成人退行性脊柱侧凸的研究进展

概述成人退行性脊柱侧凸及其治疗的研究进展。文献资料来自1965—2004年，用“退行性”、“脊柱侧凸”和“治疗”这三个关键词在MEDLINE上搜索，然后查全文。成人退行性脊柱侧凸的治疗根据临床症状和脊柱畸形程度和范围分为保守治疗，单纯椎管减压术，椎管减压＋后路内固定融合术，椎管减压＋后路内固定术＋前后路融合术。脊柱畸形一般包括侧凸、生理前凸的丢失、椎体滑移和脊柱旋转。根据症状和畸形的严重程度来选择合适的治疗方法是至关重要的，全面评价脊柱冠状面和矢状面的畸形程度和了解神经受累情况一样重要，可以指导治疗。生理前凸的丢失、椎体滑移和脊柱旋转的纠正对下肢和腰背疼痛的缓解有很大帮助，然而侧凸的纠正是否有助于缓解下肢和腰背症状仍存争议。畸形中最重要的是生理前凸的丢失，应该尽可能的纠正以达到脊柱矢状面的平衡，从而缓解腰背症状。

Advanced progress on adult degenerative scoliosis

To summarize advances in the study of adult degenerat iv e scoliosis and its treatment. Data from 1965 to 2004 was collected on MEDLINE by searching of degene rative,scoli osis and treatment.The treatment options of adult degenerative scoliosis were cl assified into conservative treatment,dec omp ression alone,decompression and posterio r spinal fusion with instrumentation,dec ompression and anterior+posterior spinal fusion with instrumentation according t o the clinical symptoms and severity and extent of the spinal deformities.It is vital to correct the deformities of the scoliosis,loss of lordosis,spondylolysis and spinal rotation.The suitable therap eutic method should be selected according to the severity of the symptom s and the deformities.Comprehensive unders tanding of the deformity in the coronal and sagittal planes as well as the neura l impingement can give the appro priate intervention.Correction of the sc oliosis,loss of lordosis,spondylolysis a nd spinal rotat ion is able to relieve pain in the leg and the back. However,it remains controversy whether o r not correction of scolicsis is conduct i ve to alleviation of pain in the low ext remity and lumbago.Loss of lordosis in t he deformity should be corrected as much as possible to achieve adequate stabili zation in the sagittal planes,thus relie ving back pain.