Goldberg C J, Dowling F E, Fogarty E E, Moore D P
Children's Research Centre, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
Genetica. 1995;96(3):247-55. doi: 10.1007/BF01439579.
Adolescent idiopathic scoliosis is the most common spinal deformity affecting children, with a prevalence from mass screening programmes of 1-3%. Despite centuries of study, it remains a problem with no generally accepted theory of aetiology, and disagreement on its natural history and management. Because the deformity consists ultimately of gross left-right asymmetry, a study was undertaken to test the hypothesis that it might be a manifestation of developmental instability. Palmar dermatoglyphics in 112 normal subjects, 62 with non-scoliosis trunk asymmetry and 85 with defined adolescent idiopathic scoliosis were examined and both the absolute right-left difference and the ratio of this to the total were considered. There was increased fluctuating asymmetry of atd difference in those with any asymmetry, scoliotic or not, and increased directional asymmetry of ab and cd ridge counts only in those with pure scoliosis. This suggests that, at adolescence, developmental instability may result in a loss of symmetry in growth, and that in the presence of an increased developmental left-right gradient, this may be of sufficient severity to be classified as deformity and come to the attention of orthopaedic surgeons. This interpretation changes the focus of many previous observations on scoliosis and raises the prospect that developmental stability in humans has relevance to problems hitherto restricted to clinical practice.
青少年特发性脊柱侧凸是影响儿童的最常见脊柱畸形，大规模筛查项目显示其患病率为1%至3%。尽管经过了数百年的研究，但病因仍无普遍接受的理论，其自然史和治疗方法也存在分歧。由于该畸形最终表现为明显的左右不对称，因此进行了一项研究，以检验其可能是发育不稳定表现的假设。对112名正常受试者、62名有非脊柱侧凸躯干不对称的受试者和85名明确诊断为青少年特发性脊柱侧凸的受试者的手掌皮纹进行了检查，并考虑了绝对左右差异及其与总数的比率。在有任何不对称（无论是否为脊柱侧凸）的人群中，atd差异的波动不对称性增加，而仅在单纯脊柱侧凸患者中，ab和cd嵴计数的方向不对称性增加。这表明，在青春期，发育不稳定可能导致生长对称性丧失，并且在发育左右梯度增加的情况下，这种情况可能严重到足以被归类为畸形并引起骨科医生的注意。这种解释改变了许多以往对脊柱侧凸观察的重点，并提出了人类发育稳定性与迄今仅限于临床实践的问题相关的可能性。
