脊柱侧弯治疗方法

脊柱侧弯治疗方法

青少年原发性脊柱侧弯无法自行痊愈或矫正，其治疗方法取决于不同的因素：

• 患者年龄
• 骨龄
• 脊柱侧弯角度
• 脊柱侧弯位置
• 月经/青春期状态
• 患者性别
• 相关症状，例如背痛或呼吸急促

定义脊柱侧弯的最小角度为11°，以下是根据严重程度和成熟程度不同的常用治疗方法：

轻度脊柱侧弯（Cobb angle = 11° - 19°）

脊柱侧弯角度（Cobb angle）= 11° - 19°

1. 青春期的患者，需定期检查以监测脊柱侧弯的恶化程度

脊柱侧弯患者在青春期间容易恶化，脊柱在发育完成 后才 会变得稳定。因此，发育期间患者应加强运动并需接受定期检查以监测脊柱侧弯的恶化程度。如果侧弯角度增加至约25°，便可能需要其他治疗方法。

伸展和强化肌肉能保持韧带和肌腱的柔韧性，从而降低脊柱肌肉失衡的程度。定期运动还可以提高活动能力，从而减少受伤和背痛的机会，有助于保持良好的姿势。

伸展运动

中度脊柱侧弯（Cobb angle = 20° - 45°）

脊柱侧弯角度（Cobb angle）= 20° - 45°

1. 处于青春期的患者需进行矫形治疗

矫形治疗适用于20°至45°侧弯、处于青春期的患者，目的是减慢脊柱侧弯的恶化速度。患者需佩戴脊柱矫形器，以在脊柱曲线的凸部施加压力（三 点压力系统），同时缓解曲线的凹部。众多研究报告指出矫形治疗有效减慢脊柱侧弯恶化从而减少手术治疗机会。矫形师会根据侧弯位置、脊柱柔韧性、侧弯数量和椎骨旋 转程度为患者设计脊柱矫形器。

三 点压力系统

全日使用的脊柱矫形器

• 颈胸腰椎矫形器（CTLSO）：适用于是脊柱侧弯点在T7或以上的患者。米华基脊柱矫形器（Milwaukee brace）是1940年代研发的颈胸腰椎矫形器（CTLSO）。它具有坚固的金属结构，需要穿戴在衣服外面。由于其外观因素和其他脊柱侧弯治疗方法的发展，如今已较少使用米华基脊柱矫形器，但仍会应用 于弯点较高的胸或颈椎侧弯。

CTLSO（米华基脊柱矫形器，Milwaukee brace）

• 胸腰椎矫形器（TLSO）（如脊柱矫形器（Under-arm brace）、波士顿脊柱矫形器（Boston Brace）和威明顿脊柱矫形器（Wilmington Brace））：适用于脊柱侧弯的弯点在T7以下的患者，例如低胸侧弯、胸腰侧弯和单腰椎侧弯。脊柱矫形器穿着的位置是腋下和臀部之间，而且由轻质塑料制成。因此，它可以穿在衣服下，比较容易被患者接受。由于人们对胸腰椎矫形器有更高的接受程度及其治疗效果显著，所以是现时最常见的矫形治疗方法之一。

TLSO

夜间脊柱矫形器

• 查尔斯顿/普罗维登斯脊柱矫形器（Charleston bending brace / Providence brace）：1979年研发的查尔斯顿胸腰椎矫形器（TLSO），适用于脊柱侧弯的弯点在T7以下，由轻质塑料制成，特征是“过度矫正”，把患者的脊椎带到过度矫正的位置。普罗维登斯脊椎矫形器在侧弯处施加压力，达到矫正的效果。晚 间使用的脊柱矫形器须在晚上穿带8至10小时直至发育完成。随着患者的发育成长，矫形器须在四至六个月内覆检。在某些情况下，夜间脊柱矫形器与日间脊柱矫形器在治疗脊柱侧弯方面具有相似的效果。

TLSO（查尔斯顿脊柱矫形器，Charleston brace）

TLSO（普罗维登斯脊柱矫形器，Providence brace）

2. 物理治疗

物理治疗是脊柱侧弯治疗中的一个方法，包括伸展和强化肌肉运动以减少肌肉失衡的影响并帮助保持良好姿势。物理治疗在物理治疗师指导下进行，在中度脊柱湾的个案中常配合脊柱矫形器以达致预期的效果。

强化肌肉运动

严重脊柱侧弯（Cobb angle > 45°）

脊柱侧弯角度（Cobb angle）> 45°

1. 手术治疗

脊柱侧弯角度大于45°应建议接受手术矫正，防止脊柱侧弯继续恶化。手术治疗是在脊柱上植入金属杆和其他接合材料以矫正脊柱侧弯和使脊柱维持在矫正后的位置，使脊柱融合为一体。接受手术治疗后，患者需住院3至6天，手术后3至4周后可回到学校学习，3至6个月便可以正常参加活动。

