Bergoin M
Service de Chirurgie Infantile et Orthopédie, CHU Nord, Marseille.
Ann Pediatr (Paris). 1993 Apr;40(4):259-69.
This is an update on the surgical and orthopedic management of scoliosis in children. After a review of the biomechanical factors underlying the scoliotic deformity in the three dimensions, methods and indications of conservative treatment combining physiotherapy and full-time or part-time bracing are discussed. Development of new segmental spinal instrumentation devices has modified the surgical treatment of scoliosis by allowing three-dimensional correction of deformities and obviating the need for postoperative immobilization in a cast or corset. Results of conservative treatment are analyzed in an original series of 56 children with progressive scoliosis treated when the angulation was still under 30 degrees. Mean follow-up since the end of treatment is 14 years. Results show that proper conservative treatment arrests progression and modifies the natural history of scoliosis. Outcome after surgical treatment is analyzed in an original and recent series composed of the 50 first children who had posterior surgery with the new Cotrel-Dubousset instrumentation. Results of anterior surgery (V.D.S. instrumentation), which is still indicated in some cases, are analyzed in an older series of 18 cases. When the deformities are too severe to allow conservative treatment, short segment fusion effectively corrects the scoliosis and reliably provides good cosmetic and functional results.
本文是关于儿童脊柱侧弯外科及矫形治疗的最新进展。在回顾了脊柱侧弯三维畸形的生物力学因素后，讨论了物理治疗与全日制或非全日制支具相结合的保守治疗方法及适应症。新型节段性脊柱内固定器械的发展改变了脊柱侧弯的外科治疗方式，可实现畸形的三维矫正，无需术后使用石膏或紧身胸衣固定。对一组56例角状弯曲仍小于30度时接受治疗的进行性脊柱侧弯儿童的原始系列病例分析了保守治疗的结果。自治疗结束后的平均随访时间为14年。结果显示，适当的保守治疗可阻止病情进展并改变脊柱侧弯的自然病程。对由首批50例采用新型Cotrel-Dubousset器械进行后路手术的儿童组成的原始及近期系列病例分析了手术治疗的结果。在一个18例的较旧系列病例中分析了前路手术（V.D.S.器械）的结果，某些情况下仍需进行前路手术。当畸形严重到无法进行保守治疗时，短节段融合可有效矫正脊柱侧弯，并可靠地提供良好的外观和功能效果。
