脊柱側(cè)彎摘要

1、特發(fā)性脊柱側(cè)彎的生物力學(xué)研究進(jìn)展脊柱側(cè)彎是脊柱的一個(gè)或多個(gè)節(jié)段在冠狀面上偏離中線(xiàn)的側(cè)彎、矢狀面上的前彎或脊椎體在縱軸上的旋轉(zhuǎn)，是最常見(jiàn)的脊柱三維畸形1。脊柱側(cè)彎是軀干的畸形，以脊柱的側(cè)向偏移和軸位旋轉(zhuǎn)為特征。許多特發(fā)性脊柱側(cè)彎患者存在肋骨的變形以及矢狀面上胸椎生理后彎的減少。少數(shù)特發(fā)性脊柱側(cè)彎患者表現(xiàn)為主彎與次彎交界區(qū)的后彎畸形。由于其病理解剖特點(diǎn)復(fù)雜，導(dǎo)致脊柱在出現(xiàn)側(cè)彎后和矯正手術(shù)后的生物力學(xué)變化較正常生理曲度的脊柱復(fù)雜得多，本文就目前國(guó)內(nèi)外在脊柱側(cè)彎生物力學(xué)方面的研究綜述如下。小兒先天性脊柱側(cè)彎合并椎管內(nèi)神經(jīng)畸形的臨床研究摘要目的探討小兒先天性脊柱側(cè)彎合并椎管內(nèi)神經(jīng)畸形的發(fā)病情況和臨床特征

2、及其神經(jīng) 畸形與臨床表現(xiàn)的相關(guān)性。方法回顧性研究122例先天性脊柱側(cè)彎患兒，對(duì)患者的體格檢查情況以及全脊柱 CT、全脊髓 MRI、雙下肢肌電圖等相關(guān)輔助檢查結(jié)果進(jìn)行整理分析。結(jié)果122例先天性脊柱側(cè)彎有63例(51.6%)合并脊髓畸形，其中脊髓栓系 (TCS)69.8%(44/63);脊髓縱裂(SCM)占 60.3%(38/63),包括 I 型脊髓縱裂占 68.4%(26/38) , II 型縱裂占31.6%(12/38);脊髓空洞27%(17/63);脊膜膨出占20.6%(13/63);椎管內(nèi)囊腫占17.5%(11/63);Chiari畸形4.8%(3/63)。結(jié)論小兒先天性脊柱側(cè)彎合并椎管

3、內(nèi)神經(jīng)畸形的發(fā) 生率高，并且常表現(xiàn)為多種脊髓畸形同時(shí)存在。合并神經(jīng)畸形的患兒常表現(xiàn)為腰背部中線(xiàn)處皮膚異常，足畸形和雙下肢不對(duì)稱(chēng)，但對(duì)于不同神經(jīng)畸形其與常見(jiàn)的臨床表現(xiàn)具有不同的相關(guān)性。關(guān)鍵詞：先天性脊柱側(cè)彎，脊髓栓系，脊髓縱裂SOX9和VEGF在小兒先天性脊柱側(cè)彎頂椎生長(zhǎng)板軟骨的表達(dá)研究先天性脊柱側(cè)彎(C o n g e ni t al S C ol io s i s,C S)是臨床上較常見(jiàn)的一種小兒先天性脊柱畸 形，其發(fā)生發(fā)展主要?dú)w因于先天存在的異常脊椎導(dǎo)致脊柱縱向不平衡生長(zhǎng)。在脊柱縱向發(fā)存 過(guò)程中脊椎生長(zhǎng)板軟骨是縱向生長(zhǎng)的基礎(chǔ)，頂椎作為先天性脊柱側(cè)彎的觸發(fā)點(diǎn)，其生長(zhǎng)板軟骨的化骨活性直接關(guān)系到

