脊柱侧弯摘要

1、特发性脊柱侧弯的生物力学研究进展脊柱侧弯是脊柱的一个或多个节段在冠状面上偏离中线的侧弯、矢状面上的前弯或脊椎体在纵轴上的旋转，是最常见的脊柱三维畸形1。脊柱侧弯是躯干的畸形，以脊柱的侧向偏移和轴位旋转为特征。许多特发性脊柱侧弯患者存在肋骨的变形以及矢状面上胸椎生理后弯的减少。少数特发性脊柱侧弯患者表现为主弯与次弯交界区的后弯畸形。由于其病理解剖特点复杂，导致脊柱在出现侧弯后和矫正手术后的生物力学变化较正常生理曲度的脊柱复杂得多，本文就目前国内外在脊柱侧弯生物力学方面的研究综述如下。小儿先天性脊柱侧弯合并椎管内神经畸形的临床研究摘要目的探讨小儿先天性脊柱侧弯合并椎管内神经畸形的发病情况和临床特征

2、及其神经 畸形与临床表现的相关性。方法回顾性研究122例先天性脊柱侧弯患儿，对患者的体格检查情况以及全脊柱 CT、全脊髓 MRI、双下肢肌电图等相关辅助检查结果进行整理分析。结果122例先天性脊柱侧弯有63例(51.6%)合并脊髓畸形，其中脊髓栓系 (TCS)69.8%(44/63);脊髓纵裂(SCM)占 60.3%(38/63),包括 I 型脊髓纵裂占 68.4%(26/38) , II 型纵裂占31.6%(12/38);脊髓空洞27%(17/63);脊膜膨出占20.6%(13/63);椎管内囊肿占17.5%(11/63);Chiari畸形4.8%(3/63)。结论小儿先天性脊柱侧弯合并椎管

3、内神经畸形的发 生率高，并且常表现为多种脊髓畸形同时存在。合并神经畸形的患儿常表现为腰背部中线处皮肤异常，足畸形和双下肢不对称，但对于不同神经畸形其与常见的临床表现具有不同的相关性。关键词：先天性脊柱侧弯，脊髓栓系，脊髓纵裂SOX9和VEGF在小儿先天性脊柱侧弯顶椎生长板软骨的表达研究先天性脊柱侧弯(C o n g e ni t al S C ol io s i s,C S)是临床上较常见的一种小儿先天性脊柱畸 形，其发生发展主要归因于先天存在的异常脊椎导致脊柱纵向不平衡生长。在脊柱纵向发存 过程中脊椎生长板软骨是纵向生长的基础，顶椎作为先天性脊柱侧弯的触发点，其生长板软骨的化骨活性直接关系到

4、侧弯的发生发展情况。以往研究已证实脊椎生长板具有类似长骨生长板的特性，生长分化受多种细胞因子的调控。 其中S O X 9是一个与哺乳动物的性别决定因子 S R Y(Y染色体上的性别决定区)具有高度同源性的转录因子，表达于除肥大软骨细胞外所有 分化型软骨细胞，并贯穿整个软骨形成过程 ，被认为在软骨内成骨的初始阶段发挥着重要作 用。血管内皮生长因子(V E G F)是刺激内皮细胞生长和血管再生的一个重要因素，研究发现在软骨内化骨过程中又于软骨细胞死亡，细胞外基质重塑，血管生成和骨骼形成是一种基本的调节物质。因此通过对侧弯顶椎凸凹两侧生长板软骨V EG F和S O X 9表达情况的检测可以判断侧弯两

