退行性腰椎侧凸与骨质疏松症的相关性研究
|
摘要
目的:退行性腰椎侧凸的发病率占退行性腰椎疾病的6%左右,是一种复杂的脊柱畸形,不仅表现为冠状面上的弯曲,常合并椎体轴位旋转、冠状面侧方移位及矢状面前方移位,多由椎间盘或小关节突退变、骨质疏松等造成脊柱的弯曲畸形,男女比例为1∶2。骨质疏松症是退行性腰椎侧凸的重要发病因素之一,严重的骨质疏松将加快退行性腰椎侧凸的发展。有报道称女性绝经后骨质疏松者退行性腰椎侧凸的发生率明显高于无骨质疏松者。腰椎侧凸还可以继发于骨质疏松引起的压缩骨折,非对称性的压缩骨折可以加重侧凸的程度。伴骨质疏松症的退行性腰椎侧凸患者常有着更广泛的椎间盘退变、小关节增生、黄韧带肥厚、脊柱失稳,多数还伴有脊柱冠状面侧方移位、旋转半脱位和矢状面椎体滑脱。同时骨质疏松症及由其引起的椎体病理性骨折与因退行性腰椎侧凸产生的肌肉劳损、躯干失平衡、腰前凸丢失、关节突关节病、椎管狭窄等因素共同作用将加重患者腰背部疼痛。本研究致力于通过对退行性腰椎侧凸患者骨密度检查及结果的统计学分析,了解两者的相关性,从而为优化手术方案,应对术中可能出现的相关并发症,以及对于病人术前及术后治疗提供理论依据。同时,掌握骨质疏松在退行性脊柱侧凸患者中的发病率,可给予健康指导,尤其对中老年人强调抗骨质疏松的重要性,即在一定程度上可防止退行性腰椎侧凸的发生
方法:2007年10月至2009年6月门诊及病房共收治退行性腰椎侧凸患者69例,其中男6例,女63例;平均年龄为69.3±11.4岁;所有患者均行X线、CT、MRI检查,部分患者行脊髓造影检查,根据影像学表现及患者病史询问,明确病情并记录患者Cobb’s角;对照组50例,均为非腰椎侧凸患者,其中腰椎管狭窄症37例,腰间盘突出症8例,腰椎滑脱症4例,腰椎管内占位1例,平均年龄62.6岁。采用我院双能X线吸收仪对患者进行骨密度测定,测定部位包括腰椎(L2-4)及股骨部,记录骨密度值及T值,同时根据不同年龄阶段、Cobb’s角观察退行性腰椎侧凸的T值变化。
结果:在69例退行性腰椎侧凸患者中,平均T值为-2.8±1.9,分布在-0.9到-4.7之间,合并骨质疏松52例,骨量减少14例,骨质疏松发生率75.4%,骨量减少发生率17.4%;对照组平均T值-1.2±1.6,分布在1.2到-2.4之间,合并骨质疏松5例,骨量减少17例,骨质疏松发生率10%,骨量减少发生率34%;两组比较有显著统计学差异(p<0.05)。根据不同年龄、Cobb’s角退行性腰椎侧凸患者的T值比较,发现骨质疏松程度与年龄呈明显正相关,而与Cobb’s角零相关。
结论:骨质疏松症是退行性腰椎侧凸发病的危险因素,两者存在显著的相关性,在本组发病率为75.4%,同时骨质疏松程度随着年龄的增大而增加,与侧凸程度无明显相关。
Objective: The incidence of degenerative lumbar scoliosis(DLS) was accounted for 6% of degenerative lumbar diseases. DLS is a complex spinal deformity, not only for the coronal plane bending, but often associated with vertebral axial rotation, lateral shift of coronal plane and frontal displacement of sagittal plane. Ratio between male and female was 1:2. It is often caused by osteoporosis and degeneration of intervertebral disc and facet joint. Decreased bone density was initially considered to be the important cause of DLS, severe osteoporosis will accelerate the development of degenerative lumbar scoliosis. It is reported that women with postmenopausal osteoporosis have significantly higher incidence of DLS than those without osteoporosis. DLS can also be secondary to osteoporotic compression fractures, non-symmetry of the compression fracture can increase the degree of scoliosis. patients with degenerative lumbar scoliosis often have a wider range of disc degeneration, facet joint hyperplasia, hypertrophy of ligamentum flavum, spinal instability when assosiated with osteoporosis, usually accompanied with lateral displacement of the spine coronal plane, rotation, subluxation and olisthesis. At the same time, osteoporosis, muscle strain, trunk loss of balance, loss of lumbar lordosis, facet joint disease, spinal stenosis and other factors will together increased patients’low back pain. The study is committed to master the correlation of DLS and osteoporosis through the statistical analysis of BMD and T values, then to supply a theoretical basis for preoperative and postoperative treatments, optimize the suigical programs, and decrease the complications on and after surgery. Meawhile, mastering the incidence of degenerative assosiated osteoporosis could give health guidances, stressed the importance of anti-osteoporosis especially for the elderly, an prevent the occurrence of degenerative lumbar scoliosis on some extent.
