青少年特发性脊柱侧弯的分型和治疗

1、青少年特发性脊柱侧弯的 分型和治疗,脊柱畸形,侧凸(Scoliosis) 前凸 后凸,功能性Scoliosis代偿性继发性 特点: 脊柱的结构是正常的 常见的原因: 1)姿势不正常 2)下肢不等长 3)LDH(椎间盘突出),结构性Scoliosis的原因 1)先天性 2)骨源性 3)神经源性 4)肌源性 5)特发性Scoliosis(10度以上1.1%),Adolescent idiopathic scoliosis (AIS),a coronal curve of 10 or more must be present to diagnose scoliosis。 presenting in patients between age 10 years and adulthood。 Idiopathic scoliosis is a diagnosis of exclusion made after a patient has been evaluated for underlying congenital, syndrome, or neurologic Causes。 Approxi

2、mately 80% of curves ultimately are diagnosed as idiopathic。,Classification of Operative Adolescent Idiopathic Scoliosis: Treatment Guidelines. Orthop Clin N Am 38 (2007) 521529,Adolescent idiopathic scoliosis (AIS),The prevalence of AIS is estimated at approximately 2% - 3%; the prevalence decreases with increasing curve severity。 20 curves have a prevalence of approximately 0.5%, whereas 40 curves have a prevalence of only 0.1%. AIS is more common in girls than in boys, with a ratio of 9:1 in

3、curves larger than 40,Classification of Operative Adolescent Idiopathic Scoliosis: Treatment Guidelines. Orthop Clin N Am 38 (2007) 521529,Adolescent idiopathic scoliosis (AIS),68% of adolescent idiopathic curvatures progressed beyond skeletal maturity Thoracic curves greater than 50 progressed at an average of 1 per year, thoracolumbar curves increased 0.5,while lumbar curves progressed 0.24 per year. Thoracic curvatures less than 30 tended not to progress.,spinal deformities the essentials Rob

4、ert F. Heary 2007,Cobb 角及端椎的确定,骨骼成熟度的确定,治疗,保守治疗支具 12小时 23小时 心理辅导 体育活动,Adolescent idiopathic scoliosis American Academy of Orthopedics surgeons 2004,The guideline of therapy from SRS ( 2004 ),The guideline of brace usage from SRS ( 2004 ),A curve that has documented progression to greater than 25 or a curve that is greater than 30 on initial presentations is indicated for bracing if the patients is still growing (Risser 0,1,or 2). The goal of brace treatment is to limit further curve progression

5、,keeping the patient from surgery. But its efficacy is impacted by curve size.,Adolescent idiopathic scoliosis American Academy of Orthopedics surgeons 2004,TLSO brace,Charleston nighttime brace,The indication for surgery in AIS are curves of greater than 45 for thoracic scoliosis an 40 for thoracolumbar or lumbar scoliosis. Coronal major Cobb angle; cosmetic; physical appearance, such as should balance, rib hump, acceptance of patient and skeletal maturity also should be considered.,The guideli

6、ne of surgery from SRS ( 2004 ),Adolescent idiopathic scoliosis American Academy of Orthopaedic surgeons 2004,The general principle of the system is that the major curve and structural minor curves should be fused and that nonstructural minor curves may be allowed to correct spontaneously following fusion of the structural curves.,Treatment guidelines based on the Lenke classification system,Classification of Operative Adolescent Idiopathic Scoliosis: Treatment Guidelines. Orthop Clin N Am 38 (2

7、007) 521529,Lenke 6CN,Case 1,Case 1,Case II Lenke 1CN,Case II Lenke 1CN,AP in 02.07.2001,BEAUCOUSIN 21.03.1993,Coronal plane T4-T12 Cobb=25,In brace 31.07.2001,AP in 26.08.2002,Coronal plane T4-T12 Cobb=12,In brace 15.11.2002,AP in 19.03.2003,Coronal plane T4-T12 Cobb=12,AP in 03.09.2003,Coronal plane T4-T12 Cobb=14,AP in 28.01.2004,Coronal plane T4-T12 Cobb=14,In brace 24.03.2004,AP in 12.01.2005,AP in 29.06.2005,Coronal plane T4-T12 Cobb=20,AP in 05.07.2006,Coronal plane T4-T12 Cobb=30,AP in 30.10.2006,Coronal plane T4-T12 Cobb=30,AP in 22.11.2006,AP in 29.08.2007,Coronal plane T4-T12 Cobb=34,AP in brace 12.09.2007,PA and lateral 03.06.2008,Coronal plane T4-T12 Cobb=45 Saggital plane T5-T12 Cobb=+9,Supine Side-bending 03.06.2008,Post operation 15.07.2008,Post operation 03.09.2008,王咏吉Lenke1BN,王咏吉Lenke1BN,邱森 男性 16岁 Lenke 1AN,顾佳煜 女性 14岁 Lenke 5CN,

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