5、侧软骨板成骨能力的差异，推断小儿先天性脊柱侧弯发病和进展的分子生物学基础，为进一步的分子生物学研究奠定基础。佛山市青少年脊柱侧凸患病率调查脊柱侧凸是指脊柱的一个或数个节段向侧方弯曲并伴有椎体旋转和矢状面上后凸或前凸的增加或减少的脊柱畸形， 其多发生于青少年，绝大部分为特发性， 部分患者的侧凸还会逐渐 进展，畸形严重时不仅会造成身体外观异常、 脊柱运动功能障碍，还可因胸廓畸形而造成心、 肺功能障碍，明显降低生存质量、影响青少年健康发育。在这个时期进行脊柱侧凸的普查，对早期发现、及时防治和减少该畸形对青少年身心健康的严重危害是一种有效的方法1-3。这不仅使需手术治疗的比例减少，也使手术患者侧凸严重

6、程度明显减轻3。我们于2009年6月至2011年9月对佛山市五区25所中小学18 798名715岁在校青少年儿童进行了 脊柱侧凸患病率的普查，现报告如下。青少年特发性脊柱侧弯发病机理的研究进展特发性脊柱侧弯(idiopathic scoliosis,IS)是指脊柱有侧弯及旋转畸形，而无任何先天性脊柱异 常或合并有神经肌肉或骨骼疾病，是最常见的结构性脊柱侧弯，占脊柱侧弯总数的80%左右。尽管对于特发性脊柱侧弯的病因进行了大量的研究，但至今其病因尚不明确。青少年特发性脊柱侧弯(adolescent idipathic scoliosis,AIS)是脊柱侧弯中最为常见的一种类型，是根据初诊年龄划分的

7、1018岁未成年患者，占特发性脊柱侧弯的80%左右4。关于AIS的病因，已有的研究基本上分为基因遗传因素、神经系统功能异常、生物化学因素和生物力学因素先后发现了褪黑素、钙调蛋白，以及雌激素受体基因多态性等同AIS发生发展之间的相关性。青少年特发性脊柱侧弯的流行病学研究进展青少年特发性脊柱侧弯(AIS)是一种表现为脊柱旋转不对称的疾病。正如它命名中“特 发性”所指，尽管学者们做了大量研究，但迄今为止它的病因仍然不明，这就给它的早期干预、 早期治疗带来了困难。AIS的流行病学研究能够帮助人们进一步认识AIS疾病的发展规律。我们从AIS的分布规律、危险因素、早期筛查、预后等方面对 AIS的流行病学研

8、究进展进 行综述。内蒙古地区蒙、汉、回族小学生生长发育及脊柱侧弯的研究荃金项目：国家自然科学基金(30660072),内蒙古医学院重大课题(NY05ZD005)。内蒙古自治区自然科学其金 (2009MS1112),关国 健康基金(PSBH)。小学阶段是儿童入学正式学习的时期，此时对于正处于不断生长发育的儿童而言，将面对诸多新的情况，如桌凳高度、长期坐姿、灯光亮度、光线角度、学习时间及日益沉重的书 包等。这些环境及生活习惯的改变对于身体发育尤其对人体的中轴、力学桥梁一脊柱的发育将产生较大的影响。国内外报道显示脊柱侧弯在儿童中较为常见一 :31 ,但未检索到对内蒙古地区儿童脊柱侧弯的调查报道。轻度

9、脊柱侧弯症状不明显，不易被发现，但仍影响儿童的体型和健康。本课题对内蒙古地区蒙、汉、回族7-13周岁小学生的生长发育及脊柱侧弯进行了调查和分析。大学生体检发现脊柱侧弯127例分析【摘要】 目的调查大学生脊柱侧弯的患病情况，以探讨早期发现并预防脊柱侧弯的发 生及干预脊柱侧弯的发展的必要性。方法对福州大学15 090位新生进行胸部透视体检，发现脊柱侧弯后，应用岛津500 mA X光机行全脊柱透视检查。 结果 本组发现脊柱侧弯127例。 结论大学生脊柱侧弯的患病率比较高，这应引起重视，需要提高患者自身对脊柱侧弯的认识 及早发现以促进其今后选择相应的干预措施和恰当的治疗方法。【关键词】脊柱侧弯；大学生