Method: From Oct.2007 to May.2010, 69 patients diagnosised with degenerative scoliosis from out-patient and wards were included in the group. There were 6 males and 63 females with an average age of 69.3 years(ranged from 58 to 81 years). To comfirm the diagnosis, all the patients underwent X-Ray , CT and MRI examines, several patients underwent myelography, Cobb’s angle was recorded respectively. Control group had 50 cases without scoliosis, including 37 spinal stenosis, 8 lumbar disc herniation, 4 spondylolisthesis and 1 lumbar spinal tumor. The bone density of lumbar(L2-4) and proximal femoral regions was measured with dual-energy x-ray absorptiometry. BMD and T values were recorded. The change of T values of diffierent ages and Cobb angles was observed to analyze the ralationship between them. Statistical analysis were performed with SPSS 13.0.
Result: Of the 69 cases with degenerative scoliosis, the average T-score was -2.8±1.9(distributed from -0.9 to -4.7), 52 cases combined with osteoporosis, 14 cases combined with osteopenia, the incidence of osteoporosis was 75.4%, the incidence of osteopenia was 17.4%; the average T-score in the control group was -0.6±1.8(distributed from 0.4 to -2.8), 5 cases combined with osteoporosis, 17 cases combined with osteopenia, the incidence of osteoporosis was 10%, the incidence of osteopenia was 34%. Significant difference was found among the mean t-scores of lumbar and proximal femoral regions of the groups(p<0.05). According to the comparision of T-score in different ages and Cobb’s angles, the T-score has a positive correlation with age, and zero correlation with Cobb’s angle.
Conclusion: Osteoporosis is a risk factor for degenerative scoliosis, there exists a significant correlation, in this cohort the incidence is 75.4%. Curve magnitude doesn’t correlate with the severity of osteoporosis.
方法:2007年10月至2009年6月门诊及病房共收治退行性腰椎侧凸患者69例,其中男6例,女63例;平均年龄为69.3±11.4岁;所有患者均行X线、CT、MRI检查,部分患者行脊髓造影检查,根据影像学表现及患者病史询问,明确病情并记录患者Cobb’s角;对照组50例,均为非腰椎侧凸患者,其中腰椎管狭窄症37例,腰间盘突出症8例,腰椎滑脱症4例,腰椎管内占位1例,平均年龄62.6岁。采用我院双能X线吸收仪对患者进行骨密度测定,测定部位包括腰椎(L2-4)及股骨部,记录骨密度值及T值,同时根据不同年龄阶段、Cobb’s角观察退行性腰椎侧凸的T值变化。
结果:在69例退行性腰椎侧凸患者中,平均T值为-2.8±1.9,分布在-0.9到-4.7之间,合并骨质疏松52例,骨量减少14例,骨质疏松发生率75.4%,骨量减少发生率17.4%;对照组平均T值-1.2±1.6,分布在1.2到-2.4之间,合并骨质疏松5例,骨量减少17例,骨质疏松发生率10%,骨量减少发生率34%;两组比较有显著统计学差异(p<0.05)。根据不同年龄、Cobb’s角退行性腰椎侧凸患者的T值比较,发现骨质疏松程度与年龄呈明显正相关,而与Cobb’s角零相关。
结论:骨质疏松症是退行性腰椎侧凸发病的危险因素,两者存在显著的相关性,在本组发病率为75.4%,同时骨质疏松程度随着年龄的增大而增加,与侧凸程度无明显相关。
Objective: The incidence of degenerative lumbar scoliosis(DLS) was accounted for 6% of degenerative lumbar diseases. DLS is a complex spinal deformity, not only for the coronal plane bending, but often associated with vertebral axial rotation, lateral shift of coronal plane and frontal displacement of sagittal plane. Ratio between male and female was 1:2. It is often caused by osteoporosis and degeneration of intervertebral disc and facet joint. Decreased bone density was initially considered to be the important cause of DLS, severe osteoporosis will accelerate the development of degenerative lumbar scoliosis. It is reported that women with postmenopausal osteoporosis