小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 年龄＞10 岁
- 青春期后 6 到 12 个月
- 姿势不对称
- 无痛或极其轻微的疼痛
- 神经系统检查正常，没有神经系统症状
- 前屈时椎旁突起
- 椎旁突起处的脊柱侧凸测量仪检测值＞5°
- 腹壁反射不对称
其他诊断因素
- 肩部不对称
- 腰线不对称
- 胸壁或乳房不对称
- 咽反射正常
- 躯干失代偿
危险因素
- 阳性家族史
- 青春期生长突增高峰
诊断性检查
首要检查
- 临床检查
需考虑的检查
- 颈椎、胸椎、腰椎和骨盆的站立后前位 X 线片
- 颈椎、胸椎、腰椎和骨盆的站立侧位 X 线片
- 颈椎、胸椎、腰椎、骶椎和脑干的磁共振成像
治疗流程
筛查时脊柱侧凸测量仪测量值＜5° 或冠状面 Cobb 角测量值≤10°
站立位冠状面 Cobb 角测量值为 11°-20°
站立位冠状面 Cobb 角测量值为 21°-45°
站立位冠状面 Cobb 角测量值＞45°
撰稿人
作者
Ryan M. Ilgenfritz, MD, MS
Pediatric Orthopaedic Surgeon
Department of Orthopaedics
Nemours Children’s Hospital
Orlando
FL
利益声明
RMI declares that he has no competing interests.
Stuart L. Weinstein, MD
Ignacio V. Ponseti Chair and Professor of Orthopaedics
Department of Orthopaedics and Rehabilitation
University of Iowa Hospitals and Clinics
Iowa City
IA
利益声明
SLW is a former board member of the Journal of Bone and Joint Surgery (ended in 2013); he was involved in a NIH RO1 research grant programme until 2015; and he is an author of several references cited in this monograph.
同行评议者
John M. (Jack) Flynn, MD
Associate Chief of Orthopaedic Surgery
The Children's Hospital of Philadelphia
Philadelphia
PA
利益声明
JMF declares that he has no competing interests.
Amer Samdani, MD
Director
Pediatric Spine Surgery
Shriners Hospitals for Children
Philadelphia
PA
利益声明
AS is a paid consultant for Synthes Spine, Depuy Spine, and SpineVision.
Andre Tomasino, MD
Neurosurgeon
Department of Neurosurgery
Hospital Munich-Bogenhausen
Munich
Germany
利益声明
AT declares that he has no competing interests.
鉴别诊断
- 先天性脊柱侧凸
- 神经肌肉型脊柱侧凸
- 脊髓空洞症
更多 鉴别诊断指南
- 脊柱侧凸研究学会/北美小儿骨科学会/美国骨科医师学会/美国儿科学会关于青少年特发性脊柱侧凸早期识别筛查的立场声明
- 对于脊柱侧凸儿童进行脊柱拉伸的磁致伸缩控制 (MAGEC) 系统
更多 指南
Log in or subscribe to access all of BMJ Best Practice
内容使用需遵循免责声明