10、；患病率不同时期广州市青少年儿童脊柱侧凸患病率调查摘要背景：脊柱侧凸还没有病因性治疗方法，仅能针对已经发生畸形后的矫形和固定，所以对年龄段学生进行定期普查以便及时发现并在早期措施，有利于降低脊柱侧弯的发生率，但是国内还没有对于同一地区不同时段脊柱侧弯的流行病学调查研究。目的：观察1996/1997与2005年广州市青少年儿童脊柱侧凸患病率变化，比较不同时期的患病情况及原因分析。方法：分别于 1996-01/1997-11及2005-02/12对广州市市区 715岁在校青少年儿童进行了 脊柱侧凸患病率的随机抽样调查。采用三检筛选法，计算不同时间脊柱侧凸患病率情况，x2检3效2次调查结果差异。结果

11、与结论：1996/1997广州市青少年儿童脊柱侧凸的患病率为1.07%。其中男性患病率 0.90%,女性患病率1.26%,两者的患病率之比为1 ： 1.4。脊柱侧凸的患病类型：特发性侧凸350人，占96.95%,先天性侧凸6人，神经肌肉源性侧凸 5人。2005年的患病率为1.21%;其中男性患病率 0.96%,女性患病率1.49%,两者的患病率之比 为1 ： 1.5。脊柱侧凸的患病类型：特发性侧凸134人，占97.81%,神经肌肉源性侧凸 3人，占2.19%,先天性侧凸0人。两次调查相比：患病率差异无显著性意义 (X 2=3.775, P0.05); 男性患病率差异无显著性意义(x 2=0.4

12、42 , P0.05);女性的总体患病率有上升(x =4.013 ,P0.05)。关键词：柱侧凸；发病率；流行病学；青少年；Cobb角 doi:10.3969/j.issn.1673-8225.2010.46.039先天性脊柱侧弯合并脊髓纵裂的临床特征和形态学研究目的探讨及归纳先天性脊柱侧弯合并的脊髓纵裂以及骨晴在椎管内的形态、节段、位置等形态学特点，提出新的纵裂分型方法，以期指导临床工作。方法回顾性总结分析136例先天性 脊柱侧弯合并脊髓纵裂患者的临床资料、CT及MRI影像学结果。结果工型及 II型脊髓纵裂在胸腰段的发生率最高，腰段及胸段次之，颈段较少；工型脊髓纵裂中推管内骨棘的发生节段以腰

13、段最多，其次为胸腰段及胸段，颈段罕见。骨靖以贯通型多见，存在腹侧型及背侧型，但数量较少。结论先天性脊柱侧弯患者常合并脊髓纵裂畸形，完善术前CT及MRI等影像学检查有助于更好的了解脊髓纵裂及骨靖的形态特点，新的临床分型对制定合理的手术治疗方案有指导意义。The role of melatonin in the pathogenesis of adolescentidiopathicscoliosis (AIS)Abstract The cause of adolescent idiopathic scoliosis(AIS) in humans remains obscure and proba

14、bly multifacto-rial. At present, there is no provenmethod or test available toidentify children or adolescent at risk of developing AIS oridentify which of the affected individuals are at risk ofprogression. Reported associations are linked in pathogen-esis rather than etiologic factors. Melatonin m

15、ay play a rolein the pathogenesis of scoliosis (neuroendocrine hypothe-sis), but at present, the data available cannot clearly show therole of melatonin in producing scoliosis in humans. The dataregarding human melatonin levels are mixed at best, and themelatonin de?ciency as a causative factor in t

16、he etiology ofscoliosis cannot be supported. It will be an important issue offuture research to investigate the role of melatonin in humanbiology, the clinical ef?cacy, and safety of melatonin underdifferent pathological situations. Research is needed tobetter de?ne the role of all factors in AIS de

17、velopment.Idiopathic scoliosis in Korean schoolchildren: a prospective screeningstudy of over 1 million childrenAbstract Cross-sectional epidemiologic scoliosis screen-ing was carried out to determine the current prevalence ofscoliosis in the Korean population and to compare with theresults of previ