4、側(cè)彎的發(fā)生發(fā)展情況。以往研究已證實(shí)脊椎生長(zhǎng)板具有類(lèi)似長(zhǎng)骨生長(zhǎng)板的特性，生長(zhǎng)分化受多種細(xì)胞因子的調(diào)控。 其中S O X 9是一個(gè)與哺乳動(dòng)物的性別決定因子 S R Y(Y染色體上的性別決定區(qū))具有高度同源性的轉(zhuǎn)錄因子，表達(dá)于除肥大軟骨細(xì)胞外所有 分化型軟骨細(xì)胞，并貫穿整個(gè)軟骨形成過(guò)程 ，被認(rèn)為在軟骨內(nèi)成骨的初始階段發(fā)揮著重要作 用。血管內(nèi)皮生長(zhǎng)因子(V E G F)是刺激內(nèi)皮細(xì)胞生長(zhǎng)和血管再生的一個(gè)重要因素，研究發(fā)現(xiàn)在軟骨內(nèi)化骨過(guò)程中又于軟骨細(xì)胞死亡，細(xì)胞外基質(zhì)重塑，血管生成和骨骼形成是一種基本的調(diào)節(jié)物質(zhì)。因此通過(guò)對(duì)側(cè)彎頂椎凸凹兩側(cè)生長(zhǎng)板軟骨V EG F和S O X 9表達(dá)情況的檢測(cè)可以判斷側(cè)彎兩

5、側(cè)軟骨板成骨能力的差異，推斷小兒先天性脊柱側(cè)彎發(fā)病和進(jìn)展的分子生物學(xué)基礎(chǔ)，為進(jìn)一步的分子生物學(xué)研究奠定基礎(chǔ)。佛山市青少年脊柱側(cè)凸患病率調(diào)查脊柱側(cè)凸是指脊柱的一個(gè)或數(shù)個(gè)節(jié)段向側(cè)方彎曲并伴有椎體旋轉(zhuǎn)和矢狀面上后凸或前凸的增加或減少的脊柱畸形， 其多發(fā)生于青少年，絕大部分為特發(fā)性， 部分患者的側(cè)凸還會(huì)逐漸 進(jìn)展，畸形嚴(yán)重時(shí)不僅會(huì)造成身體外觀(guān)異常、 脊柱運(yùn)動(dòng)功能障礙，還可因胸廓畸形而造成心、 肺功能障礙，明顯降低生存質(zhì)量、影響青少年健康發(fā)育。在這個(gè)時(shí)期進(jìn)行脊柱側(cè)凸的普查，對(duì)早期發(fā)現(xiàn)、及時(shí)防治和減少該畸形對(duì)青少年身心健康的嚴(yán)重危害是一種有效的方法1-3。這不僅使需手術(shù)治療的比例減少，也使手術(shù)患者側(cè)凸嚴(yán)重

6、程度明顯減輕3。我們于2009年6月至2011年9月對(duì)佛山市五區(qū)25所中小學(xué)18 798名715歲在校青少年兒童進(jìn)行了 脊柱側(cè)凸患病率的普查，現(xiàn)報(bào)告如下。青少年特發(fā)性脊柱側(cè)彎發(fā)病機(jī)理的研究進(jìn)展特發(fā)性脊柱側(cè)彎(idiopathic scoliosis,IS)是指脊柱有側(cè)彎及旋轉(zhuǎn)畸形，而無(wú)任何先天性脊柱異 ?；蚝喜⒂猩窠?jīng)肌肉或骨骼疾病，是最常見(jiàn)的結(jié)構(gòu)性脊柱側(cè)彎，占脊柱側(cè)彎總數(shù)的80%左右。盡管對(duì)于特發(fā)性脊柱側(cè)彎的病因進(jìn)行了大量的研究，但至今其病因尚不明確。青少年特發(fā)性脊柱側(cè)彎(adolescent idipathic scoliosis,AIS)是脊柱側(cè)彎中最為常見(jiàn)的一種類(lèi)型，是根據(jù)初診年齡劃分的

7、1018歲未成年患者，占特發(fā)性脊柱側(cè)彎的80%左右4。關(guān)于AIS的病因，已有的研究基本上分為基因遺傳因素、神經(jīng)系統(tǒng)功能異常、生物化學(xué)因素和生物力學(xué)因素先后發(fā)現(xiàn)了褪黑素、鈣調(diào)蛋白，以及雌激素受體基因多態(tài)性等同AIS發(fā)生發(fā)展之間的相關(guān)性。青少年特發(fā)性脊柱側(cè)彎的流行病學(xué)研究進(jìn)展青少年特發(fā)性脊柱側(cè)彎(AIS)是一種表現(xiàn)為脊柱旋轉(zhuǎn)不對(duì)稱(chēng)的疾病。正如它命名中“特 發(fā)性”所指，盡管學(xué)者們做了大量研究，但迄今為止它的病因仍然不明，這就給它的早期干預(yù)、 早期治療帶來(lái)了困難。AIS的流行病學(xué)研究能夠幫助人們進(jìn)一步認(rèn)識(shí)AIS疾病的發(fā)展規(guī)律。我們從AIS的分布規(guī)律、危險(xiǎn)因素、早期篩查、預(yù)后等方面對(duì) AIS的流行病學(xué)研

