Adolescent idiopathic scoliosis: natural history and long term treatment effects.
Adolescent idiopathic scoliosis: natural history and long term treatment effects.
复制标题
DOI：
10.1186/1748-7161-1-2
复制
发表时间：
2006-03-31
期刊：
影响因子：
--
通讯作者：
Burton DC
中科院分区：
文献类型：
--
作者：
Asher MA;Burton DC
青少年特发性脊柱侧凸是一种终身的、可能是全身性的、原因不明的疾病，在大多数人群中约有2.5%的人会导致脊柱弯曲10度或以上。然而，只有约0.25%的曲线进展到需要治疗的程度。未经治疗的青少年特发性脊柱侧凸不会增加死亡率，即使在极少数情况下，它可以进展到>100°范围并导致过早死亡。尽管成熟时弯曲度为50°或成年期弯曲度为80°的患者发生呼吸短促的风险增加，但呼吸短促的发生率并未增加。与非脊柱侧凸对照组相比，大多数未经治疗的青少年特发性脊柱侧凸患者的功能处于或接近正常水平。他们确实增加了疼痛的患病率，可能会或可能不会增加疼痛的严重程度。自我形象往往会下降。心理健康通常不会受到影响。社会功能，包括婚姻和生育可能会受到影响，但只在相对较大的曲线的阈值。非手术治疗包括对25°至35°或40°弯曲的患者进行支具，患者的生长期为1至2年或更长。与使用支具相比，使用观察的弯曲进展≥ 6°的可能性高20%至40%。手术治疗包括器械和关节融合术，以重新调整和稳定脊柱最受影响的部分。通常可实现约40%的持久曲线改善。在迄今为止最完整的研究系列中，在20 - 28年的随访中，与非脊柱侧凸对照组相比，支具和手术患者的功能下降和疼痛增加相似，显著，具有临床意义。然而，他们的功能和疼痛评分比其他更严重疾病的患者组更接近正常。与治疗相关的风险包括戴支架患者的自我形象暂时下降。手术患者面临着大手术的常见风险，需要再次手术的可能性为6%至29%，并且发生疼痛管理问题的可能性很小。对青少年特发性脊柱侧凸的自然病史和长期治疗效果的了解现在和将来都是不完全的。然而，有足够的知识为患者和父母提供所需的信息，以做出明智的管理决策。
Adolescent idiopathic scoliosis is a lifetime, probably systemic condition of unknown cause, resulting in a spinal curve or curves of ten degrees or more in about 2.5% of most populations. However, in only about 0.25% does the curve progress to the point that treatment is warranted. Untreated, adolescent idiopathic scoliosis does not increase mortality rate, even though on rare occasions it can progress to the >100° range and cause premature death. The rate of shortness of breath is not increased, although patients with 50° curves at maturity or 80° curves during adulthood are at increased risk of developing shortness of breath. Compared to non-scoliotic controls, most patients with untreated adolescent idiopathic scoliosis function at or near normal levels. They do have increased pain prevalence and may or may not have increased pain severity. Self-image is often decreased. Mental health is usually not affected. Social function, including marriage and childbearing may be affected, but only at the threshold of relatively larger curves. Non-operative treatment consists of bracing for curves of 25° to 35° or 40° in patients with one to two years or more of growth remaining. Curve progression of ≥ 6° is 20 to 40% more likely with observation than with bracing. Operative treatment consists of instrumentation and arthrodesis to realign and stabilize the most affected portion of the spine. Lasting curve improvement of approximately 40% is usually achieved. In the most completely studied series to date, at 20 to 28 years follow-up both braced and operated patients had similar, significant, and clinically meaningful reduced function and increased pain compared to non-scoliotic controls. However, their function and pain scores were much closer to normal than patient groups with other, more serious conditions. Risks associated with treatment include temporary decrease in self-image in braced patients. Operated patients face the usual risks of major surgery, a 6 to 29% chance of requiring re-operation, and the remote possibility of developing a pain management problem. Knowledge of adolescent idiopathic scoliosis natural history and long-term treatment effects is and will always remain somewhat incomplete. However, enough is know to provide patients and parents the information needed to make informed decisions about management options.