特发性脊柱侧弯畸形的分型和治疗幻灯片VIP免费

精品文档AdolescentScoliosisClassificationandTreatment特发性脊柱侧弯畸形的分型与治疗JaneS.Hoashi,MD,MPH,PatrickJ.Cahill,MD,JamesT.Bennett,MD,AmerF.Samdani,MD*NeurosurgClinNAm24(2021)173–183精品文档KEYWORDS•AdolescentidiopathicscoliosisLenkeclassificationScoliosisPediatricspinedeformityPediclescrews•青少年特发性脊柱侧弯Lenke分型弓根螺钉矫形精品文档KEYPOINTS•Adolescentidiopathicscoliosis(AIS)canbeclassifiedaccordingtotheLenkeclassificationsystem,whichincorporatescurvemagnitude,flexibility,thelumbarmodifier,andthesagittalplane.•青少年特发性脊柱侧凸〔AIS〕可根据Lenke分类系统进展分类，该系统包括曲线大小，柔韧性。•TheLenkeclassificationservesasaguidewithrespecttolevelselectioninpatientswithAIS.•Lenke分类可作为AIS患者融合水平选择的指南。•ThewidespreaduseofpediclescrewshasresultedinmostAISbeingtreatedthroughaposteriorapproach.•椎弓根螺钉的广泛使大多数AIS可以用后路治疗。精品文档INTRODUCTION•Adolescentidiopathicscoliosis(AIS)isaspinalconditioncausingdeformityofthespinein3dimensions:thecoronal,sagittal,andaxialplanes.AISisdefinedasanycurveequaltoorgreaterthan10inthecoronalplane1,2inpatients10to18yearsold.3Itisadiagnosisofexclusionaftercongenital,neuromuscular,neural,orsyndromiccausesofscoliosishavebeenruledout.Preoperativemag-neticresonanceimagingisusefulforrulingoutneuralcausesofscoliosis,suchassyringomyeliaorChiarimalformation,althoughitsuseasapreop-erativescreeningtooliscontroversial.4,5AgeneticcomponenthasbeendescribedregardingthecauseofAIS.6–11Withanincidenceof11%amongfirst-degreerelatives,12itisnotuncommonforahealthcareprovidertomanagemultiplemem-bersofafamilywithscoliosis.•青少年特发性脊柱侧凸〔AIS〕是一种脊柱疾病，在三维方面引起脊柱畸形：冠状面，矢状面和轴面。AIS被定义为10-18岁患者冠状面等于或大于10。排除先天性，神经肌肉，神经或综合征引起的脊柱侧凸原因。术前磁共振成像对于排除脊柱侧凸的神经原因，如脊髓空洞症或Chiari畸形是有用的，尽管其作为术前筛查工具的使用还存在争议.已经报道了AIS的原因.在一级亲属中，发生率为11％，医疗保健提供者报道一个家庭有多个脊柱侧弯患者的情况并不少见。精品文档•AISaffectsapproximately2%to3%oftheadolescentpopulation,butfewerthan10%ofpatientswithAISneedtreatment.13Thehigherthecurvemagnitude,thelowertheprevalenceandthehigherthefemale/maleratio.Curvesgreaterthan30havea0.1%to0.3%prevalenceandaffectfemales10timesmorethanmales.•AIS对青春期人群的影响约为2％〜3％，而AIS患者中只有不到10％需要治疗。曲度越重，患病率越低，女性比例越高。曲度大于30的患病率为0.1％〜0.3％，女性患病率是男性的10倍以上。精品文档•Foryears,theKing-MoeclassificationwasthemostwidelyusedsystemforguidingtreatmentinAIS.Itsshortcomingsincludedclassifyingcurvesbasedonlyonthecoronalplaneandshowinglowinterobserverreliability.15Also,onlyvariantsofthethoraciccurveweredescribed,leavingsomeothercurvetypessuchasthoracolumbarorlumbarcurvesunabletobeclassifiedbythissystem.TheLenkeclassification16addressestheseshortcomingsandisnowconsideredthegoldstandardforclassifyingAISandguidingtreatment.Inthisarticle,theLenkeclassificationisusedtodescribetheAIStypesandthetreat-mentoptions.•多年来，King-Moe分类是用于指导AIS治疗的最广泛使用的系统。其缺点是包括仅仅根据冠状面分型，并显示出较低的观察者间的可靠性。另外，仅描述了胸弯的变体，残留了一些其他曲线类型，如胸腰弯或腰椎弯无法通过该系统进展分类。Lenke分类解决了这些缺点，现在认为是AIS分类和指导治疗的金标准。在本文中，Lenke分类用于AIS类型和治疗选择。精品文...