特发性脊柱侧凸诊疗相关研究进展

Research Progress in the Diagnosis and Treatment of Idiopathic Scoliosis

摘要: 特发性脊柱侧凸(Idiopathic Scoliosis, IS)是一类病因不明、以脊柱三维畸形为核心特征的脊柱疾病，涵盖青少年特发性脊柱侧凸(AIS)、成人特发性脊柱侧凸(AdIS)等亚型，其中以Lenke 5/6型为代表的腰弯/胸腰弯型IS因术后易出现冠状面失衡、椎间盘退变等并发症，一直是临床诊疗的重难点。近年来，国内外学者围绕IS的影像学参数标准化、远端融合椎(Lowest Instrumented Vertebra, LIV)选择策略、术后冠状面失衡的危险因素与防治、椎旁肌失衡的机制及评估等核心问题开展了大量研究，在手术技术优化、围手术期评估、基础病因探索及椎旁肌分子标志物转化方面取得诸多突破。本文结合最新临床与基础研究成果，对IS诊疗领域的关键进展进行系统综述，分析当前研究的不足，并展望未来研究方向，为IS的个体化诊疗与基础研究提供参考。

Abstract: Idiopathic scoliosis (IS) is a spinal disorder of unknown etiology primarily characterized by three-dimensional spinal deformity, encompassing subtypes such as adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AdIS). Among these, lumbar/thoracolumbar IS, represented by Lenke types 5 and 6, has consistently been a major challenge in clinical diagnosis and treatment due to its susceptibility to postoperative complications such as coronal imbalance and intervertebral disc degeneration. In recent years, scholars worldwide have conducted extensive research on core issues of IS, including the standardization of radiographic parameters, selection strategies for the lowest instrumented vertebra (LIV), risk factors and prevention of postoperative coronal imbalance, and the mechanisms and evaluation of paraspinal muscle imbalance. Numerous breakthroughs have been made in optimizing surgical techniques, perioperative evaluation, exploration of underlying etiologies, and the clinical translation of paraspinal muscle molecular biomarkers. Based on the latest clinical and basic research findings, this article systematically reviews the key advances in the diagnosis and treatment of IS, analyzes the limitations of current research, and looks forward to future research directions, aiming to provide a reference for the individualized management and basic research of IS.