Italian Scientific Spine Institute, Milan, Italy.
Eur J Phys Rehabil Med. 2009 Dec;45(4):595-603.
An increase of the physiological kyphosis during growth is defined hyperkyphosis (HK) and, according to the level where the apex of the curve can be retrieved, we can distinguish a thoracic HK and a thoraco-lumbar one, also called junctional kyphosis. Since these conditions can cause pain and esthetics impairments, lead in adulthood to an higher incidence of spinal and shoulder pain, and evolve during growth, it is important to manage this deformity. The aim of this paper was to present the state of the art about HK and its treatment. Scheuermann Disease (SCHK) is the better known cause of HK; other causes can be idiopathic or postural, trunk extensor muscles weakness or neurological problems. Despite etiology a specific treatment can be required during growth to prevent evolution and reach a better spinal alignment in adulthood. It is at the base of treatment and allow monitoring. There are some validated methods that can be used in a comprehensive rehabilitation approach. Evidence in this field is scanty, even if there is quite a consensus on possible treatments. They aim at improving posture and esthetics, and abolishing pain; they include: exercises, used mainly in mobile postural/idiopathic HK, and in SCHK without HK; braces (plus exercises, in this case aimed at reducing brace impairments), that in rigid HK and in most of SCHK patients also allow a better vertebral growth; surgery could be used in worst cases, even if it should be carefully considered, because it requires fusion and loss of spinal function.
生长过程中生理后凸增加被定义为过度后凸（hyperkyphosis，HK），根据可以检索到曲线顶点的水平，我们可以区分胸椎 HK 和胸腰椎 HK，也称为交界性后凸。由于这些情况可能导致疼痛和美观受损，在成年后导致更高的脊柱和肩部疼痛发生率，并在生长过程中演变，因此管理这种畸形很重要。本文旨在介绍 HK 及其治疗的最新进展。Scheuermann 病（SCHK）是导致 HK 的更为人所知的原因；其他原因可能是特发性或姿势性的，躯干伸肌肌肉无力或神经问题。尽管病因不同，但在生长过程中可能需要特定的治疗来预防进展并在成年时获得更好的脊柱排列。这是治疗的基础，并允许进行监测。有一些经过验证的方法可用于综合康复方法。该领域的证据很少，尽管对可能的治疗方法存在相当大的共识。它们旨在改善姿势和美观，消除疼痛；它们包括：运动，主要用于活动性姿势/特发性 HK 和无 HK 的 SCHK；支具（结合运动，在这种情况下，旨在减少支具的影响），在僵硬性 HK 和大多数 SCHK 患者中也允许更好的椎体生长；手术可用于最严重的病例，尽管应仔细考虑，因为它需要融合和丧失脊柱功能。
