Mechanical modulation of spinal growth and progression of adolescent scoliosis.
Mechanical modulation of spinal growth and progression of adolescent scoliosis.
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发表时间：
2008
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通讯作者：
I. Stokes
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作者：
I. Stokes
目前尚不清楚为什么一些在青春期发育初期患有小幅度脊柱侧凸的儿童会发展成渐进式曲线。正常情况下，骨骼生长是对称的，这可能是因为尽管活动和环境因素导致脊柱负荷不对称，但遗传和表观遗传因素调节生长以保持生长对称。本章回顾了最近发表的有关脊柱侧凸进展是生物力学因素调节脊柱生长的结果（“恶性循环”理论）这一概念的数据。在分析脊柱侧凸曲线进展的关键变量时，存在定量数据。在模拟“恶性循环”理论的脊柱侧弯进化预测模型中，使用这些已发表的数据，脊柱的小侧弯可以产生不对称的脊柱负荷，导致不对称的生长和骨骼生长过程中自我延续的进行性畸形。如果肌肉激活的神经肌肉控制是为了最小化肌肉压力（单位横截面的力），尽管其他激活策略可能会产生不同的脊柱生长模式，但这可能发生。椎体生长的机械调节是脊柱侧凸畸形发展的重要因素。这一机制的定量模拟表明，改变躯干肌肉的神经肌肉控制或以其他方式改变脊柱负荷的治疗干预可能会改变进展的自然历史。
It is unclear why some children with a small magnitude scoliosis at the onset of the adolescent growth spurt develop a progressive curve. Normally the skeleton grows symmetrically, presumably because genetic and epigenetic factors regulating growth to maintain growth symmetry despite activities and environmental factors causing asymmetrical loading of the spine. This chapter reviews the recently published data relating to the notion that progression of scoliosis is a result of biomechanical factors modulating spinal growth ('vicious cycle' theory). Quantitative data exist for the key variables in an analysis of scoliosis curve progression. In a predictive model of the evolution of scoliosis simulating the 'vicious cycle' theory, and using these published data, a small lateral curvature of the spine can produce asymmetrical spinal loading that causes asymmetrical growth and a self-perpetuating progressive deformity during skeletal growth. This can occur if the neuromuscular control of muscle activation is directed at minimizing the muscular stress (force per unit cross section), although other activation strategies may produce differing spinal growth patterns. Mechanical modulation of vertebral growth is a significant contributor to the progression of an established scoliosis deformity. Quantitative simulation of this mechanism demonstrates how therapeutic interventions to alter neuromuscular control of trunk muscles or otherwise modify spinal loading may alter the natural history of progression.