少年性椎体骨软骨病的病因及支具与手术矫形治疗对其病情的控制

Etiology of Scheuermann disease and the effect of brace and orthopaedic surgeries in controlling its process

目的:少年性椎体骨软骨病又称Scheuermann病,通常表现为脊柱胸段或胸腰段后凸畸形,是青少年结构性后凸的主要原因。至今缺乏明确的结果证实支具治疗可以有效的治疗少年性椎体骨软骨病畸形,但支具仍较广泛的应用于治疗具有此类畸形的骨骼未成熟患者。尽管有许多证据支持该病的发生与遗传学有关,但目前还没有完全证实。病因学上认为该病的发生是多因素作用的结果。因此有必要进一步认识少年性椎体骨软骨病的病因及其治疗内容。资料来源:应用计算机检索Medline1980/2003与少年性椎体骨软骨病病因及治疗的相关文献,检索词“Scheuermann,disease”,并限定文献语种为英文。资料选择:对资料进行初审,筛除部分个案报告,选取回顾性临床研究文章,查找全文。资料提炼:共收集到41篇关于少年性椎体骨软骨病的回顾性临床研究文章,33篇符合纳入标准。排除的8篇文献中属于单纯个案报道及综述。资料综合:33篇文献中,分别涉及少年性椎体骨软骨病的病因、病理、自然史及诊断、治疗方面的临床研究及临床实验,共1100余例,治疗中又包括保守治疗和手术治疗。少年性椎体骨软骨病支具治疗的经典适应证是胸椎后凸45°～65°的患者,而后凸大于75°以及伴有保守治疗无法控制疼痛的患者应行手术治疗,但是必须让患者权衡手术治疗的潜在危险与非手术治疗的预期效果。脊柱后凸畸形所致的生理功能改变,主要是脊柱屈曲畸形压迫并限制胸腔及腹腔某些脏器生理活动所致。手术矫形后,可使颈椎曲度、髋关节和膝关节的生理状态得到改善或恢复正常。结论:少年性椎体骨软骨病非特异性原因包括骨软骨炎及骨骺炎,此病家族成员中特发性脊柱侧弯发病率较高,并在连续传代时具有继承性。少年性椎体骨软骨病后凸在举重和体力劳动者中更常见,因此力学因素也可能是原因之一。绝大多数患者可以通过支具治疗控制病情,只有合并保守治疗后疼痛无法控制及后凸超过75°且病情逐渐加重的患者需要进行手术治疗。

OBJECTIVE： Scheuermann disease is a progressive thoracic or thoracolumbar kyphotic deformity of spine, which is the most common cause of structural kyphosis in adolescents. Braces have been applied in the treatment of such deformed immature skeletons of patients, through there are lack of definite results to verify that braces can be employed to treat deformities of Scheuermann disease effectively so far. The etiology is still incompletely unknown, although the episode of Scheuermann disease is related to genetics. The cause of Scheuermann disease is probably multifarious. So, it is necessary to comprehend the etiology and treatment of Scheuermann disease further. DATA SOURCES： A computer-based search of Medline for the articles about etiology and .treatment of Scheuermann disease published between 1980 and 2003 was performed by using the key word “Scheuermann disease, and the language was limited to English”. STUDY SELECTION： After the articles were primarily checked up, some case reports were screened out, and retrospective clinical articles were looked up for the full texts. DATA EXTRACTION： Totally 41 retrospective clinical studies on Scheuermann disease were collected, in which 33 were accordant with inclusion criteria, and 8 were excluded because they were simple case reports or reviews. DATA SYNTHESIS： In the 33 articles, over 1100 clinical studies and experiments were performed on the etiology, pathology, natural history, diagnosis and treatment of Scheuermann disease.Operation manners included conservative treatment and surgical treatment.The braces for Scheuermann disease is most satisfactory to those with 45° to 65° thoracic kyphosis, but to those with conservative management- more than 75° kyphosis or those with conservative management-uncontrollable pain, they should be treated by operation after they were told to weigh the potential risk of operation and expected outcomes of nonoperative treatment,Kyphotic deformity-induced changes of physiological function mainly resulted from some physiologic activities of viscera in thoracic cavity and abdominal cavity compressed and limited by flexion deformity of spine. Physiological status of curvature of cervical vertebra, hip joint and knee joint could be improved or recovered by orthopaedic surgeries. CONCLUSION： Osteochondritis and epiphysitis result in Scheuermann disease nonspecifically, Lateral curvature.possesses high incidence in the family members of Scheuermann disease, and is hereditary during successive passage, Kyphosis of Scheuermann disease was commonly found in weightlifting and manual workers, so mechanical factor may be one of the causes of Scheuermann disease, Scheuermann disease is controllable in majority patients treated with braces, and surgical treatment is only for those with unrelieved pain by conservative treatment or those with severe kyphosis（over 75°） and progressive severity,