have significantly higher incidence of DLS than those without osteoporosis. DLS can also be secondary to osteoporotic compression fractures, non-symmetry of the compression fracture can increase the degree of scoliosis. patients with degenerative lumbar scoliosis often have a wider range of disc degeneration, facet joint hyperplasia, hypertrophy of ligamentum flavum, spinal instability when assosiated with osteoporosis, usually accompanied with lateral displacement of the spine coronal plane, rotation, subluxation and olisthesis. At the same time, osteoporosis, muscle strain, trunk loss of balance, loss of lumbar lordosis, facet joint disease, spinal stenosis and other factors will together increased patients’low back pain. The study is committed to master the correlation of DLS and osteoporosis through the statistical analysis of BMD and T values, then to supply a theoretical basis for preoperative and postoperative treatments, optimize the suigical programs, and decrease the complications on and after surgery. Meawhile, mastering the incidence of degenerative assosiated osteoporosis could give health guidances, stressed the importance of anti-osteoporosis especially for the elderly, an prevent the occurrence of degenerative lumbar scoliosis on some extent.
Method: From Oct.2007 to May.2010, 69 patients diagnosised with degenerative scoliosis from out-patient and wards were included in the group. There were 6 males and 63 females with an average age of 69.3 years(ranged from 58 to 81 years). To comfirm the diagnosis, all the patients underwent X-Ray , CT and MRI examines, several patients underwent myelography, Cobb’s angle was recorded respectively. Control group had 50 cases without scoliosis, including 37 spinal stenosis, 8 lumbar disc herniation, 4 spondylolisthesis and 1 lumbar spinal tumor. The bone density of lumbar(L2-4) and proximal femoral regions was measured with dual-energy x-ray absorptiometry. BMD and T values were recorded. The change of T values of diffierent ages and Cobb angles was observed to analyze the ralationship between them. Statistical analysis were performed with SPSS 13.0.
Result: Of the 69 cases with degenerative scoliosis, the average T-score was -2.8±1.9(distributed from -0.9 to -4.7), 52 cases combined with osteoporosis, 14 cases combined with osteopenia, the incidence of osteoporosis was 75.4%, the incidence of osteopenia was 17.4%; the average T-score in the control group was -0.6±1.8(distributed from 0.4 to -2.8), 5 cases combined with osteoporosis, 17 cases combined with osteopenia, the incidence of osteoporosis was 10%, the incidence of osteopenia was 34%. Significant difference was found among the mean t-scores of lumbar and proximal femoral regions of the groups(p<0.05). According to the comparision of T-score in different ages and Cobb’s angles, the T-score has a positive correlation with age, and zero correlation with Cobb’s angle.
Conclusion: Osteoporosis is a risk factor for degenerative scoliosis, there exists a significant correlation, in this cohort the incidence is 75.4%. Curve magnitude doesn’t correlate with the severity of osteoporosis.