18、ous studies. Between 2000 and 2008,1,134,890 schoolchildren underwent scoliosis screening.The children were divided into two age groups, 10 -12-year-olds (elementary school) and 13 -14-year-olds (middleschool), to calculate age- and sex- speci?c prevalence rates.Children with measured curvetypes, ma

19、gnitudes, and Risser scores (inter-observerr = 0.964, intra-observer r = 0.978). Yearly and overallprevalence rates of scoliosis were calculated. There were584,554 boys and 550,336 girls in the sample, with a male tofemale ratio of 1.1:1. There were 77,910 (6.2%) children(26,824 boys and 51,086 girl

20、s) with scoliometer readings5, and 37,339 of them had positive results with Cobbangles C10 (positive predictive value, 46.4%). The overallscoliosis prevalence rate was 3.26%; girls had a higherprevalence (4.65%) than boys (1.97%). Prevalence ratesincreased progressively from 1.66 to 6.17% between 20

21、00and 2008, with the exception of 2002. According to age andgender, 10 -12-year-old girls had the highest scoliosisprevalence rates (5.57%), followed by 13T4-year-old girls(3.90%),10T2-year-old boys (2.37%), and13 14-year-oldboys (1.42%). In girls and boys, prevalence rates dropped by64.53 and 60.65

22、% among 10 12-year-olds and 13 14-year-olds, respectively (P = 0.00). The proportion of 10 19curves was 95.25 and 84.45%in boys and girls, respectively;and the proportion of 2029 curves was 3.91 and 11.28%,which was a signi?cant difference (P = 0.00).Thoraciccurves were the most common (47.59%) foll

23、owed bythoracolumbar/lumbar (40.10%), double (9.09%), and dou-ble thoracic (3.22%) curves. A comparison of the curvepatterns revealed signi?cant differences between genders(P = 0.00). We present this report as a guide for studyingthe prevalence of idiopathic scoliosis in a large population,and the i

24、ncreasing trend in the prevalence of idiopathicscoliosis emphasizes the need for awareness.Timing of menarche in Chinese girls with and without adolescentidiopathic scoliosis: current results and review of the literatureAbstract Age at menarche is closely related to scoliosisprogression during adole

25、scence. Current data concerningthe timing of menarche between scoliotic and non-scolioticgirls in the literature are con?icting, with inconclusiveresults. The aim of this study was to investigate the distri -bution difference of age at menarche for adolescent idio-pathic scoliosis (AIS) girls and no

26、rmal control populationand to subsequently elucidate the menarche age differencethrough literature reviewing. Moreover, menarche age ofAIS girls with Cobb angle40, 40 -were com-pared toestimate its association with curve severity. Men-strual status data were available for 6,376 healthy femaleadolesc

27、ents and 2,196 AIS girls. We notice that less than10% of healthy Chinese girls experienced onset of mensesbefore 11.38 years, and approximately 90% of healthyChinese girls were menstruating by 13.88 years, with amedian age of 12.63 years. As for AIS girls, less than 10%started to menstruate before 1

28、1.27 years, and approximately90% were menstruating by 14.38 years, with a medianage of 12.83 years. Average menarche age in AIS(12.831.22 years)土was signi?cantly later than that ofnormal control girls (12.63 0.98 years) (p0.001). Ageat menarche for AIS affected girls was signi?cantly greaterthan tha

29、t of normal control girls at 75%, 90% of whom hadattained menarche (p = 0.001, p0.001). Proportion ofgirls starting to menstruate after 14 years was sig ni?cantlyhigher in AIS population compared with normal controls(16.3 vs.8.1%, p0.001). In addition, AIS girls withexperienced onset of menses at an

30、average ageof 13.25 years, which was signi?cantly later than AIS girlswith Cobb angle 40 (12.81 years, p0.05) and mar-ginally signi?cantly later than AIS girls with Cobb anglebetween 40observedin Chinese idiopathic scoliotic girls in this large samplestudy, especially for girls with Cobb angle60, wh