8、究進(jìn)展進(jìn) 行綜述。內(nèi)蒙古地區(qū)蒙、漢、回族小學(xué)生生長(zhǎng)發(fā)育及脊柱側(cè)彎的研究荃金項(xiàng)目：國(guó)家自然科學(xué)基金(30660072),內(nèi)蒙古醫(yī)學(xué)院重大課題(NY05ZD005)。內(nèi)蒙古自治區(qū)自然科學(xué)其金 (2009MS1112),關(guān)國(guó) 健康基金(PSBH)。小學(xué)階段是兒童入學(xué)正式學(xué)習(xí)的時(shí)期，此時(shí)對(duì)于正處于不斷生長(zhǎng)發(fā)育的兒童而言，將面對(duì)諸多新的情況，如桌凳高度、長(zhǎng)期坐姿、燈光亮度、光線(xiàn)角度、學(xué)習(xí)時(shí)間及日益沉重的書(shū) 包等。這些環(huán)境及生活習(xí)慣的改變對(duì)于身體發(fā)育尤其對(duì)人體的中軸、力學(xué)橋梁一脊柱的發(fā)育將產(chǎn)生較大的影響。國(guó)內(nèi)外報(bào)道顯示脊柱側(cè)彎在兒童中較為常見(jiàn)一 :31 ,但未檢索到對(duì)內(nèi)蒙古地區(qū)兒童脊柱側(cè)彎的調(diào)查報(bào)道。輕度

9、脊柱側(cè)彎癥狀不明顯，不易被發(fā)現(xiàn)，但仍影響兒童的體型和健康。本課題對(duì)內(nèi)蒙古地區(qū)蒙、漢、回族7-13周歲小學(xué)生的生長(zhǎng)發(fā)育及脊柱側(cè)彎進(jìn)行了調(diào)查和分析。大學(xué)生體檢發(fā)現(xiàn)脊柱側(cè)彎127例分析【摘要】 目的調(diào)查大學(xué)生脊柱側(cè)彎的患病情況，以探討早期發(fā)現(xiàn)并預(yù)防脊柱側(cè)彎的發(fā) 生及干預(yù)脊柱側(cè)彎的發(fā)展的必要性。方法對(duì)福州大學(xué)15 090位新生進(jìn)行胸部透視體檢，發(fā)現(xiàn)脊柱側(cè)彎后，應(yīng)用島津500 mA X光機(jī)行全脊柱透視檢查。 結(jié)果 本組發(fā)現(xiàn)脊柱側(cè)彎127例。 結(jié)論大學(xué)生脊柱側(cè)彎的患病率比較高，這應(yīng)引起重視，需要提高患者自身對(duì)脊柱側(cè)彎的認(rèn)識(shí) 及早發(fā)現(xiàn)以促進(jìn)其今后選擇相應(yīng)的干預(yù)措施和恰當(dāng)?shù)闹委煼椒ā！娟P(guān)鍵詞】脊柱側(cè)彎；大學(xué)生

10、；患病率不同時(shí)期廣州市青少年兒童脊柱側(cè)凸患病率調(diào)查摘要背景：脊柱側(cè)凸還沒(méi)有病因性治療方法，僅能針對(duì)已經(jīng)發(fā)生畸形后的矯形和固定，所以對(duì)年齡段學(xué)生進(jìn)行定期普查以便及時(shí)發(fā)現(xiàn)并在早期措施，有利于降低脊柱側(cè)彎的發(fā)生率，但是國(guó)內(nèi)還沒(méi)有對(duì)于同一地區(qū)不同時(shí)段脊柱側(cè)彎的流行病學(xué)調(diào)查研究。目的：觀(guān)察1996/1997與2005年廣州市青少年兒童脊柱側(cè)凸患病率變化，比較不同時(shí)期的患病情況及原因分析。方法：分別于 1996-01/1997-11及2005-02/12對(duì)廣州市市區(qū) 715歲在校青少年兒童進(jìn)行了 脊柱側(cè)凸患病率的隨機(jī)抽樣調(diào)查。采用三檢篩選法，計(jì)算不同時(shí)間脊柱側(cè)凸患病率情況，x2檢3效2次調(diào)查結(jié)果差異。結(jié)果