引文
1 Schwab F, Dubey A, Gamez, L, et al. Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population.Spine,2005, 30(9): 1082-1085
2 Melton LR. Perspective: how many women have osteoporosis now.J Bone Miner Res,1995,10:175-177
3 Healev JH, Lane JM. Structural scoliosis in osteoprotic women.Clin Orthop,1985,195:216-223
4马远征,余方圆,赵铭,等.腰椎退行性脊柱侧凸患者的X线及骨密度检测.中华骨科杂志,2006,26(7):438-441
5 Vanderpool DW, James JI, Wynne- Davies R. Scoliosis in the elderly.J Bone Joint Surg Am,1969,51(3):446-455
6 Perennou D, Marcelli C, Herisson C, et al. Adult lumbar scoliosis: epidemiologic aspects in a low-back pain population.Spine, 1994,19 (2):123-128
7 Pappou IP, Girardi FP, Sandhu HS, et al. Discordantly high spinal bone mineral density values in patients with adult lumbar scoliosis.Spine, 2006,14:1614-1620
8 Grubb SA, Lipscomb HJ, Coonrad RW. Degenerative adult onset scoliosis.Spine,1988,13:241-245
9 Murata Y, Takahashi K, Hanaoka E, et al. Changes in scoliotic curvature and lordotic angle during the early phase degenerative lumbar scoliosis.Spine,2002,27:2268 -2273
10 Padokostakis G, Katonis P, Gaitanis I, et a1. Lumbar scoliosis and postmenopausal osteoporosis.J Bone Joint Surg Br 2003,85(Suppl 3):220
11吴丽萍,陶天遵.男性骨质疏松症.国外医学·内分泌分册,2003,23 (2):114-117
12李平生.老年人骨质疏松.人民军医,2004,47(7):419-421
13 Marshall D,Brogi E, Bindi G, et al. Bone density measurement-a systematic review.J Inter Med,1997,739 (suppl):1-60
14 Daffner SD, Vaccaro AR. Adult degenerative lumbar scoliosis. Am J Orthop,2003,32(2):77-82
15 Keane B EI. Quantitative evaluation of bone mineral by aradiographic method.Br J Radio,1999,12:162
16 Simmons. Osteoporosis and bone density measurement methods. Clin Orthop,1991,271:149
17 He Y. The investigation present condition and progression of bone density determination technique. Foreign Medical Sciences-Section of Radiation Medicine and Nuclear Medicine,2001,25(4):161-162
18 Watts NB. Fundamentals and pitfalls of bone densitometry using dual-energy X-ray absorptiometry (DEXA).Osteoporos Int,2004,15:847 -854
19丁柱,朱兆洪,李国岩.骨密度测量诊断骨质疏松研究概况.中国中医骨伤科杂志,2004,6(12):47
20孟迅吾.原发性骨质疏松症的诊断及防治.中华内分泌代谢杂志, 2006,22(3):205-208
21 Siminoski K, Leslie WD, Frame H, et al. Recommendations for bone mineral density reporting in Canada: a shift to absolute fracture risk assessment.J Clin Densitom,2007, 10 (2):120-123
22 Velis KP, Healey JH, Schneider R. Osteoporosis in unstable adult scoliosis. Clin Orthop,1998,237:132-141
23曹洪海,李明.成人退行性脊柱侧凸的研究现状.中国矫形外志, 2006,1(14):63-65
24 Robin GC. Scoliosis in the elderly idiopathic or osteoporotic. Clin Orthop, 1986,205:311-312
25 Tan JS, Kwon BK, Dvorak MF, et al. Pedicle screw motion in the osteoporotic spine after augmentation with laminar hooks, sublaminar wires, or calcium phosphate cement: a comparative analysis.Spine, 2004, 29(16):1723-1730
1 Ghogawa Z, Benzel EC, Am in-Hanjani S, et al. Prospective outcomes evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative Grade I spondylosisthesis.J Neurosurg, 2004,1:267-272
2 Vanderpool DW, James JI, Wynne- Davies R. Scoliosis in the elderly.J Bone Joint Surg Am,1969,51(3):446-455
3 Schwab F, Dubey A, Gamez L, et al. Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine, 2005,30(2):1082-1085
4 Pritchett JW, Bortel DT. Degenerative symptomatic lumbar scoliosis. Spine,1993, 18(6):700-703
5 Velis KP, Healey JH, Schneider R. Osteoporosis in unstable adult scoliosis. Clin Orthop Relat Res,1988,237:132-141