31、ich issupported by multiple previously established positivelinkages on AIS etiology studies. Accordingly it is believedthat late menarche may contribute importantly to abnormalpubertal growth and subsequently modulate curve behaviorin AIS.Rib length asymmetry in thoracic adolescent idiopathic scolio

32、sis:is itprimary or secondary?Abstract The development of scoliosis in animal modelsafter inducing asymmetric rib growth suggests the possiblerole of asymmetric rib growth in the etiopathogenesis ofadolescent idiopathic scoliosis (AIS). Asymmetric riblength is well recognized in idiopathic scoliosis

33、; however,whether this rib asymmetry is primary or secondary has notbeen clearly documented. The objectives of this study wereto investigate any rib length asymmetry in patients withAIS and compare those with scoliosis with syringomyelia(SS) with the intention of elucidating any relationshipbetween

34、rib growth and pathogenesis of AIS. Forty-eightAIS and 29 SS with apical vertebrae located between T7and T9 were recruited. The average age was 13.5 2.3versus 12.5 3.4 years, and the average 16.4 versus 45.622.6 inpatients with AIS or SS,respectively. The length of all ribswas measured from the tip

35、of costal head to the end of thesame rib by built-in software on spiral computed tomog-raphy. At the levels of the apical vertebrae, the vertebraeabove and below the apex, the mean discrepancy in riblength (concave minus convex rib) was 7, 4 and 7 mm,respectively, in AIS group (p0.01), and 6, 5 and

36、7 mmin SS group, respectively (p0.01). The rib length dis-crepancy between concave and convex sides was signi?-cantly correlated with the magnitude of the Cobb angle ofthoracic curve in both AIS and SS groups 0.01).Similar ?ndings of the asymmetry of rib length in both AISand SS patients pointed str

37、ongly to the fact that the riblength asymmetry in apical region is most likely secondaryto the scoliosis deformity rather than playing a primary rolein the etiopathogenesis.Adolescent idiopathic scoliosis (AIS), environment,exposome and epigenetics: a molecularperspective of postnatal normal spinal

38、growthand the etiopathogenesis of AIS withconsideration of a network approach andpossible implications for medical therapyAbstractGenetic factors are believed to play an important role in the etiology of adolescent idiopathic scoliosis (AIS).Discordant findings for monozygotic (MZ) twins with AIS sh

39、ow that environmental factors including differentintrauterine environments are important in etiology, but what these environmental factors may be is unknown.Recent evidence for common chronic non-communicable diseases suggests epigenetic differences may underlie MZtwin discordance, and be the link b

40、etween environmental factors and phenotypic differences. DNA methylation isone important epigenetic mechanism operating at the interface between genome and environment to regulatephenotypic plasticity with a complex regulation across the genome during the first decade of life. The wordexposome refer

41、s to the totality of environmental exposures from conception onwards, comprising factors in externaland internal environments. The word exposome is used here also in relation to physiologic and etiopathogeneticfactors that affect normal spinal growth and may induce the deformity of AIS. In normal po

42、stnatal spinal growthwe propose a new term and concept, physiologic growth-plate exposome for the normal processes particularly ofthe internal environments that may have epigenetic effects on growth plates of vertebrae. In AIS, we propose anew term and concept pathophysiologic scoliogenic exposome f

43、or the abnormal processes in molecular pathwaysparticularly of the internal environment currently expressed as etiopathogenetic hypotheses; these are suggested tohave deforming effects on the growth plates of vertebrae at cell, tissue, structure and/or organ levels that areconsidered to be epigeneti

44、c. New research is required for chromatin modifications including DNA methylation inAIS subjects and vertebral growth plates excised at surgery. In addition, consideration is needed for a possiblenetwork approach to etiopathogenesis by constructing AIS diseasomes. These approaches may lead throughsc