11、與結(jié)論：1996/1997廣州市青少年兒童脊柱側(cè)凸的患病率為1.07%。其中男性患病率 0.90%,女性患病率1.26%,兩者的患病率之比為1 ： 1.4。脊柱側(cè)凸的患病類(lèi)型：特發(fā)性側(cè)凸350人，占96.95%,先天性側(cè)凸6人，神經(jīng)肌肉源性側(cè)凸 5人。2005年的患病率為1.21%;其中男性患病率 0.96%,女性患病率1.49%,兩者的患病率之比 為1 ： 1.5。脊柱側(cè)凸的患病類(lèi)型：特發(fā)性側(cè)凸134人，占97.81%,神經(jīng)肌肉源性側(cè)凸 3人，占2.19%,先天性側(cè)凸0人。兩次調(diào)查相比：患病率差異無(wú)顯著性意義 (X 2=3.775, P0.05); 男性患病率差異無(wú)顯著性意義(x 2=0.4

12、42 , P0.05);女性的總體患病率有上升(x =4.013 ,P0.05)。關(guān)鍵詞：柱側(cè)凸；發(fā)病率；流行病學(xué)；青少年；Cobb角 doi:10.3969/j.issn.1673-8225.2010.46.039先天性脊柱側(cè)彎合并脊髓縱裂的臨床特征和形態(tài)學(xué)研究目的探討及歸納先天性脊柱側(cè)彎合并的脊髓縱裂以及骨晴在椎管內(nèi)的形態(tài)、節(jié)段、位置等形態(tài)學(xué)特點(diǎn)，提出新的縱裂分型方法，以期指導(dǎo)臨床工作。方法回顧性總結(jié)分析136例先天性 脊柱側(cè)彎合并脊髓縱裂患者的臨床資料、CT及MRI影像學(xué)結(jié)果。結(jié)果工型及 II型脊髓縱裂在胸腰段的發(fā)生率最高，腰段及胸段次之，頸段較少；工型脊髓縱裂中推管內(nèi)骨棘的發(fā)生節(jié)段以腰

13、段最多，其次為胸腰段及胸段，頸段罕見(jiàn)。骨靖以貫通型多見(jiàn)，存在腹側(cè)型及背側(cè)型，但數(shù)量較少。結(jié)論先天性脊柱側(cè)彎患者常合并脊髓縱裂畸形，完善術(shù)前CT及MRI等影像學(xué)檢查有助于更好的了解脊髓縱裂及骨靖的形態(tài)特點(diǎn)，新的臨床分型對(duì)制定合理的手術(shù)治療方案有指導(dǎo)意義。The role of melatonin in the pathogenesis of adolescentidiopathicscoliosis (AIS)Abstract The cause of adolescent idiopathic scoliosis(AIS) in humans remains obscure and proba

14、bly multifacto-rial. At present, there is no provenmethod or test available toidentify children or adolescent at risk of developing AIS oridentify which of the affected individuals are at risk ofprogression. Reported associations are linked in pathogen-esis rather than etiologic factors. Melatonin m

15、ay play a rolein the pathogenesis of scoliosis (neuroendocrine hypothe-sis), but at present, the data available cannot clearly show therole of melatonin in producing scoliosis in humans. The dataregarding human melatonin levels are mixed at best, and themelatonin de?ciency as a causative factor in t

16、he etiology ofscoliosis cannot be supported. It will be an important issue offuture research to investigate the role of melatonin in humanbiology, the clinical ef?cacy, and safety of melatonin underdifferent pathological situations. Research is needed tobetter de?ne the role of all factors in AIS de

17、velopment.Idiopathic scoliosis in Korean schoolchildren: a prospective screeningstudy of over 1 million childrenAbstract Cross-sectional epidemiologic scoliosis screen-ing was carried out to determine the current prevalence ofscoliosis in the Korean population and to compare with theresults of previ

18、ous studies. Between 2000 and 2008,1,134,890 schoolchildren underwent scoliosis screening.The children were divided into two age groups, 10 -12-year-olds (elementary school) and 13 -14-year-olds (middleschool), to calculate age- and sex- speci?c prevalence rates.Children with measured curvetypes, ma

19、gnitudes, and Risser scores (inter-observerr = 0.964, intra-observer r = 0.978). Yearly and overallprevalence rates of scoliosis were calculated. There were584,554 boys and 550,336 girls in the sample, with a male tofemale ratio of 1.1:1. There were 77,910 (6.2%) children(26,824 boys and 51,086 girl