参考资料

1. SRS. "Scoliosis Research Society." https://www.srs.org/patients-and-families/common-questions-and-glossary/frequently-asked-questions/treatment-and-coping.
2. H.-R. Weiss, S. Negrini, M. Rigo, T. Kotwicki, M. C. Hawes, T. B. Grivas, T. Maruyama, and F. Landauer, "Indications for conservative management of scoliosis (guidelines)," Scoliosis, vol. 1, no. 1, p. 5, 2006.
3. S. Weinstein and I. Ponseti, "Curve progression in idiopathic scoliosis," The Journal of bone and joint surgery. American volume, vol. 65, no. 4, pp. 447-455, 1983.
4. A. Gruca, "The pathogenesis and treatment of idiopathic scoliosis: a preliminary report," JBJS, vol. 40, no. 3, pp. 570-584, 1958.
5. V. Akuthota, A. Ferreiro, T. Moore, and M. Fredericson, "Core stability exercise principles," Current sports medicine reports, vol. 7, no. 1, pp. 39-44, 2008.
6. R. Fernandez-Feliberti, J. Flynn, N. Ramirez, M. Trautmann, and M. Alegria, "Effectiveness of TLSO bracing in the conservative treatment of idiopathic scoliosis," Journal of pediatric orthopedics, vol. 15, no. 2, pp. 176-181, 1995.
7. SRS. "Scoliosis Research Society." https://www.srs.org/patients-and-families/conditions-and-treatments/adolescents.
8. A. Howard, J. G. Wright, and D. Hedden, "A comparative study of TLSO, Charleston, and Milwaukee braces for idiopathic scoliosis," Spine, vol. 23, no. 22, pp. 2404-2411, 1998.
9. K. J. Noonan, S. L. Weinstein, W. C. Jacobson, and L. A. Dolan, "Use of the Milwaukee brace for progressive idiopathic scoliosis," JBJS, vol. 78, no. 4, pp. 557-67, 1996.
10. F. C. Wickers, W. H. Bunch, and P. M. Barnett, "Psychological factors in failure to wear the Milwaukee brace for treatment of idiopathic scoliosis," Clinical Orthopaedics and Related Research, no. 126, pp. 62-66, 1977.
11. J. E. Lange, H. Steen, and J. I. Brox, "Long-term results after Boston brace treatment in adolescent idiopathic scoliosis," Scoliosis, vol. 4, no. 1, p. 17, 2009.
12. R. S. Fayssoux, R. H. Cho, and M. J. Herman, "A history of bracing for idiopathic scoliosis in North America," Clinical Orthopaedics and Related Research®, vol. 468, no. 3, pp. 654-664, 2010.
13. A. Simony, I. Beuschau, L. Quisth, S. M. Jespersen, L. Y. Carreon, and M. O. Andersen, "Providence nighttime bracing is effective in treatment for adolescent idiopathic scoliosis even in curves larger than 35," European Spine Journal, vol. 28, no. 9, pp. 2020-2024, 2019.
14. R. Gepstein, Y. Leitner, E. Zohar, I. Angel, S. Shabat, I. Pekarsky, T. Friesem, Y. Folman, A. Katz, and B. Fredman, "Effectiveness of the Charleston bending brace in the treatment of single-curve idiopathic scoliosis," Journal of Pediatric Orthopaedics, vol. 22, no. 1, pp. 84-87, 2002.
15. H. Berdishevsky, V. A. Lebel, J. Bettany-Saltikov, M. Rigo, A. Lebel, A. Hennes, M. Romano, M. Białek, A. M’hango, and T. Betts, "Physiotherapy scoliosis-specific exercises–a comprehensive review of seven major schools," Scoliosis and spinal disorders, vol. 11, no. 1, p. 20, 2016.
16. S. Negrini, C. Fusco, S. Minozzi, S. Atanasio, F. Zaina, and M. Romano, "Exercises reduce the progression rate of adolescent idiopathic scoliosis: results of a comprehensive systematic review of the literature," Disability and rehabilitation, vol. 30, no. 10, pp. 772-785, 2008.
17. H.-R. Weiss, G. Weiss, and H.-J. Schaar, "Incidence of surgery in conservatively treated patients with scoliosis," Pediatric Rehabilitation, vol. 6, no. 2, pp. 111-118, 2003.
18. S. Yadla, M. G. Maltenfort, J. K. Ratliff, and J. S. Harrop, "Adult scoliosis surgery outcomes: a systematic review," Neurosurgical focus, vol. 28, no. 3, p. E3, 2010.
19. E. R. Westrick and W. T. Ward, "Adolescent idiopathic scoliosis: 5-year to 20-year evidence-based surgical results," Journal of Pediatric Orthopaedics, vol. 31, pp. S61-S68, 2011.

本文原文来自香港理工大学生物医学工程系