45、reening, genetic, epigenetic, biochemical, metabolic phenotypes and pharmacogenomic research to identifysusceptible individuals at risk and modulate abnormal molecular pathways of AIS. The potential of epigenetic-based medical therapy for AIS cannot be assessed at present, and must await new researc

46、h derived from theevaluation of epigenetic concepts of spinal growth in health and deformity. The tenets outlined here for AIS areapplicable to other musculoskeletal growth disorders including infantile and juvenile idiopathic scoliosis.The metabolic basis of adolescent idiopathic scoliosis: 2011 re

47、port of the metabolic workgroup of the Fondation Yves CotrelAbstractObjective The purpose of this review is to elucidate themetabolic processes involved in the pathogenesis of ado-lescent idiopathic scoliosis (AIS) in light of research by thepresent authors as well as current literature.Methods Path

48、ogenetic mechanisms involved in AIS weremodeled as (a) a form of neuromuscular scoliosis (inconjunction with an adverse mechanical environment suchas bipedality), in which hormonal and other chemicalfactors act as regulators of skeletal muscle tone andfunction; (b) as a consequence of an abnormality

49、 in growthof the spinal column (in conjunction with an adversemechanical environment such as bipedality), in whichhormones and other chemical factors act as regulators ofgrowth; and (c) as a mechanical failure of one side of thevertebral column due to a defect in trabecular formation ormineralizatio

50、n (in conjunction with an adverse mechanicalenvironment such as bipedality); in which hormonal andother chemical factors act as regulators of bone formation,mineralization and/or resorption.Results and conclusion Current evidence supportingthese models individually or in combination is discussed.青少年

51、特发性脊柱侧弯的国内治疗现况特发性脊柱侧弯(记访pathic, coliosis, IS)是指脊柱有侧弯及旋转畸形，而无任何先天性脊 柱异常或合并有神经肌肉或骨骼疾病，是最常见的结构性脊柱侧弯。而青少年特发性脊柱侧弯(Pathic。coliosis , AIS)又是脊柱侧弯中最为常见的一种类型，占特发性脊柱侧弯的80%左右，发病率约1.5% 3%llo目前AIS的病因还未明确，崔泰铭等吼急结了可能有关因素：遗传基因：特发性脊柱侧弯的基因因子是复杂的基因无序列状态，已被大家广泛接受，在 对特发性脊柱侧弯的研究中发现单卵双胞胎脊柱侧弯畸形发生率较二卵双胞胎高：神经系统异常：伴有神经系统异常的脊柱侧

52、弯更容易进展，因此许多学者对AIS的发生发展是否与神经系统异常相关进行了研究：生物化学因素：褪黑素(Melatonin)、雌激素(Estrogen)及钙调蛋白；生物力学因素：生物力学因素在脊柱侧弯中起着重要作用，任何造成脊柱生物力学改 变的因素均可能导致侧弯；肌肉一骨骼系统。尽管许多学者已获得许多有益资料，做了大 量研究，但仍未得出确切的病因，且病因也不可能就一个。因此，对 AIS的治疗也就有多 种方法。但总的可分为非手术治疗和手术治疗两大类。治疗目的在于：矫正畸形：获得稳定;维持平衡；尽可能减少融和范围。现将近年来我国国内AIS的治疗介绍如下。通过建立实验动物模型实现对伴有复杂脊髓损伤的先天

53、性脊柱侧凸疾病的实验医学研究【摘要】目的通过建立大白鼠试验动物模型实现对伴有复杂脊髓损伤的先天性脊柱侧凸疾病 的实验医学研究。方法采用经9.4%的氢氧化钠水溶液稀释后的6-疏基喋吟液，按30 ml/kg剂量行腹腔内注射造模，并对具有先天性脊柱侧弯临床和影像学诊断的20只仔鼠(其中5只仔鼠出生后立即出现脊髓瘫临床症状)中剩余的15只无明显神经症状的仔鼠进行被动直立状态下的生活观察，6 d10 d, 13只仔鼠出现了典型的双侧后肢完全性瘫痪。对所有实验 动物模型进行影像学和脊柱脊髓的组织学观察。结果脊柱影像学观察，所有实验动物模型都表现出典型的先天性脊柱侧弯畸形伴有楔形半椎体和附件的畸形；组织学观