20、s) with scoliometer readings5, and 37,339 of them had positive results with Cobbangles C10 (positive predictive value, 46.4%). The overallscoliosis prevalence rate was 3.26%; girls had a higherprevalence (4.65%) than boys (1.97%). Prevalence ratesincreased progressively from 1.66 to 6.17% between 20

21、00and 2008, with the exception of 2002. According to age andgender, 10 -12-year-old girls had the highest scoliosisprevalence rates (5.57%), followed by 13T4-year-old girls(3.90%),10T2-year-old boys (2.37%), and13 14-year-oldboys (1.42%). In girls and boys, prevalence rates dropped by64.53 and 60.65

22、% among 10 12-year-olds and 13 14-year-olds, respectively (P = 0.00). The proportion of 10 19curves was 95.25 and 84.45%in boys and girls, respectively;and the proportion of 2029 curves was 3.91 and 11.28%,which was a signi?cant difference (P = 0.00).Thoraciccurves were the most common (47.59%) foll

23、owed bythoracolumbar/lumbar (40.10%), double (9.09%), and dou-ble thoracic (3.22%) curves. A comparison of the curvepatterns revealed signi?cant differences between genders(P = 0.00). We present this report as a guide for studyingthe prevalence of idiopathic scoliosis in a large population,and the i

24、ncreasing trend in the prevalence of idiopathicscoliosis emphasizes the need for awareness.Timing of menarche in Chinese girls with and without adolescentidiopathic scoliosis: current results and review of the literatureAbstract Age at menarche is closely related to scoliosisprogression during adole

25、scence. Current data concerningthe timing of menarche between scoliotic and non-scolioticgirls in the literature are con?icting, with inconclusiveresults. The aim of this study was to investigate the distri -bution difference of age at menarche for adolescent idio-pathic scoliosis (AIS) girls and no

26、rmal control populationand to subsequently elucidate the menarche age differencethrough literature reviewing. Moreover, menarche age ofAIS girls with Cobb angle40, 40 -were com-pared toestimate its association with curve severity. Men-strual status data were available for 6,376 healthy femaleadolesc

27、ents and 2,196 AIS girls. We notice that less than10% of healthy Chinese girls experienced onset of mensesbefore 11.38 years, and approximately 90% of healthyChinese girls were menstruating by 13.88 years, with amedian age of 12.63 years. As for AIS girls, less than 10%started to menstruate before 1

28、1.27 years, and approximately90% were menstruating by 14.38 years, with a medianage of 12.83 years. Average menarche age in AIS(12.831.22 years)土was signi?cantly later than that ofnormal control girls (12.63 0.98 years) (p0.001). Ageat menarche for AIS affected girls was signi?cantly greaterthan tha

29、t of normal control girls at 75%, 90% of whom hadattained menarche (p = 0.001, p0.001). Proportion ofgirls starting to menstruate after 14 years was sig ni?cantlyhigher in AIS population compared with normal controls(16.3 vs.8.1%, p0.001). In addition, AIS girls withexperienced onset of menses at an

30、average ageof 13.25 years, which was signi?cantly later than AIS girlswith Cobb angle 40 (12.81 years, p0.05) and mar-ginally signi?cantly later than AIS girls with Cobb anglebetween 40observedin Chinese idiopathic scoliotic girls in this large samplestudy, especially for girls with Cobb angle60, wh

31、ich issupported by multiple previously established positivelinkages on AIS etiology studies. Accordingly it is believedthat late menarche may contribute importantly to abnormalpubertal growth and subsequently modulate curve behaviorin AIS.Rib length asymmetry in thoracic adolescent idiopathic scolio

32、sis:is itprimary or secondary?Abstract The development of scoliosis in animal modelsafter inducing asymmetric rib growth suggests the possiblerole of asymmetric rib growth in the etiopathogenesis ofadolescent idiopathic scoliosis (AIS). Asymmetric riblength is well recognized in idiopathic scoliosis

33、; however,whether this rib asymmetry is primary or secondary has notbeen clearly documented. The objectives of this study wereto investigate any rib length asymmetry in patients withAIS and compare those with scoliosis with syringomyelia(SS) with the intention of elucidating any relationshipbetween

34、rib growth and pathogenesis of AIS. Forty-eightAIS and 29 SS with apical vertebrae located between T7and T9 were recruited. The average age was 13.5 2.3versus 12.5 3.4 years, and the average 16.4 versus 45.622.6 inpatients with AIS or SS,respectively. The length of all ribswas measured from the tip

