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Adult Degenerative Scoliosis 成人退变性脊柱侧弯 A Patient’s Guide to Adult Degenerative Scoliosis
成人退变性脊柱侧弯患者指南
Introduction概述 normal healthy spine will be straight when seen from the front or the back. When seen from the side, the normal spine forms a gentle “S” curve, which is known as adult degenerative scoliosis. 正常健康的脊柱从前面或后面观察应该是挺直的。从侧面观察，正常的脊柱形成柔和的“S”形曲线。
Scoliosis is an abnormal or exaggerated curve of the spine from the side or from the front or back. Adult degenerative scoliosis is different from the type of scoliosis that occurs in teenagers. Adult degenerative scoliosis occurs after the spine has stopped growing and results from wear and tear of the spine. The condition most often affects the lumbar spine. 脊柱侧弯是从侧面或从前面或从后面观察时脊柱异常或超常的弯曲。成人退变性脊柱侧弯与青少年发生的脊柱侧弯类型不同。成人退变性脊柱侧弯在脊柱生长停止以后发生，通常由脊柱的慢性劳损所致，这种情况往往发生于腰椎。
This guide will help you understand · what parts make up the spine · what causes adult degenerative scoliosis · how your doctor will diagnose this condition · what treatment options are available
这篇指南将有助于您理解： l 脊柱由哪几部分组成 l 引起成人退变性脊柱侧弯的原因 l 您的医生对这种状况如何进行诊断 l 有哪些治疗方法可供选择 Anatomy解剖
What parts make up the spine? 脊柱由哪几部分组成？
The spine is made up of 24 moveable bone segments called vertebrae. The spine is divided into three distinct portions. There are seven cervical or neck vertebrae, 12 thoracic or mid-back vertebrae and five lumbar or low back vertebrae. 脊柱由24块可活动的称为椎体的骨节组成。脊柱分成三个不同的部分，包括7块颈椎，12块胸椎，5块腰椎。
The spine is made up of three general parts. The top portion is the cervical spineand connects with the skull or cranium. The middle portion is the thoracic spineand is identified by the ribs that attach to each of the vertebrae. The lower portion is the lumbar spine. It connects with the pelvis at the sacrum. 脊柱大体上分成三个部分。上部是颈椎，连接头颅和大脑，中部是胸椎，因每个椎骨附着肋骨而有显著区别，下部是腰椎，通过骶骨与骨盆相连。
The vertebra stack on top of one another and are separated by discs. The spine has normal curves. When looking at the spine from the side, the spinal column is not straight up and down, but forms an “S” curve. The cervical spine has an inward curve called a lordosis. The thoracic spine curves outward. This curve is called a kyphosis. The lumbar spine usually has an inward curve or a lordosis. The “S” curve seen in the side view allows for shock-absorption and acts as a spring when the spine is loaded with weight. This “S” curve maintains balance of the spine in a forward and backward plane. 椎骨依次相叠，其间由椎间盘分隔。脊柱有正常的弯曲。从侧面看，脊柱由上到下并非笔直，而是形成“S”形的曲线。颈椎有向前的弯曲，称为前凸。胸椎有向后的弯曲，称为后凸。腰椎通常是向前弯曲，即前凸。从侧面看上去呈“S”形的弯曲在脊柱承受载荷时可吸收震荡，就象弹簧一样。“S”形弯曲在前后方向的平面上保持脊柱的平衡。
The spinal cord travels within a canal made by the vertebra. Branching off of the spinal cord are nerve roots. These nerves then supply arm, trunk, and leg muscles for movement. They also supply muscles of organs such as the bladder. 脊髓在由椎骨形成的隧道内穿行。从脊髓发出分支即神经根。这些神经支配上肢、躯干和下肢的运动肌肉，还支配像膀胱这样的内脏肌肉。
Discs are fluid-filled cushions between the vertebrae. Facet joints are small joints in the back that allow movement. Facet joints are lined with cartilage. The cartilage is a covering of the joint surface that gives some cushion and protects the bone. It is also slippery which helps with motion. 椎间盘是椎体间充满液体的软垫。椎间关节是后方的小关节，允许运动。椎间关节内衬软骨。软骨覆盖关节表面，有一些缓冲作用，保护了骨头，同时软骨表面很光滑，有助于运动。
Related Document: A Patient’s Guide to Cervical Spine Anatomy Related Document: A Patient’s Guide to Thoracic Spine Anatomy Related Document: A Patient’s Guide to Lumbar Spine Anatomy 相关文章：颈椎解剖患者指南 相关文章：胸椎解剖患者指南 相关文章：腰椎解剖患者指南
Causes病因
What causes adult degenerative scoliosis? 成人退变性脊柱侧弯是怎么造成的？
Adult degenerative scoliosis can be a result of scoliosis from childhood. The curvature may increase during adulthood and become painful. Scoliosis that happens in childhood is usually idiopathic, meaning there is no known reason for it. 成人退变性脊柱侧弯可以是幼时脊柱侧弯而造成的，在成人期曲度加大出现疼痛。儿童期发生的脊柱侧弯往往是特发性的，意味着它的病因还不清楚。
Any part of the spine can be affected by scoliosis including the cervical, thoracic, or lumbar vertebrae. Most often the lumbar spine is affected. The vertebrae curve to one side and may rotate, which makes the waist, hips, or shoulders appear uneven. 包括颈椎、胸椎、腰椎等任何一部分脊柱都可能出现侧弯。腰椎出现侧弯最常见。椎体弯向一侧并可能旋转，使腰部、臀部、肩部出现不对称。