54、察，畸形半椎体发生了明显向椎管方向的移位，压迫相应节段的脊髓，在部分实验动物表现为侧弯顶点的楔形半椎体连同间盘一起向椎管方向移位；相应的骨性结构对脊髓节段形成压迫；骨与脊髓的滋养血管被破坏，楔形半椎体上部的椎管内软脊膜上瘀滞的静脉丛，下方无血管区和椎管狭窄区的血管分布缺失和侧弯顶点水平静脉丛的破败，血管的狭窄和动脉瘤样增宽的病灶区。结论模型大白鼠生长发育的脊柱在受到来自垂直方向上的动-静态负荷的作用，导致脊柱畸形的进一步加重，并通过影像学和组织学观察得到证实。 其发病机制变化特点与临床资料相 符合，为临床工作提供了实验医学基础，对临床治疗原则的制定起到指导作用。特发性脊柱侧凸的病因学研究进展脊

55、柱侧弯是脊柱的一个或多个节段在冠状面上偏离中线的侧弯、矢状面上的前凸或脊 椎体在纵轴上的旋转，是最常见的脊柱三维畸形川。特发性脊柱侧凸(idiopathic scoliosis, IS)患者无任何先天性脊柱异常、神经肌肉及骨骼疾病，但出现脊柱侧弯及旋转畸形，该病多发 于青少年，初诊年龄低于18岁的患者占特发性脊柱侧凸患者的80%,故对该年龄段发病特称为青少年特发性脊柱侧凸(adolescent idiopathicscoliosis , AIS ) z。大多数IS患者脊柱侧凸相对较轻且病情稳定，但少数患者侧弯将不断地加重并且需要支具或手术治疗，而侧凸高速进展常发生在骨骼发育成熟之前的青春期，畸

56、形导致患者留下终身残疾，更严重的使患者心肺功能受损，少数甚至死亡。尽管至今对于特发性脊柱侧弯的发病原因已经进行了大 量的研究，但还未能阐明其具体的发病机制，故也没有找到可靠的方法来预测疾病是否将进行性加重。研究人员对特发性脊柱侧凸的发病原因提出了很多假说，包括遗传基因因素、内分泌异常、神经系统异常、生物力学作用等。本文就以上因素与 IS发病的相关性的研究近 况进行综述。Normal Leptin Expression, Lower Adipogenic Ability,DecreasedLeptin Receptor and Hyposensitivity to Leptin in Adole

57、scent IdiopathicScoliosisAbstractLeptin has been suggested to play a role in the etiology of Adolescent Idiopathic Scoliosis (AIS), however, the leptin levels inAIS girls are still a discrepancy, and no in vitro study of leptin in AIS is reported. We took a series of case-control studies,trying to u

58、nderstand whether Leptin gene polymorphisms are involved in the etiology of the AIS or the change in leptinlevel is a secondary event, to assess the level of leptin receptor, and to evaluate the differences of response to leptinbetween AIS cases and controls. We screened all exons of Leptin gene in

59、45 cases and 45 controls and selected six tag SNPsto cover all the observed variations. Association analysis in 446 AIS patients and 550 healthy controls showed no associationbetween the polymorphisms of Leptin gene and susceptibility/severity to AIS. Moreover, adipogenesis assay of bonemesenchymal

60、stem cells (MSCs) suggested that the adipogenic ability of MSCs from AIS girls was lower than controls. Afteradjusting the differentiation rate, expressions of leptin and leptin receptor were similar between two groups. Meanwhile,osteogenesis assay of MSC showed the leptin level was similar after ad