Janicki Joseph A, Alman Benjamin
Department of Orthopaedics, Northwestern University, Children's Memorial Hospital, Chicago, Illinois, USA.
Paediatr Child Health. 2007 Nov;12(9):771-6. doi: 10.1093/pch/12.9.771.
Scoliosis is a spinal deformity consisting of lateral curvature and rotation of the vertebrae. The causes of scoliosis vary and are classified broadly as congenital, neuromuscular, syndrome-related, idiopathic and spinal curvature due to secondary reasons. The majority of scoliosis cases encountered by the general practitioner will be idiopathic. The natural history relates to the etiology and age at presentation, and usually dictates the treatment. However, it is the patient's history, physical examination and radiographs that are critical in the initial evaluation of scoliosis, and in determining which patients need additional considerations. Scoliosis with a primary diagnosis (nonidiopathic) must be recognized by the physician to identify the causes, which may require intervention. Patients with congenital scoliosis must be evaluated for cardiac and renal abnormalities. School screening for scoliosis is controversial and is falling out of favour. The treatment for idiopathic scoliosis is based on age, curve magnitude and risk of progression, and includes observation, orthotic management and surgical correction with fusion. A child should be referred to a specialist if the curve is greater than 10 degrees in a patient younger than 10 years of age, is greater than 20 degrees in a patient 10 years of age or older, has atypical features or is associated with back pain or neurological abnormalities.
脊柱侧弯是一种脊柱畸形，包括椎体的侧方弯曲和旋转。脊柱侧弯的病因多种多样，大致可分为先天性、神经肌肉性、综合征相关性、特发性以及继发原因导致的脊柱弯曲。全科医生遇到的大多数脊柱侧弯病例将是特发性的。其自然病史与发病时的病因和年龄有关，通常决定治疗方式。然而，患者的病史、体格检查和X光片在脊柱侧弯的初始评估以及确定哪些患者需要进一步评估方面至关重要。必须由医生识别出具有初步诊断（非特发性）的脊柱侧弯，以确定病因，这可能需要进行干预。先天性脊柱侧弯患者必须评估是否存在心脏和肾脏异常。学校对脊柱侧弯的筛查存在争议，且已不再流行。特发性脊柱侧弯的治疗基于年龄、弯曲程度和进展风险，包括观察、支具治疗以及融合手术矫正。如果10岁以下患者的侧弯大于10度、10岁及以上患者的侧弯大于20度、具有非典型特征或伴有背痛或神经异常，则应将儿童转诊至专科医生处。