6 Robin GC, Span Y, Steinberg R, et al. Scoliosis in the elderly: a follow-up study.Spine,1982,7(4):355-359
7 Kobayashi T, Atsuta Y, Takemitsu M, et al. A prospective study of de novo scoliosis in a community based cohort. Spine, 2006,31(2):178-182
8 Murata Y, Takahashi K, Hanaoka E, et al. Changes in scoliotic curvature and lordotic angle during the early phase of degenerative lumbar scoliosis.Spine, 2002,27(20): 2268-2273
9 Benoist M. Natural history of the aging spine. Eur Spine J,2003, 12( Suppl2): S86-89
10徐宏光,邱贵兴.椎体软骨终板在脊柱退性行疾病及脊柱侧凸发病中的作用.中华骨科杂志,2005,25(8):507-510
11 Tsantrizos A, Andreou A, Aebi M, et al. Biomechanical stability of five stand-alone anterior lumbar interbody fusion constructs.Ero Spine J, 2000,9:14-22
12 Truumees E, Demetroploulos CK, Yang KH, et al.Failure of human cervical endplates: a cadaveric experimental model. Spine,2003, 28:2204 -2208
13 Sohn HM, You JW, Lee JY. The relationship between disc degeneration and morphologic changes in the intervetebral foramen of the cervical spine: a cadaveric MRI and CT study.J Korean Med Sct,2004,19 (1):101-106
14 Zhou H, Hou S, Shan GW, et al. A new in vivo animal model to createintervetebral disc degeneration characterized by MRI and radiography, CT/discogram, biochemistry and histology.Spine,2007,32 (8):864-872
15 Antoniou J, Aelet V, Goswami T, et al. Elevated synthetic activity in the convex side of scoliotic intervetebral discs and endplates compared with normal tissues.Spine, 2001,26:198-206
16 Daffner SD, Vaccaro AR. Adult degenerative lumbar scoliosis.Am J Orthop,2003,32(2):77-82
17 Pappou IP, Girardi FP, Sandhu HS, et al. Discordantly high spinal bone mineral density values in patients with adult lumbar scoliosis. Spine, 2006,14:1614-1620
18 Grubb SA, Lipscomb HJ, Coonrad RW. Degenerative adult onset scoliosis.Spine,1988,13:241-245
19 Bridwell KH. Degenerative scoliosis. In: Bridwell KH, Dewald RL, eds.The textbook of spinal surgery.Philadelphia: JB Lippincott, 1997, 728 -741
20 Perennou D, Marcelli C, Herisson C, et al. Adult lumbar scoliosis: epidemiologic aspects in a low-back pain population. Spine, 1994, 19 (2):123-128
21 Trammell TR, Schroeder RD, Reed DB. Rotatory olisthesis in idiopathic scoliosis. Spine,1988,13(12):1378-1382
22 Schwab FJ, Smith VA, Biserni M, et al. Adult scoliosis: a quantitative radiographic and clinical analysis.Spine, 2002, 27(4):387-932
23 Glassman SD, Bridwell K, Dimar JR, et al. The impact of positive sagittal balance in adult spinal deformity.Spine, 2005,30(18):2024-2029
24 Liu H, Ishihara H, Kanamori M, et al. Characteristics of nerve root compression caused by degenerative lumbar spinal stenosis with scoliosis.Spine,2003,3(6): 524-529
25 Kostuik JP, Israel J, Hall JE. Scoliosis surgery in adults. Clin Orthop Relat Res,1973,93:225-234
26 Weidenbaum M. Considerations for focused surgical intervention in the presence of adult spinal deformity. Spine,2006,31(Suppl 19):139-143
27 Oskouian RJ Jr, Shaffrey CI. Degenerative lumbar scoliosis. Neurosurg Clin N Am, 2006,17(3):299-315
28 Faldini C, Pagkrati S, Grandi G, et al. Degenerative lumbar scoliosis: features and surgical treatment.J Orthop Traumatol,2006,7(2):67-71
29 Gupta MC. Degenerative scoliosis: options for surgical management. Orthop Clin North Am,2003,34(2):269-279
30 Simmons ED. Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis.Clin Orthop Relat Res,2001,384:45-53
