Professional Documents
Culture Documents
休门氏病自然史及治疗研究进展
休门氏病自然史及治疗研究进展
・综述・
休门氏病自然史及治疗研究进展
李卫国 邱勇
作者单位:210008,南京大学附属鼓楼医院脊柱外科
kyphosis. Spine, 2007, 32(Suppl 19):S115-119. adult Scheuermann's disease: study about 45 patients. J Med Liban,
2 Dziewulski M, Szymanik W. Epidemiology of Scheuermann's disease 2004,52:19-24.
in children and adolescents. Ortop Traumatol Rehabil, 2002,4:752- 20 杨操, Geoffrey Askin, 杨述华. 胸腔镜下前路松解结合后路矫形治疗
757. Scheuermann病后凸畸形. 中华外科杂志, 2004,21:1293-1295.
3 Lowe TG. Scheuermann's disease. In: Bridwell KH, DeWald RL (eds): 21 Mac-Thiong JM, Labelle H, Berthonnaud E, et al. Sagittal spinopelvic
Textbook of Spine Surgery. Philadelphia, Lippincott-Raven, 1997: balance in normal children and adolescents.Eur Spine J, 2007,16:
1173-1198. 227-234.
4 Ghoussoub K, Kreichati G, Azzi L, et al. The particularities of the 22 Tribus CB. Scheuermann's kyphosis in adolescents and adults: Diag-
adult Scheuermann's disease: study about 45 patients. J Med Liban, nosis and management. J Am Acad Orthop Surg, 1998,6:36-43.
2004,52:19-24. 23 Lowe TG. Scheuermann's disease. Orthop Clin North Am, 1999,30:
5 Pola E, Lupparelli S, Aulisa AG, et al. Study of vertebral morphology 475-487.
in Scheuermann's kyphosis before and after treatment. Stud Health 24 Bradford DS, Moe JH, Montalvo FJ, et al. Scheuermann's kyphosis
Technol Inform, 2002,91:405-411. and roundback deformity: Results of Milwaukee brace treatment. J
6 Tayyab NA, Samartzis D, Altiok H, et al. The reliability and diagnostic Bone Joint Surg, 1974,56:740-758.
valueofradiographiccriteriainsagittalspinedeformities:comparison 25 Marty C, Boisaubert B, Descamps H, et al. The sagittal anatomy of
of the vertebral wedge ratio to the segmental cobb angle. Spine, 2007, the sacrum among young adults, infants and spondylolisthesis patients.
32:E451-459. Eur Spine J, 2002,11:119-125.
7 Damborg F, Engell V, Andersen M, et al. Prevalence, concordance, 26 Pizzutillo PD. Nonsurgical treatment of kyphosis. Instr Course Lect.
and heritability of Scheuermann kyphosis based on a study of twins. 2004,53:485-491.
J Bone Joint Surg Am, 2006,88:2133-2136. 27 Montgomery SP, Erwin WE. Scheuermann' s kyphosis: Long term
8 Sorensen KH. Scheuermann's Juvenile Kyphosis: Clinical Appearances, resultswith Milwaukee brace treatment. Spine, 1981,6:5-8.
Radiography, Aetiology and Prognosis. Copenhagen: Munksgaard, 28 Sachs B, Bradford DS, Winter R, et al. Scheuermann kyphosis: Follow-
1964. up of Milwaulkee brace treatment. J Bone Joint Surg, 1987,69:50-57.
9 Jansen RC, van Rhijn LW, van Ooij A. Predictable correction of the 29 Bradford DS, Moe JH, Montalvo FJ, et al. Scheuermann's kyphosis
unfused lumbar lordosis after thoracic correction and fusion in and roundback deformity: Results of Milwaukee brace treatment. J
Scheuermann kyphosis. Spine, 2006,31:1227-1231. Bone Joint Surg, 1974,56:740-758.
10 Lowe TG. Scheuermann's kyphosis. Neurosurg Clin North Am, 2007, 30 Riddle EC, Bowen JR, Shah SA, et al. The duPont kyphosis brace
18:305-315. for the treatment of adolescent Scheuermann kyphosis. J South Orthop
11 Stoddard A, Osborn JF. Scheuermann's disease or spinal osteochondrosis: Assoc,2003,12:135-140.
Its frequency and relationship with spondylosis. J Bone Joint Surg, 31 Hosman AJ, Langeloo DD, Kleuver M, et al. Analysis of the sagittal
1979,61:56-58. plane after surgical management for Scheuermann' s disease. Spine,