35、of costal head to the end of thesame rib by built-in software on spiral computed tomog-raphy. At the levels of the apical vertebrae, the vertebraeabove and below the apex, the mean discrepancy in riblength (concave minus convex rib) was 7, 4 and 7 mm,respectively, in AIS group (p0.01), and 6, 5 and

36、7 mmin SS group, respectively (p0.01). The rib length dis-crepancy between concave and convex sides was signi?-cantly correlated with the magnitude of the Cobb angle ofthoracic curve in both AIS and SS groups 0.01).Similar ?ndings of the asymmetry of rib length in both AISand SS patients pointed str

37、ongly to the fact that the riblength asymmetry in apical region is most likely secondaryto the scoliosis deformity rather than playing a primary rolein the etiopathogenesis.Adolescent idiopathic scoliosis (AIS), environment,exposome and epigenetics: a molecularperspective of postnatal normal spinal

38、growthand the etiopathogenesis of AIS withconsideration of a network approach andpossible implications for medical therapyAbstractGenetic factors are believed to play an important role in the etiology of adolescent idiopathic scoliosis (AIS).Discordant findings for monozygotic (MZ) twins with AIS sh

39、ow that environmental factors including differentintrauterine environments are important in etiology, but what these environmental factors may be is unknown.Recent evidence for common chronic non-communicable diseases suggests epigenetic differences may underlie MZtwin discordance, and be the link b

40、etween environmental factors and phenotypic differences. DNA methylation isone important epigenetic mechanism operating at the interface between genome and environment to regulatephenotypic plasticity with a complex regulation across the genome during the first decade of life. The wordexposome refer

41、s to the totality of environmental exposures from conception onwards, comprising factors in externaland internal environments. The word exposome is used here also in relation to physiologic and etiopathogeneticfactors that affect normal spinal growth and may induce the deformity of AIS. In normal po

42、stnatal spinal growthwe propose a new term and concept, physiologic growth-plate exposome for the normal processes particularly ofthe internal environments that may have epigenetic effects on growth plates of vertebrae. In AIS, we propose anew term and concept pathophysiologic scoliogenic exposome f

43、or the abnormal processes in molecular pathwaysparticularly of the internal environment currently expressed as etiopathogenetic hypotheses; these are suggested tohave deforming effects on the growth plates of vertebrae at cell, tissue, structure and/or organ levels that areconsidered to be epigeneti

44、c. New research is required for chromatin modifications including DNA methylation inAIS subjects and vertebral growth plates excised at surgery. In addition, consideration is needed for a possiblenetwork approach to etiopathogenesis by constructing AIS diseasomes. These approaches may lead throughsc

45、reening, genetic, epigenetic, biochemical, metabolic phenotypes and pharmacogenomic research to identifysusceptible individuals at risk and modulate abnormal molecular pathways of AIS. The potential of epigenetic-based medical therapy for AIS cannot be assessed at present, and must await new researc

46、h derived from theevaluation of epigenetic concepts of spinal growth in health and deformity. The tenets outlined here for AIS areapplicable to other musculoskeletal growth disorders including infantile and juvenile idiopathic scoliosis.The metabolic basis of adolescent idiopathic scoliosis: 2011 re

47、port of the metabolic workgroup of the Fondation Yves CotrelAbstractObjective The purpose of this review is to elucidate themetabolic processes involved in the pathogenesis of ado-lescent idiopathic scoliosis (AIS) in light of research by thepresent authors as well as current literature.Methods Path

48、ogenetic mechanisms involved in AIS weremodeled as (a) a form of neuromuscular scoliosis (inconjunction with an adverse mechanical environment suchas bipedality), in which hormonal and other chemicalfactors act as regulators of skeletal muscle tone andfunction; (b) as a consequence of an abnormality

49、 in growthof the spinal column (in conjunction with an adversemechanical environment such as bipedality), in whichhormones and other chemical factors act as regulators ofgrowth; and (c) as a mechanical failure of one side of thevertebral column due to a defect in trabecular formation ormineralizatio

50、n (in conjunction with an adverse mechanicalenvironment such as bipedality); in which hormonal andother chemical factors act as regulators of bone formation,mineralization and/or resorption.Results and conclusion Current evidence supportingthese models individually or in combination is discussed.青少年