The most common cause of adult degenerative scoliosis is from degeneration, known as wear and tear. It usually occurs after the age of 40. In older women, it is often related toosteoporosis. Osteoporosis is the loss of calcium in the supporting bone. This makes the vertebrae weak. 成人退变性脊柱侧弯的主要原因是退变所致，即大家所熟悉的劳损。常发生于40岁以后。大老年妇女，常与骨质疏松相关。骨质疏松是支撑骨的钙质丢失，使椎骨变衰弱。 In adult degenerative scoliosis, the spine loses its structural stability and becomes unbalanced. This imbalance of the spine causes changes in the way the forces of the spine are directed. The larger the scoliotic curve becomes, the faster these changes cause degeneration of the spine. This creates a vicious cycle where increasing deformity causes more imbalance, that in turn causes more deformity. While this process occurs very slowly, it usually continues to slowly progress until something is done to restore the balance in the spine. 在成人退变性脊柱侧弯，脊柱失去了结构性稳定变得失去平衡。脊柱的失衡导致脊柱受力方向的改变。侧弯曲度越大，引起脊柱退变越快。这样就形成了恶性循环：畸形的增加导致更加失衡，失衡加重反过来又导致畸形变得更为严重。由于这种过程发生缓慢，如不采取一些措施来保留脊柱的平衡，它通常继续发生缓慢的进展。 When there is an “S” curve when viewing the spine from the front, the condition is called scoliosis. The scoliotic deformity may also affect the normal “S” curve that the spine has when vised from the side. These curves are normal and required to maintain the proper balance of the spine. Many patients with scoliosis actually lose the normal curves of the spine. 当从前方观察脊柱出现了“S”形弯曲，这种状况被称为脊柱侧弯。侧弯畸形也会影响脊柱从侧面观察正常的“S”形弯曲。侧面的“S”形弯曲是正常的，是为了保持脊柱正常的平衡。许多脊柱侧弯的患者事实上失去了脊柱正常的弯曲。 Our body has a natural tendency to try to maintain a balance where the head is straight above the middle of the pelvis. If one leg is longer that the other, and the pelvis tilts, the spine will curve in the opposite direction to place the head above the center of the pelvis. If there is a curve in a portion of the spine, then the remainder of the spine will bend in the opposite direction to try and keep the head above the middle of the pelvis. 人体有维持平衡的本能，使脑袋正好落在骨盆中心的正上方。如果双下肢不等长，骨盆会发生倾斜，脊柱会向对侧弯曲以使脑袋仍旧在骨盆中心的上方。如果脊柱的一部分有弯曲，其余的脊柱会弯向对侧，试图将头部维持在骨盆中心的上方。 The scoliotic curve has a convex and concave side. The convex side is simply the outside of the curve where concave is the inside of the curve. The spine above and below the curve will tend to bend in the opposite direction in an attempt to balance the spine. Remember, the body will always try to place the head immediately above the middle of the pelvis. The concave side will tend to have more compression of the facet joints and possibly the nerve roots. This can lead to more pain from arthritis on the concave side of the curve and may lead to pain, weakness and numbness into the legs from the compressed nerve roots. These nerve changes are called radiculopathy. 侧弯的弯曲有凸侧和凹侧。凸侧是弯曲的外侧，凹侧是弯曲的内侧。弯曲上下的脊柱会向对侧弯曲，以图平衡脊柱。请记住，身体总是试图将头部靠近骨盆中心的上方。凹侧的椎间关节趋于承受更大的压力，同时神经根也可能受压。这导致凹侧更容易发生关节炎，也可能因为神经根受压导致下肢的疼痛、无力和麻木。这些神经根改变称为神经根病。
In adult degenerative scoliosis, there is gradual narrowing of the discs that cushion between the vertebrae. The cartilage and joint surfaces of the facet joints in the spine can wear out, causing arthritis. This can cause back pain. 在成人退变性脊柱侧弯，垫于椎体之间的椎间盘逐渐变窄。脊柱椎间关节的软骨和关节面会磨损，引起关节炎，由此导致背痛。
Stenosis is a term meaning narrowing. There are times when the canal for the spinal cord is narrowed. The openings for the nerve roots may also be narrowed. This will usually cause compression of the nerve structures. When the spinal cord or spinal nerves are compressed, pain, changes in feeling and/or motor function of the muscles can happen. 椎管狭窄这一术语用于描述缩窄。脊髓通行管道有时会狭窄，神经根管也会狭窄，这将导致神经结构的受压。当脊髓或脊神经受压，就会发生疼痛，感觉异常或肌肉运动功能障碍。
Sometimes spondylolisthesis occurs. This is slippage of one vertebra on the other. This can happen in adult degenerative scoliosis when the vertebrae do not stack on top of one another like they are supposed to. One vertebra may be shifted sideways, not lining up as it should. The slippage is graded from I to IV, one being mild, IV often causing neurological symptoms. 有时会发生椎体滑脱，即一个椎体相对于另一个发生滑移。在成人退变性脊柱侧弯，如一个椎体没有按正常情况叠于另一个椎体上方就会发生这种情况。椎体也会侧向移位，并有按其应有位置排列。滑移可分为I度-IV度，I度较轻，IV度常引起神经症状。 In rare and severe cases, the chest may become deformed because of scoliosis. This may affect the lungs and heart. This can lead to breathing problems, fatigue, and even heart failure. 在罕见而严重的病例，胸廓因侧弯而变形，从而影响心肺功能，可能导致呼吸问题、疲劳甚至心脏衰竭。 Degenerative scoliosis is more common the older we get. As our population ages, adult scoliosis will be even more common. It will be an increasing source of deformity, pain, and disability. 当我们变老时，退变性脊柱侧弯很普遍。随着人口老化，成人脊柱侧弯会变得更加普遍，成为畸形、疼痛、残废增加的根源。 Related Document: A Patient’s Guide to Scoliosis 相关文件：脊柱侧弯患者指南
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