Kotwicki Tomasz, Durmała Jacek, Czaprowski Dariusz, Głowacki Maciej, Kołban Maciej, Snela Sławomir, Sliwiński Zbigniew, Kowalski Ireneusz M
Katedra i Klinika Ortopedii i Traumatologii Dzieciecej Uniwersytet Medyczny, Poznań, Poland.
Ortop Traumatol Rehabil. 2009 Sep-Oct;11(5):379-95.
Idiopathic scoliosis, defined as a lateral curvature of the spine of above 10 degrees (Cobb angle), is seen in 2-3% of the growing age population, while curves above 20 degrees , requiring conservative treatment, are found in 0.3-0.5%. In our observation, both under-treatment of progressive curves and over-treatment of stable cases are common during conservative management of scoliosis.
A model of therapeutic management is presented based on the experience of Polish clinicians specialising in the treatment of scoliosis as well as the effects of work of a panel of experts of SOSORT (Society on Scoliosis Orthopaedic and Rehabilitation Treatment). The model comprises the indications for conservative treatment according to age, curve type and size and Risser grading. The aetiology, classifications, usefulness of the Lonstein and Carlson factor of progression and other methods of determining the probability of scoliosis progression, as well as the psychological aspects of conservative management are presented.
Based on the knowledge of the natural history of idiopathic scoliosis, factors of progression and on the SOSORT experts' opinion, guidelines are proposed for clinicians treating children and adolescents with idiopathic scoliosis, including the timing and course of brace treatment and the types of exercises.
Uniform practical guidelines developed by experts may represent an essential step towards establishing standards of conservative scoliosis care in our country.
特发性脊柱侧弯定义为脊柱侧弯超过10度（Cobb角），在2 - 3%的成长年龄段人群中可见，而超过20度、需要保守治疗的侧弯在0.3 - 0.5%的人群中出现。在我们的观察中，脊柱侧弯保守治疗期间，进展性侧弯治疗不足和稳定性病例治疗过度的情况都很常见。
基于波兰脊柱侧弯治疗临床医生的经验以及脊柱侧弯矫形与康复治疗协会（SOSORT）专家小组的工作成果，提出了一种治疗管理模型。该模型包括根据年龄、侧弯类型和大小以及Risser分级进行保守治疗的指征。介绍了病因、分类、Lonstein和Carlson进展因素的实用性以及其他确定脊柱侧弯进展可能性的方法，以及保守治疗的心理方面。
基于对特发性脊柱侧弯自然史、进展因素的了解以及SOSORT专家的意见，为治疗特发性脊柱侧弯的儿童和青少年的临床医生提出了指导方针，包括支具治疗的时机和疗程以及运动类型。
专家制定的统一实用指南可能是在我国建立脊柱侧弯保守治疗标准的重要一步。