31 Low T, Berven SH, Schwab FJ, et al. The SRS classification for adult spinal deformity: building on the King/Moe and Lenke classification systems.Spine, 2006,31(Suppl 19):119- 125
32邱勇,王斌,朱峰,等.退变性腰椎侧凸的冠状面失衡分型及对截骨矫形术式选择的意义.中华骨科杂志,2009,5(29):418-423
33 DeWald CJ, Stanley T. Instrumentation-related complications of multilevel fusions for adult spinal deformity patients over age 65: surgical considerations and treatment options in patients with poor bone quality.Spine,2006,31(Suppl 19):144-151
34 Tan JS, Kwon BK, Dvorak MF, et al. Pedicle screw motion in the osteoporotic spine after augmentation with laminar hooks, sublaminar wires, or calcium phosphate cement: a comparative analysis.Spine, 2004, 29(16):1723-1730
35曾岩,陈仲强,郭昭庆,等.腰椎管狭窄症伴退变性腰椎侧凸患者的影像学表现与临床特点.中国脊柱脊髓杂志,2007,17(10): 753-756
36 Aebi M. The adult scoliosis.Eur Spine J,2005,14(10): 925 -948
37 Edwards CC, Bridwell KH, Patel A, et al. Long adult deformity fusions to L5 and the sacrum: a matched cohort analysis. Spine,2004,29 (18):1996-2005
38 Simmons ED. Spinal stenosis with scoliosis.Spine,1992,17 (Suppl 6):117-120
39 Shapiro GS, Taira G, Boachie- Adjei O. Results of surgical treatment of adult idiopathic scoliosis with low back pain and spinal stenosis: a studylong-term clinical and radiographic outcomes.Spine,2003,28(4):358-363
40 Arlet V, Marchesi D, Papin P, et al. Decompensation following scoliosis surgery: treatment by decreasing the correction of the main thoracic curve or "letting the spine go".Eur Spine J,2000,9(2):156-160
41 Grubb BP, Samoil D, Kosinski D, et al. Results of surgical treatment of painful adult scoliosis.Spine,1994,19(14): 1619-1627
42 Liu HY, Zhou DG, Wang HM, et al. Surgical t reatment of degenerative scoliosis.Zhonghua Yi Xue Za Zhi,2003,83 (12):1066-1069
2 Melton LR. Perspective: how many women have osteoporosis now.J Bone Miner Res,1995,10:175-177
3 Healev JH, Lane JM. Structural scoliosis in osteoprotic women.Clin Orthop,1985,195:216-223
4马远征,余方圆,赵铭,等.腰椎退行性脊柱侧凸患者的X线及骨密度检测.中华骨科杂志,2006,26(7):438-441
5 Vanderpool DW, James JI, Wynne- Davies R. Scoliosis in the elderly.J Bone Joint Surg Am,1969,51(3):446-455
6 Perennou D, Marcelli C, Herisson C, et al. Adult lumbar scoliosis: epidemiologic aspects in a low-back pain population.Spine, 1994,19 (2):123-128
7 Pappou IP, Girardi FP, Sandhu HS, et al. Discordantly high spinal bone mineral density values in patients with adult lumbar scoliosis.Spine, 2006,14:1614-1620
8 Grubb SA, Lipscomb HJ, Coonrad RW. Degenerative adult onset scoliosis.Spine,1988,13:241-245
9 Murata Y, Takahashi K, Hanaoka E, et al. Changes in scoliotic curvature and lordotic angle during the early phase degenerative lumbar scoliosis.Spine,2002,27:2268 -2273
10 Padokostakis G, Katonis P, Gaitanis I, et a1. Lumbar scoliosis and postmenopausal osteoporosis.J Bone Joint Surg Br 2003,85(Suppl 3):220
11吴丽萍,陶天遵.男性骨质疏松症.国外医学·内分泌分册,2003,23 (2):114-117
12李平生.老年人骨质疏松.人民军医,2004,47(7):419-421
13 Marshall D,Brogi E, Bindi G, et al. Bone density measurement-a systematic review.J Inter Med,1997,739 (suppl):1-60
14 Daffner SD, Vaccaro AR. Adult degenerative lumbar scoliosis. Am J Orthop,2003,32(2):77-82
15 Keane B EI. Quantitative evaluation of bone mineral by aradiographic method.Br J Radio,1999,12:162
16 Simmons. Osteoporosis and bone density measurement methods. Clin Orthop,1991,271:149
