椎间盘在脊柱侧弯矫正中的作用。特发性脊柱侧弯发病机制的理论模型。
The role of the intervertebral disc in correction of scoliotic curves. A theoretical model of idiopathic scoliosis pathogenesis.
作者信息
Grivas T B, Vasiliadis E S, Rodopoulos G, Bardakos N
机构信息
Scoliosis Clinic, Orthopaedic Department, Thriasio General Hospital, G. Genimata Avenue, Magula, 19600, Athens, Greece.
出版信息
Stud Health Technol Inform. 2008;140:33-6.
Wedging of the scoliotic inter-vertebral disc (IVD) was previously reported as a contributory factor for progression of idiopathic scoliotic (IS) curves. The present study introduces a theoretical model of IVD's role in IS pathogenesis and examines if, by reversing IVD wedging with conservative treatment (full- and night-time braces and exercises) or fusionless IS surgery with staples, we can correct the deformity of the immature spine. The proposed model implies the role of the diurnal variation and the asymmetric water distribution in the scoliotic IVD and the subsequent alteration of the mechanical environment of the adjacent vertebral growth plates. Modulation of the IVD by applying corrective forces on the scoliotic curve restores a close-to-normal force application on the vertebral growth plates through the Hueter-Volkmann principle and consequently prevents curve progression. The forces are now transmitted evenly to the growth plate and increase the rate of proliferation of chondrocytes at the corrected pressure side, the concave. Application of appropriately directed forces, ideally opposite to the apex of the deformity, likely leads to optimal correction. The wedging of the elastic IVD in the immature scoliotic spine could be reversed by application of corrective forces on it. Reversal of IVD wedging is thus amended into a "corrective", rather than "progressive", factor of the deformity. Through the proposed model, treatment of progressive IS with braces, exercises and fusionless surgery by anterior stapling could be effective.
先前有报道称,脊柱侧弯椎间盘(IVD)楔形变是特发性脊柱侧弯(IS)曲线进展的一个促成因素。本研究引入了一个关于IVD在IS发病机制中作用的理论模型,并探讨通过保守治疗(全天和夜间支具及运动)或用吻合器进行无融合IS手术来逆转IVD楔形变,是否能够纠正未成熟脊柱的畸形。所提出的模型暗示了昼夜变化和脊柱侧弯IVD中不对称水分布的作用,以及相邻椎体生长板机械环境的后续改变。通过对脊柱侧弯曲线施加矫正力来调节IVD,可通过休特尔 - 福尔克曼原理恢复对椎体生长板接近正常的力施加,从而防止曲线进展。现在力均匀地传递到生长板,并增加了矫正压力侧(凹侧)软骨细胞的增殖速率。施加方向适当的力,理想情况下与畸形顶点相反,可能会导致最佳矫正效果。通过对未成熟脊柱侧弯弹性IVD施加矫正力,可以逆转其楔形变。因此,IVD楔形变的逆转被修正为畸形的一个“矫正”而非“进展”因素。通过所提出的模型,用支具、运动以及前路吻合器进行无融合手术治疗进展性IS可能是有效的。