什么是脊柱侧凸?

The spine is made up of a stack of rectangular-shaped building blocks called vertebrae. 从后面看，脊柱通常是直的. 然而, a spine affected by scoliosis is curved — often appearing like an S or C — with a rotation of the vertebrae. This curvature gives the appearance that the person is leaning to one side.

脊柱侧凸 is determined when the curvature of the spine measures 10 degrees or greater on an x射线. Spinal curvature from scoliosis may occur on the right or left side of the spine, 或者在两边不同的部分. Both the thoracic (mid) and lumbar (lower) spine may be affected by scoliosis. 脊柱侧凸是脊柱畸形的一种.

在超过80%的情况下, the cause of scoliosis is unknown — a condition called idiopathic scoliosis. In other cases, scoliosis may develop as a result of degeneration of the spinal discs, as seen with 关节炎, 骨质疏松症 或者作为一种家族遗传疾病.

脊柱侧凸有哪些不同类型?

先天性脊柱侧凸

In congenital scoliosis, spinal curvature develops because of misshapen vertebrae. The diagnosis of congenital scoliosis may be made in early infancy if outward signs are present, 但许多病例在童年后期才被诊断出来.

As a child grows, scoliosis may worsen, and asymmetries in the body may develop. Typically, congenital scoliosis is treated with a “watch and wait” approach. Surgery is considered only if a curve is clearly getting worse and the child is facing ongoing deformity and risk of future pain.

特发性脊柱侧凸

医生, nurses and scientists have been studying the natural history and genetics of scoliosis for decades, 但直到今天, 特发性脊柱侧凸的病因尚不清楚. But we do know that the most common time for idiopathic scoliosis to develop is at the onset of adolescence, 或者在10岁左右. 我们也知道，经济增长会让情况变得更糟, and we should be most concerned about scoliosis in a child that has significant growth remaining.

When diagnosed in children 2 or younger, this type of scoliosis is called 婴儿特发性脊柱侧凸.

神经肌肉性脊柱侧弯

A child with an underlying neuromuscular condition is at higher risk for developing scoliosis. A straight spine requires normal muscle balance and strength in the torso. 在脑瘫，脊柱裂和 肌肉萎缩症, the 肌肉 are often weak and unbalanced, leading to the development of a spinal curvature.

A child with neuromuscular scoliosis is given the option of wearing a scoliosis brace that may slow or prevent the worsening of the condition. Surgical intervention is offered when the curve has reached the tipping point of 50 degrees. Over time, these curves will continue to worsen, leading to progressive imbalance of the torso. Beyond 80 degrees, breathing challenges develop as space for the lungs decreases.

脊柱侧凸的症状是什么?

以下是脊柱侧凸最常见的症状. 然而，每个人可能经历不同的症状. 症状可能包括:

• 肩高差

• 头部与身体的其他部分不在中间

• 臀部高度或位置的差异

• 肩胛骨高度或位置不同

• When standing straight, difference in the way the arms hang beside the body

• When bending forward, the sides of the back appear different in height

• 从前面或后面看肋骨的突出或不对称

The symptoms of scoliosis may resemble other spinal conditions or deformities, 也可能是受伤或感染的结果. 一定要向医生咨询诊断.

Symptoms that are not commonly associated with idiopathic scoliosis are back pain, 腿部疼痛, 以及排便和膀胱习惯的改变. 如果一个人正在经历这些症状, he or she requires immediate further medical evaluation by a doctor to determine the cause of the symptoms.

如何诊断脊柱侧凸?

Early detection of scoliosis is most important for successful treatment. In addition to a complete medical history and physical examination, an x射线 是脊柱侧凸的主要诊断工具吗. 建立脊柱侧凸的诊断, 医生在x光片上测量脊柱弯曲的程度.

The following additional diagnostic procedures may be performed for nonidiopathic curvatures, 非典型曲线型或先天性脊柱侧凸:

• 核磁共振成像. This diagnostic procedure uses a combination of large magnets and a computer to produce detailed images of organs and structures within the body.

• CT扫描. This diagnostic imaging procedure uses a combination of x射线s and computer technology to produce horizontal, 或轴向, 身体的图像(通常称为切片). CT扫描显示身体任何部位的详细图像, 包括骨头, 肌肉, 脂肪和器官. CT扫描比普通的x光扫描更详细.

如何治疗脊柱侧凸?

The goal of treatment is to stop the progression of the curve and prevent deformity. Observation and repeated examinations — also referred to as the “watch and wait” approach — may be necessary to determine if the spine is continuing to curve. These are used when a person has a curve that is less than 20 degrees and who is still growing.

For actively growing children with scoliosis curves between 20 and 50 degrees, 建议使用支撑. An external torso brace, or TLSO, is worn for a prescribed number of hours. 支架对生长中的脊柱施加矫正压力, 防止脊柱侧凸进一步恶化.

Surgery is a recommended treatment option for a child with severe scoliosis or a curve that has worsened to more than 50 degrees. 在约翰霍普金斯儿童中心，我们的团队 小儿脊柱外科医生, nurses and anesthesiologists use a family-centered approach to develop a plan for the care of your child. 我们是一个高容量的脊柱侧凸中心, and we are constantly learning and adopting best practices for the operative and postoperative care of children with scoliosis.