12 Lowe TG. Scheuermann Disease. J Bone Joint Surg, 1990,72:940- 2002,27:167-175.
945. ′T, Bellyei A. Surgical correction of Scheuermann's
32 De Jonge T, Illes
13 Khoury NJ, Hourani MH, Arabi MM, et al. Imaging of back pain in kyphosis. Int Orthop, 2001,25:70-73.
children and adolescents. Curr Probl Diagn Radiol, 2006,35:224-244. 33 Galasko CS. Experience with combined video-assisted thoracoscopic
14 Bowles AO, King JC. Scheuermann's disease: the lumbar variant. surgery (VATS) anterior spinal release and posterior spinal fusion in
Am J Phys Med Rehabil, 2004,83:467. Scheuermann' s kyphosis. Spine, 2006,31:1513.
15 Weiss HR, Dieckmann J, Gerner HJ. Effect of intensive rehabilitation 34 Papagelopoulos PJ, Klassen RA, Peterson HA, et al. Surgical treatment
on pain in patients with Scheuermann's disease. Stud Health Technol of Scheuermann's disease with segmental compression instrumentation.
Inform,2002,88:254-257. Clin Orthop, 2001,139-149.
16 Bradford DS, Moe JH, Montalvo FJ, et al. Scheuermann's kyphosis: 35 Poolman RW, Been HD, Ubags LH. Clinical outcome and radiographic
Results of surgical treatment by posterior spine arthrodesis in twenty- results after operative treatment of Scheuermann's disease. Eur Spine
two patients. J Bone Joint Surg, 1975,57:439-448. J, 2002,11:561-569.
17 Arun R, Mehdian SM, Freeman BJ, et al. Do anterior interbody cages 36 Chiu KY, Luk KD. Cord compression caused by multiple disc herniations
have a potential value in comparison to autogenous rib graft in the and intraspinal cyst in Scheuermann's disease. Spine, 1995 20:1075-
surgical management of Scheuermann's kyphosis? Spine J, 2006,6: 1079.
413-420. 37 Obremskey WT, Pappas N, Attallah-Wasif E, et al. Levels of evidence
18 Murray PM, Weinstein SL, Spratt KF. The natural history and longterm in orthopaedic journals. J Bone Joint Surg Am, 2005,87:2632-2638.
follow-up of Scheuermann kyphosis. J Bone Joint Surg Am, 1993, 38 Jones CM. Posture. In: Kandel ER, ed. Principles of Neural Science.
75:236-248. Norwalk, CT: Appleton & Lange, 2000:816-831.
19 Ghoussoub K, Kreichati G, Azzi L, et al. The particularities of the 39 Edwards CC, Lenke LG, Peelle M, et al. Selective thoracic fusion for
中国骨肿瘤骨病2008年4月第7卷第2期 Chin J Bone Tumor & Bone Disease, Apri 2008, Vol 7, No.2 ・115・
adolescent idiopathic scoliosis with C modifier lumbar curves: 2-to plane after surgical management for Scheuermann's disease: a view
16-year radiographic and clinical results. Spine, 2004,29:536-546. on overcorrection and the use of an anterior release. Spine, 2002,27:
40 Lowe TG. Current concept review, Scheuermann disease. J Bone Joint 167-175.
Surg, 1990,72-A:940-945. 46 Speck GR, Chopin DC. The surgical treatment of Scheuermann's
41 Van Rhijn LW, Plasmans CM, Veraart BE. No relationship exists kyphosis. J Bone Joint Surg, 1986,68:189-193.
between the correction of the thoracic and the lumbar curves after 47 Lowe TG. Double L-rod instrumentation in the treatment of severe
selectivethoracicfusionforadolescentidiopathicscoliosisKingtype kyphosis secondary to Scheuermann's disease. Spine, 1987,12:336-
II. Eur Spine J, 2002,11:550-555. 341.
42 Vaz G, Roussouly P, Berthonnaud E, et al. Sagittal morphology and 48 Lim M, Green DW, Billinghurst JE, et al. Scheuermann kyphosis:
equilibrium of pelvis and spine. Eur Spine J, 2002,11:80-87. safe and effective surgical treatment using multisegmental instrumen-
43 Atici T, Aydinli U, Akesen B, et al. Results of surgical treatment for tation.Spine,2004,29:1789-1794.
kyphotic deformity of the spine secondary to trauma or Scheuermann's 49 Tribus CB. Transient paraparesis: a complication of the surgical man-
disease. Acta Orthop Belg, 2004,70:344-348. agement of Scheuermann 's kyphosis secondary to thoracic stenosis.