17 He Y. The investigation present condition and progression of bone density determination technique. Foreign Medical Sciences-Section of Radiation Medicine and Nuclear Medicine,2001,25(4):161-162
18 Watts NB. Fundamentals and pitfalls of bone densitometry using dual-energy X-ray absorptiometry (DEXA).Osteoporos Int,2004,15:847 -854
19丁柱,朱兆洪,李国岩.骨密度测量诊断骨质疏松研究概况.中国中医骨伤科杂志,2004,6(12):47
20孟迅吾.原发性骨质疏松症的诊断及防治.中华内分泌代谢杂志, 2006,22(3):205-208
21 Siminoski K, Leslie WD, Frame H, et al. Recommendations for bone mineral density reporting in Canada: a shift to absolute fracture risk assessment.J Clin Densitom,2007, 10 (2):120-123
22 Velis KP, Healey JH, Schneider R. Osteoporosis in unstable adult scoliosis. Clin Orthop,1998,237:132-141
23曹洪海,李明.成人退行性脊柱侧凸的研究现状.中国矫形外志, 2006,1(14):63-65
24 Robin GC. Scoliosis in the elderly idiopathic or osteoporotic. Clin Orthop, 1986,205:311-312
25 Tan JS, Kwon BK, Dvorak MF, et al. Pedicle screw motion in the osteoporotic spine after augmentation with laminar hooks, sublaminar wires, or calcium phosphate cement: a comparative analysis.Spine, 2004, 29(16):1723-1730
1 Ghogawa Z, Benzel EC, Am in-Hanjani S, et al. Prospective outcomes evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative Grade I spondylosisthesis.J Neurosurg, 2004,1:267-272
2 Vanderpool DW, James JI, Wynne- Davies R. Scoliosis in the elderly.J Bone Joint Surg Am,1969,51(3):446-455
3 Schwab F, Dubey A, Gamez L, et al. Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine, 2005,30(2):1082-1085
4 Pritchett JW, Bortel DT. Degenerative symptomatic lumbar scoliosis. Spine,1993, 18(6):700-703
5 Velis KP, Healey JH, Schneider R. Osteoporosis in unstable adult scoliosis. Clin Orthop Relat Res,1988,237:132-141
6 Robin GC, Span Y, Steinberg R, et al. Scoliosis in the elderly: a follow-up study.Spine,1982,7(4):355-359
7 Kobayashi T, Atsuta Y, Takemitsu M, et al. A prospective study of de novo scoliosis in a community based cohort. Spine, 2006,31(2):178-182
8 Murata Y, Takahashi K, Hanaoka E, et al. Changes in scoliotic curvature and lordotic angle during the early phase of degenerative lumbar scoliosis.Spine, 2002,27(20): 2268-2273
9 Benoist M. Natural history of the aging spine. Eur Spine J,2003, 12( Suppl2): S86-89
10徐宏光,邱贵兴.椎体软骨终板在脊柱退性行疾病及脊柱侧凸发病中的作用.中华骨科杂志,2005,25(8):507-510
11 Tsantrizos A, Andreou A, Aebi M, et al. Biomechanical stability of five stand-alone anterior lumbar interbody fusion constructs.Ero Spine J, 2000,9:14-22
12 Truumees E, Demetroploulos CK, Yang KH, et al.Failure of human cervical endplates: a cadaveric experimental model. Spine,2003, 28:2204 -2208
13 Sohn HM, You JW, Lee JY. The relationship between disc degeneration and morphologic changes in the intervetebral foramen of the cervical spine: a cadaveric MRI and CT study.J Korean Med Sct,2004,19 (1):101-106
14 Zhou H, Hou S, Shan GW, et al. A new in vivo animal model to createintervetebral disc degeneration characterized by MRI and radiography, CT/discogram, biochemistry and histology.Spine,2007,32 (8):864-872
15 Antoniou J, Aelet V, Goswami T, et al. Elevated synthetic activity in the convex side of scoliotic intervetebral discs and endplates compared with normal tissues.Spine, 2001,26:198-206
16 Daffner SD, Vaccaro AR. Adult degenerative lumbar scoliosis.Am J Orthop,2003,32(2):77-82
17 Pappou IP, Girardi FP, Sandhu HS, et al. Discordantly high spinal bone mineral density values in patients with adult lumbar scoliosis. Spine, 2006,14:1614-1620
