29; P = 0.009 and OR, 2.10; P = 0.012, respectively). Scoliosis group experienced significantly more severe pain, and of a significantly longer duration with more frequent recurrences in comparison to No scoliosis group. Scoliosis group showed significantly more back pain in the upper and middle right back in comparison to No scoliosis group. These findings suggest that there is a relationship between pain around the right scapula in Scoliosis group and the right rib hump that is common in IS.     

Predicting growth and curve progression in the individual patient with adolescent idiopathic scoliosis: design of a prospective longitudinal cohort study

Background  

Scoliosis is present in 3-5% of the children in the adolescent age group, with a higher incidence in females. Treatment of adolescent idiopathic scoliosis is mainly dependent on the progression of the scoliotic curve. There is a close relationship between curve progression and rapid (spinal) growth of the patient during puberty. However, until present time no conclusive method was found for predicting the timing and magnitude of the pubertal growth spurt in total body height, or the curve progression of the idiopathic scoliosis.     

Prevalence of the thoracic scoliosis in children and adolescents candidates for strabismus surgery: results from a 1935-patient cross-sectional study in China

No study so far has paid attention to strabismus-related spinal imbalance. This study aimed to determine the epidemiology of thoracic scoliosis in children and adolescents with strabismus and investigate the association of two diseases. A cross-sectional study. Study group consists of 1935 consecutive candidates for strabismus surgery (4–18 years); Control group consists of the age- and sex-matched patients with respiratory diseases. All subjects underwent a screening program based on chest plain radiographs using the Cobb method. Their demographic information, clinical variables and results of Cobb angle were recorded and analyzed. A significantly higher prevalence of thoracic scoliosis (289/1935, 14.94% versus 58/1935, 3.00%) was found in study group compared with control group. Among strabismic patients, the coronal thoracic scoliosis curve mainly distributed in right and in main thoracic (198/289) and in the curves 10°–19° (224/289); Age range 7–9 years (103/1935), female (179/1935) and concomitant exotropia patients (159/851) were more likely to have thoracic scoliosis. According to the logistic regression, thoracic scoliosis had no significant association with age, BMI, duration of illness and onset age (p > 0.05). However, gender, BCVA, type of strabismus and degree of strabismus showed a significant relationship with the prevalence of thoracic scoliosis (p < 0.05). With a pooled prevalence of 14.94%, strabismus patients showed a great higher risk of developing thoracic scoliosis. Screening for scoliosis in strabismus patients can be helpful to discover a high prevalence of potential coronal scoliosis. More attention should be paid to ophthalmological problems in patients with scoliosis. These slides can be retrieved under Electronic Supplementary Material.     

New strategies and decision making in the management of neuromuscular scoliosis

The outcome of spinal fusion in neuromuscular scoliosis demonstrates a consistently high satisfaction rate among parents and caretakers. It is somewhat more difficult to determine the functional benefits in individual patients, especially in those with the most severe involvement. Even in those children, a predicted 70% survival rate at 11 years has been documented following surgery. Scoliosis is common in children with neuromuscular diseases, especially cerebral palsy. Most of these children need stabilization to enhance their quality of life by improving sitting ability. Studies continue to show a high family satisfaction and caregiver satisfaction following spine reconstructive surgery for neuromuscular scoliosis and other spine deformities.     

Three-dimensional imaging for the surgical treatment of idiopathic scoliosis in adolescents.

Scoliosis is not simply a lateral deviation of the spine but is a complex deformity of the entire trunk. Recent advances in 3-dimensional (3-D) imaging have improved our understanding of the 3-D nature of adolescent idiopathic scoliosis (AIS) and have resulted in the development of a new generation of spinal instrumentation. Stereophotogrammetry, computed tomography, magnetic resonance imaging and surface topography all have their specific 3-D applications and relevance in the clinical management of AIS. In the near future, novel 3-D imaging applications will provide tools to guide the surgeon in the planning, performance and evaluation of increasingly sophisticated and less invasive surgical procedures, thus improving the outcome of surgical treatment for AIS.