51、特發(fā)性脊柱側(cè)彎的國(guó)內(nèi)治療現(xiàn)況特發(fā)性脊柱側(cè)彎(記訪(fǎng)pathic, coliosis, IS)是指脊柱有側(cè)彎及旋轉(zhuǎn)畸形，而無(wú)任何先天性脊 柱異?；蚝喜⒂猩窠?jīng)肌肉或骨骼疾病，是最常見(jiàn)的結(jié)構(gòu)性脊柱側(cè)彎。而青少年特發(fā)性脊柱側(cè)彎(Pathic。coliosis , AIS)又是脊柱側(cè)彎中最為常見(jiàn)的一種類(lèi)型，占特發(fā)性脊柱側(cè)彎的80%左右，發(fā)病率約1.5% 3%llo目前AIS的病因還未明確，崔泰銘等吼急結(jié)了可能有關(guān)因素：遺傳基因：特發(fā)性脊柱側(cè)彎的基因因子是復(fù)雜的基因無(wú)序列狀態(tài)，已被大家廣泛接受，在 對(duì)特發(fā)性脊柱側(cè)彎的研究中發(fā)現(xiàn)單卵雙胞胎脊柱側(cè)彎畸形發(fā)生率較二卵雙胞胎高：神經(jīng)系統(tǒng)異常：伴有神經(jīng)系統(tǒng)異常的脊柱側(cè)

52、彎更容易進(jìn)展，因此許多學(xué)者對(duì)AIS的發(fā)生發(fā)展是否與神經(jīng)系統(tǒng)異常相關(guān)進(jìn)行了研究：生物化學(xué)因素：褪黑素(Melatonin)、雌激素(Estrogen)及鈣調(diào)蛋白；生物力學(xué)因素：生物力學(xué)因素在脊柱側(cè)彎中起著重要作用，任何造成脊柱生物力學(xué)改 變的因素均可能導(dǎo)致側(cè)彎；肌肉一骨骼系統(tǒng)。盡管許多學(xué)者已獲得許多有益資料，做了大 量研究，但仍未得出確切的病因，且病因也不可能就一個(gè)。因此，對(duì) AIS的治療也就有多 種方法。但總的可分為非手術(shù)治療和手術(shù)治療兩大類(lèi)。治療目的在于：矯正畸形：獲得穩(wěn)定;維持平衡；盡可能減少融和范圍?，F(xiàn)將近年來(lái)我國(guó)國(guó)內(nèi)AIS的治療介紹如下。通過(guò)建立實(shí)驗(yàn)動(dòng)物模型實(shí)現(xiàn)對(duì)伴有復(fù)雜脊髓損傷的先天

53、性脊柱側(cè)凸疾病的實(shí)驗(yàn)醫(yī)學(xué)研究【摘要】目的通過(guò)建立大白鼠試驗(yàn)動(dòng)物模型實(shí)現(xiàn)對(duì)伴有復(fù)雜脊髓損傷的先天性脊柱側(cè)凸疾病 的實(shí)驗(yàn)醫(yī)學(xué)研究。方法采用經(jīng)9.4%的氫氧化鈉水溶液稀釋后的6-疏基喋吟液，按30 ml/kg劑量行腹腔內(nèi)注射造模，并對(duì)具有先天性脊柱側(cè)彎臨床和影像學(xué)診斷的20只仔鼠(其中5只仔鼠出生后立即出現(xiàn)脊髓癱臨床癥狀)中剩余的15只無(wú)明顯神經(jīng)癥狀的仔鼠進(jìn)行被動(dòng)直立狀態(tài)下的生活觀(guān)察，6 d10 d, 13只仔鼠出現(xiàn)了典型的雙側(cè)后肢完全性癱瘓。對(duì)所有實(shí)驗(yàn) 動(dòng)物模型進(jìn)行影像學(xué)和脊柱脊髓的組織學(xué)觀(guān)察。結(jié)果脊柱影像學(xué)觀(guān)察，所有實(shí)驗(yàn)動(dòng)物模型都表現(xiàn)出典型的先天性脊柱側(cè)彎畸形伴有楔形半椎體和附件的畸形；組織學(xué)觀(guān)

