摘要
退行性脊柱侧凸(degenerative scoliosis,DS)是成人最常见的脊柱畸形类型,尤其在中老年人群中发病率较高.随着人口老龄化趋势的加剧,其发病率逐年上升,给社会和个人带来了沉重的经济负担.DS的病因复杂,与椎间盘退变、生物力学改变、骨质疏松和肌肉减少症等因素密切相关.诊断DS依赖临床体格检查和影像学检查,脊柱侧凸研究学会(Scoliosis Research Society,SRS)分型、Schwab 分型、SRS-Schwab 分型、Lenke-Silva分型、Berjano分型等分型系统为其分类和治疗提供了标准.DS的治疗包括保守治疗和手术治疗.保守治疗如物理治疗、药物治疗主要用于控制症状,治疗效果缺乏高等级的临床研究证据支持.手术治疗需要个性化规划,微创手术技术提供了创伤小、恢复快的治疗选择,但存在特定适应证和禁忌证.针对目前存在的疾病病因复杂、机制不清晰、微创手术存在局限、手术方式差异化大等问题,进一步深入DS的生物学机制研究非常必要.其目的是拓展安全、有效的微创技术应用,精细化个体化治疗策略和手术规划,以应对人口老龄化背景下DS带来的健康和经济挑战.
Abstract
Adult scoliosis is categorized into two main types:idiopathic and degenerative.Degenerative scoliosis(DS)is the most common type of spinal deformity in adults,with a higher incidence observed in the middle-aged and elderly population.As the population ages,its incidence is increasing annually,resulting in a significant economic burden and health impact on both society and individuals.The etiology of DS is complex and closely related to several factors,including intervertebral disc degenera-tion,biomechanical changes,osteoporosis,and sarcopenia.The diagnosis of DS relies on clinical physical examinations and imag-ing,with staging systems such as SRS,Schwab's,SRS-Schwab's,Lenke-Silva,and Berjano providing criteria for its classification and treatment.The treatment of DS consists of conservative and surgical approaches.Conservative treatments,such as physical therapy and medications,are employed primarily for symptom control.However,the therapeutic effects of these treatments have not been substantiated by high-level clinical research evidence.Surgical treatment necessitates individualized planning.Minimal-ly invasive surgical techniques offer less invasive and faster recovery treatment options but come with specific indications and con-traindications.In light of the current challenges posed by the unclear etiology,limitations of minimally invasive surgery,and the necessity to differentiate surgical approaches,there is a clear need for further research into the biological mechanisms of DS,the expansion of the application of safe and effective minimally invasive techniques,and the fine-tuning of individualized treatment strategies and surgical planning to address the health and economic challenges posed by DS in the context of an aging population.
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