44 Lonner BS, Newton P, Betz R, et al. Operative management of Spine, 2001,26:1086-1089.
Scheuermann's kyphosis in 78 patients: radiographic outcomes,
complications, and technique. Spine, 2007,32:2644-2652. (收稿日期:2008-01-16 )
45 Hosman AJ, Langeloo DD, de Kleuver M, et al. Analysis of the sagittal
(上接英文目次 2 页)
内容涉及带和不带血管蒂的腓骨移植、异体骨、异体骨 + 人工假体复合物、骨转运、瘤骨灭活再植等。报道了不同重建
方式的肿瘤学结果、 功能结果以及手术并发症。 骨转运技术重建骨干缺损的优点是利用牵开成骨原理达到了用自体骨重建缺
损的目的,但其缺点是治疗时间长、并发症发生率高以及需多次手术。
九、翻修术
此专题涉及的内容包括各种原因所致的人工假体翻修、生物性重建的翻修、软组织肿瘤的二次手术。
意大利Istituto Rizzolia医院对于无菌性松动、假体柄断裂的翻修经验是首选非水泥固定型假体。 研究认为假体设计和材
料的改进可以降低并发症的发生率,从而提高假体的使用寿命。大多数患者翻修术后功能满意。
股骨近端人工假体置换是否需要同时行髋臼置换一直颇有争议。 来自英国的医生研究了股骨近端单动股骨头置换的结果。
作者建议对于年轻的原发肿瘤患者在行股骨近端人工假体置换时可考虑同时行髋臼的表面置换, 而对于预期寿命不足4年的
患者则可仅行单动头股骨近端假体置换。
十、骨转移瘤的治疗
对于骨转移瘤患者在决定是否手术时需要对生存期进行比较可靠的估计。 斯堪的纳维亚肉瘤协作组进行了一项关于肢体
和骨盆骨转移瘤患者预后的多中心前瞻性研究。 结果发现原发肿瘤类型是重要的生存预测因素, 肺癌的预后最差,乳腺癌、
肾
癌、骨髓瘤和淋巴瘤的预后最好。
肾癌骨转移中位生存时间为 12.5 个月,5 年生存率为 20%。研究认为积极的手术治疗(肿瘤切除术)与刮除或简单的髓
内针固定相比,不仅局部复发率下降,而且整体生存期也较长。乳腺癌骨转移中位生存期为 25 个月,即使转移广泛,仍有较
长的生存期,病变内去除肿瘤辅以放疗与积极地手术切除肿瘤相比,有较好的功能结果,且在生存时间和局部复发方面未显
示出不利之处。
十一、放射治疗
此专题主要集中于软组织肉瘤放疗。 有研究认为软组织肉瘤术前放疗后手术如果切除边缘为阳性, 术后补充放疗并不能
预防局部复发。对于有局部复发高危因素(如肿瘤较大、邻近骨或神经血管束、复发的肿瘤)的肢体高恶软组织肉瘤,保肢
术后行大剂量近距放疗可以得到很好的局部控制,伤口问题是主要的并发症。
十二、基础研究
与骨肉瘤生长、转移有关的基础研究是此部分的重点。骨肉瘤转移过程中 cyr61 的表达和调节、组织蛋白酶和骨肉瘤的
关系、PEDF在抑制骨肉瘤的生长和转移中的作用、甲状旁腺激素I 型受体的过度表达与骨肉瘤的复发和生存率的关系、人类
骨肉瘤的血清蛋白质组均有相关报道。
其他的基础研究包括:间叶组织肿瘤中干细胞样细胞的分离、吖啶橙在光能作用下的抗癌作用、骨巨细胞瘤中 P-
53 和 Ki-67的表达活性与预后和肺转移的关系等。
十三、P E T - C T
在肿瘤的影像学诊断方面,有关 PET-CT 的应用研究较多。研究内容包括:PET-CT 在原发部位不明的转移瘤中查
找原发部位的作用;PET-CT 用于骨与软组织肿瘤的手术计划、发现复发危险部位;预测化疗效果; PET-CT 用于区别
良恶性肿瘤所致的病理骨折;骨与软组织肿瘤的 PET 成像特点等。
本次 ISOLS 大会共收到论文摘要 700 余篇,录用 508 篇,注册参会人数达 606 人,大会取得了圆满成功。本次理
事会还决定第 16 届 ISOLS 大会将在中国举行,让我们共同努力为这次盛会的到来做好准备。
(孙宇庆,张清,丁易,牛晓辉)