中医药治疗青少年特发性脊柱侧弯的临床研究进展

Progress of Clinical Research on TCM in the Treatment of Adolescent Idiopathic Scoliosis

摘要: 脊柱侧弯临床表现为脊柱、躯干、胸部形状异常变化，额状面脊柱侧弯角(Cobb角) > 10˚，伴有轴向旋转。其中，特发性脊柱侧凸占全部脊柱侧凸类型的80%，在青少年人群中发病率为0.47%~5.20%。青少年特发性脊柱侧弯(Adolescent idiopathic scoliosis, AIS)与脊柱生物力学、肌肉骨骼密度、神经中枢系统、遗传、环境及代谢等因素相关，是多因素综合致病的结果。AIS可影响躯体平衡，导致椎体、躯干代偿，甚则引起轴骨疼痛、压迫脏器、损伤脊髓，给青少年身心带来极大伤害。目前临床干预手段主要包括手术、支具保护、运动疗法等，存在治疗费用高昂、疗效不确切及依从性不高等不足。AIS临床主要表现为外观形态异常，中医认为该病属“龟背”范畴，基本病机为“筋骨失衡”，“筋出槽，骨错缝”则致脊柱侧凸、腰背酸痛。大量临床报道指出，中医内治、外治可有效矫正脊柱侧弯，恢复脊柱力学平衡，缓解腰背酸痛症状等。基于上述，笔者整理近年来中医药治疗AIS的临床研究报道，归纳总结不同治疗方式的优点及不足，旨在为AIS的临床治疗提供参考，现综述如下。

Abstract: Scoliosis is clinically manifested as an abnormal change in the shape of the spine, trunk, and thorax, with a frontal plane scoliosis angle (Cobb’s angle) of >10˚, accompanied by axial rotation. Of these, idiopathic scoliosis accounts for 80% of all scoliosis types, with a prevalence of 0.47%~5.20% in the adolescent population. Adolescent idiopathic scoliosis (AIS) is associated with spinal biomechanics, musculoskeletal density, the central nervous system, genetics, the environment, and metabolism, and is the result of a multifactorial combination of factors. AIS can affect the balance of the torso, result in vertebral and trunk compensations, and even cause axial pain, compression of organs, and spinal cord damage, causing physical and psychological damage to adolescents. Currently, clinical interventions mainly include surgery, brace protection, exercise therapy, etc., which have high treatment costs, inaccurate efficacy and low compliance. AIS is mainly manifested as abnormal appearance, which is regarded as the category of “tortoise back” by traditional Chinese medicine (TCM). The basic mechanism of the disease is “tendon imbalance”, “tendon out of the groove, bone wrong seam” will cause scoliosis, low back pain. A large number of clinical reports have pointed out that internal and external treatments of Chinese medicine can effectively correct scoliosis, restore the mechanical balance of the spine, and relieve the symptoms of low back pain. Based on the above, the author compiles the clinical research reports on TCM treatment of AIS in recent years, summarises the advantages and shortcomings of different treatment modalities, and aims to provide references for the clinical treatment of AIS, which are summarised as follows.