54、察，畸形半椎體發(fā)生了明顯向椎管方向的移位，壓迫相應(yīng)節(jié)段的脊髓，在部分實(shí)驗(yàn)動(dòng)物表現(xiàn)為側(cè)彎頂點(diǎn)的楔形半椎體連同間盤(pán)一起向椎管方向移位；相應(yīng)的骨性結(jié)構(gòu)對(duì)脊髓節(jié)段形成壓迫；骨與脊髓的滋養(yǎng)血管被破壞，楔形半椎體上部的椎管內(nèi)軟脊膜上瘀滯的靜脈叢，下方無(wú)血管區(qū)和椎管狹窄區(qū)的血管分布缺失和側(cè)彎頂點(diǎn)水平靜脈叢的破敗，血管的狹窄和動(dòng)脈瘤樣增寬的病灶區(qū)。結(jié)論模型大白鼠生長(zhǎng)發(fā)育的脊柱在受到來(lái)自垂直方向上的動(dòng)-靜態(tài)負(fù)荷的作用，導(dǎo)致脊柱畸形的進(jìn)一步加重，并通過(guò)影像學(xué)和組織學(xué)觀(guān)察得到證實(shí)。 其發(fā)病機(jī)制變化特點(diǎn)與臨床資料相 符合，為臨床工作提供了實(shí)驗(yàn)醫(yī)學(xué)基礎(chǔ)，對(duì)臨床治療原則的制定起到指導(dǎo)作用。特發(fā)性脊柱側(cè)凸的病因?qū)W研究進(jìn)展脊

55、柱側(cè)彎是脊柱的一個(gè)或多個(gè)節(jié)段在冠狀面上偏離中線(xiàn)的側(cè)彎、矢狀面上的前凸或脊 椎體在縱軸上的旋轉(zhuǎn)，是最常見(jiàn)的脊柱三維畸形川。特發(fā)性脊柱側(cè)凸(idiopathic scoliosis, IS)患者無(wú)任何先天性脊柱異常、神經(jīng)肌肉及骨骼疾病，但出現(xiàn)脊柱側(cè)彎及旋轉(zhuǎn)畸形，該病多發(fā) 于青少年，初診年齡低于18歲的患者占特發(fā)性脊柱側(cè)凸患者的80%,故對(duì)該年齡段發(fā)病特稱(chēng)為青少年特發(fā)性脊柱側(cè)凸(adolescent idiopathicscoliosis , AIS ) z。大多數(shù)IS患者脊柱側(cè)凸相對(duì)較輕且病情穩(wěn)定，但少數(shù)患者側(cè)彎將不斷地加重并且需要支具或手術(shù)治療，而側(cè)凸高速進(jìn)展常發(fā)生在骨骼發(fā)育成熟之前的青春期，畸

56、形導(dǎo)致患者留下終身殘疾，更嚴(yán)重的使患者心肺功能受損，少數(shù)甚至死亡。盡管至今對(duì)于特發(fā)性脊柱側(cè)彎的發(fā)病原因已經(jīng)進(jìn)行了大 量的研究，但還未能闡明其具體的發(fā)病機(jī)制，故也沒(méi)有找到可靠的方法來(lái)預(yù)測(cè)疾病是否將進(jìn)行性加重。研究人員對(duì)特發(fā)性脊柱側(cè)凸的發(fā)病原因提出了很多假說(shuō)，包括遺傳基因因素、內(nèi)分泌異常、神經(jīng)系統(tǒng)異常、生物力學(xué)作用等。本文就以上因素與 IS發(fā)病的相關(guān)性的研究近 況進(jìn)行綜述。Normal Leptin Expression, Lower Adipogenic Ability,DecreasedLeptin Receptor and Hyposensitivity to Leptin in Adole

57、scent IdiopathicScoliosisAbstractLeptin has been suggested to play a role in the etiology of Adolescent Idiopathic Scoliosis (AIS), however, the leptin levels inAIS girls are still a discrepancy, and no in vitro study of leptin in AIS is reported. We took a series of case-control studies,trying to u

58、nderstand whether Leptin gene polymorphisms are involved in the etiology of the AIS or the change in leptinlevel is a secondary event, to assess the level of leptin receptor, and to evaluate the differences of response to leptinbetween AIS cases and controls. We screened all exons of Leptin gene in

59、45 cases and 45 controls and selected six tag SNPsto cover all the observed variations. Association analysis in 446 AIS patients and 550 healthy controls showed no associationbetween the polymorphisms of Leptin gene and susceptibility/severity to AIS. Moreover, adipogenesis assay of bonemesenchymal

60、stem cells (MSCs) suggested that the adipogenic ability of MSCs from AIS girls was lower than controls. Afteradjusting the differentiation rate, expressions of leptin and leptin receptor were similar between two groups. Meanwhile,osteogenesis assay of MSC showed the leptin level was similar after ad