18 Grubb SA, Lipscomb HJ, Coonrad RW. Degenerative adult onset scoliosis.Spine,1988,13:241-245
19 Bridwell KH. Degenerative scoliosis. In: Bridwell KH, Dewald RL, eds.The textbook of spinal surgery.Philadelphia: JB Lippincott, 1997, 728 -741
20 Perennou D, Marcelli C, Herisson C, et al. Adult lumbar scoliosis: epidemiologic aspects in a low-back pain population. Spine, 1994, 19 (2):123-128
21 Trammell TR, Schroeder RD, Reed DB. Rotatory olisthesis in idiopathic scoliosis. Spine,1988,13(12):1378-1382
22 Schwab FJ, Smith VA, Biserni M, et al. Adult scoliosis: a quantitative radiographic and clinical analysis.Spine, 2002, 27(4):387-932
23 Glassman SD, Bridwell K, Dimar JR, et al. The impact of positive sagittal balance in adult spinal deformity.Spine, 2005,30(18):2024-2029
24 Liu H, Ishihara H, Kanamori M, et al. Characteristics of nerve root compression caused by degenerative lumbar spinal stenosis with scoliosis.Spine,2003,3(6): 524-529
25 Kostuik JP, Israel J, Hall JE. Scoliosis surgery in adults. Clin Orthop Relat Res,1973,93:225-234
26 Weidenbaum M. Considerations for focused surgical intervention in the presence of adult spinal deformity. Spine,2006,31(Suppl 19):139-143
27 Oskouian RJ Jr, Shaffrey CI. Degenerative lumbar scoliosis. Neurosurg Clin N Am, 2006,17(3):299-315
28 Faldini C, Pagkrati S, Grandi G, et al. Degenerative lumbar scoliosis: features and surgical treatment.J Orthop Traumatol,2006,7(2):67-71
29 Gupta MC. Degenerative scoliosis: options for surgical management. Orthop Clin North Am,2003,34(2):269-279
30 Simmons ED. Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis.Clin Orthop Relat Res,2001,384:45-53
31 Low T, Berven SH, Schwab FJ, et al. The SRS classification for adult spinal deformity: building on the King/Moe and Lenke classification systems.Spine, 2006,31(Suppl 19):119- 125
32邱勇,王斌,朱峰,等.退变性腰椎侧凸的冠状面失衡分型及对截骨矫形术式选择的意义.中华骨科杂志,2009,5(29):418-423
33 DeWald CJ, Stanley T. Instrumentation-related complications of multilevel fusions for adult spinal deformity patients over age 65: surgical considerations and treatment options in patients with poor bone quality.Spine,2006,31(Suppl 19):144-151
34 Tan JS, Kwon BK, Dvorak MF, et al. Pedicle screw motion in the osteoporotic spine after augmentation with laminar hooks, sublaminar wires, or calcium phosphate cement: a comparative analysis.Spine, 2004, 29(16):1723-1730
35曾岩,陈仲强,郭昭庆,等.腰椎管狭窄症伴退变性腰椎侧凸患者的影像学表现与临床特点.中国脊柱脊髓杂志,2007,17(10): 753-756
36 Aebi M. The adult scoliosis.Eur Spine J,2005,14(10): 925 -948
37 Edwards CC, Bridwell KH, Patel A, et al. Long adult deformity fusions to L5 and the sacrum: a matched cohort analysis. Spine,2004,29 (18):1996-2005
38 Simmons ED. Spinal stenosis with scoliosis.Spine,1992,17 (Suppl 6):117-120
39 Shapiro GS, Taira G, Boachie- Adjei O. Results of surgical treatment of adult idiopathic scoliosis with low back pain and spinal stenosis: a studylong-term clinical and radiographic outcomes.Spine,2003,28(4):358-363
40 Arlet V, Marchesi D, Papin P, et al. Decompensation following scoliosis surgery: treatment by decreasing the correction of the main thoracic curve or "letting the spine go".Eur Spine J,2000,9(2):156-160
41 Grubb BP, Samoil D, Kosinski D, et al. Results of surgical treatment of painful adult scoliosis.Spine,1994,19(14): 1619-1627
42 Liu HY, Zhou DG, Wang HM, et al. Surgical t reatment of degenerative scoliosis.Zhonghua Yi Xue Za Zhi,2003,83 (12):1066-1069