Scheuermann’s Disease休门氏病 A Patient’s Guide to Scheuermann’s Disease休门氏病患者指南Introduction引言 The section of spine from below the neck to the bottom of the rib cage is called the thoracic spine. From the side, the thoracic spine appears slightly rounded. Its shape is like the letter “C” with the opening facing the front of the body. This normal curve is called kyphosis. With excessive kyphosis, the thoracic spine takes on a hunchbacked appearance. 从颈部下方到胸廓底部的脊柱段称为胸椎。从侧面看，胸椎看起来略圆。 它的形状像字母“C”，开口面向身体的前面。 这种正常曲线称为后凸。脊柱过度后凸，胸椎就会呈现驼背的外观。 Scheuermann’s disease (also called Scheuermann’s kyphosis) is a condition that starts in childhood. It affects less than one percent of the population and occurs mostly in children between the ages of 10 and 12. It affects boys and girls with a slightly higher number of boys affected. Those who do not get proper treatment for the condition during childhood often experience back pain from the spinal deformity as adults. Sometimes Scheuermann’s disease doesn’t develop until adulthood. 休门病（也称为休门氏后凸畸形）是一种从童年开始的病症。它影响不到1％的人口，主要发生在10岁和12岁之间的儿童。男孩和女孩都可以发病，男孩数量略高。 若患儿在儿童期间没有得到恰当治疗的病人，成年之后会出现由于脊柱畸形产生的背痛。有时候休门病直到成年才进展。 This guide will help you understand · how the problem develops · how doctors diagnose the condition · what treatment options are available 这个指南将帮助你理解：
Anatomy解剖 What parts of the spine are involved? 脊柱的哪部分受累？ A healthy human spine has three gradual curves. From the side, the neck and low back curve gently inward. This is called lordosis. The thoracic kyphosis (outward curve) gives the mid back its slightly rounded appearance. These normal curves help the spine absorb forces from gravity and daily activities, such as lifting. 正常人体脊柱有三条生理曲线。从侧面，颈部和腰部曲线稍向内（凸向前侧）。 这称为脊柱前凸。 胸部后凸使中后部略呈圆形的外观。 这些正常曲线帮助脊柱缓冲来自重力和日常活动对脊柱的负担，如举重物时。
The angle of normal kyphosis in the thoracic spine varies. During the growth years of adolescence, a normal curve measures between 25 and 40 degrees. If the curve angles more than 40 degrees, doctors consider the kyphosis a deformity. In general, kyphosis tends to be more exaggerated in girls. The angle increases slightly throughout life both in women and men. Scheuermann’s disease causes the thoracic kyphosis to angle too far (more than 45 degrees). 胸椎的正常后凸角度各不相同。 在青春期的生长周期中，正常生理曲线在25和40度之间。 如果曲线角度超过40度，医生认为是后凸畸形。 一般来说，脊柱后凸在女孩中往往更明显。不管男人还是女人随着年龄增长，后凸角度都略微增加。休门病则会导致胸椎后凸角度显著加重（往往超过45度）。
The 12 thoracic vertebrae are known as T1 to T12. The main section of each thoracic vertebra is a round block of bone, called a vertebral body. A ring of bone attaches to the back of the vertebral body. This ring surrounds and protects the spinal cord. 12个胸椎分别被命名为T1到T12。 每个胸椎的主要部分是一个圆形的骨块，称为椎体。 环状骨性结构连接到椎体的背部。这个骨环包围并保护脊髓。
In Scheuermann’s disease, the front of the vertebral body becomes wedge-shaped, possibly from abnormal growth. This produces a triangular-shaped vertebral body, with the narrow, wedged part closest to the front of the body. The wedge puts a bigger bend in the kyphosis of the thoracic spine. 在休门病中，可能由于异常生长，椎体的前部变成楔形。 这产生了三角形椎体，其中窄的楔形部分最靠近身体的前部。 楔形使后凸的胸椎后方承受更大的弯曲张力。 The vertebral bodies are separated by a cushion, called an intervertebral disc. Between each disc and vertebral body is a vertebral end plate. Sometimes one or more discs in patients with Scheuermann’s disease squeeze through the vertebral end plate, which is often weaker in patients with Scheuermann’s disease. This forms pockets of disc material inside the vertebral body, a condition called Schmorl’s nodes. 椎体之间由椎间盘分开，椎间盘起到缓冲垫的作用。 在每个椎间盘和椎体之间是椎体终板。休门病患者软骨终板较薄，有时一个或多个椎间盘经过终板挤压椎体；这导致在椎体内形成椎间盘结节，我们称之为许莫氏结节。
A long ligament called the anterior longitudinal ligament connects on the front of the vertebral bodies. This ligament typically thickens in patients with Scheuermann’s disease. This adds to the forward pull on the spine, producing more wedging and kyphosis. 前纵韧带连接在椎体的前部。这种韧带通常在患有休门氏病的患者中变厚。 这增加了脊柱的前向拉力，产生更大的脊柱楔形改变和脊柱后凸。 The disease usually produces kyphosis in the middle section of the thorax (the chest), between the shoulder blades. The condition sometimes causes kyphosis in the lower part of the thoracic spine, near the bottom of the rib cage. 该疾病通常在胸部的中间部分，即肩胛骨之间产生脊柱后凸。 该病症有时后凸位于胸椎远端，即靠近胸廓底部的位置。 Related Document: A Patient’s Guide to Thoracic Spine Anatomy 相关阅读：胸椎解剖患者指南（翻译招募中，有意者请留言） Causes 病因 Why do I have this problem? 为什么我会得这个病？ Famed for discovering this disease, Scheuermann himself thought a lack of blood to the cartilage around the vertebral body caused the wedging. Though scientists have since disproved this theory, the root cause of the disease is still unknown. 因发现这种疾病而闻名的Scheuermann自己认为椎体周围软骨缺血导致椎体楔形压缩。虽然科学家们后来否定了这一理论，但是导致疾病的原因尚未明确。 主流观点 Mounting evidence suggests wedging develops as a problem vertebral body grows. During normal growth, the cartilage around the vertebral body turns evenly and completely to bone. If the change from cartilage to bone doesn’t happen evenly, one side of the vertebral body grows at a faster rate. By the time the entire vertebral body turns to bone, one side is taller than the other. This is the wedge shape that leads to abnormal kyphosis. 很多证据表明病变椎体生长的同时，椎体楔形改变也在进展。在椎体正常生长期，椎体周围的软骨均匀且完全地转化为骨质。 如果从软骨到骨的变化不均匀发生，椎体的一侧以更快的速度生长。 到整个椎体转化为骨时，一侧比另一侧高。这就导致脊柱异常后凸。 Other theories of how Scheuermann’s kyphosis starts include 其他休门病发病机制包括: · genetics
· childhood osteoporosis
· mechanical reasons
Genetics 基因 Researchers have suggested that this disease can be passed down in families. Studies have shown multiple families who have passed the disease through inheritance of certain types of genes. The genetic link is uncommon but remains under investigation. 研究人员指出这种疾病可以在家庭几代中发生。 研究表明，通过某些基因的遗传，使得休门氏病在许多家庭几代中发生。 确定的遗传联系目前不清楚，许多研究仍在进行中。 Childhood Osteoporosis 儿童期骨质疏松 One medical study found that some patients with Scheuermann’s disease had mildosteoporosis (decreased bone mass) even though they were very young. Other studies did not show problems with osteoporosis. More research is needed to confirm the role of osteoporosis in Scheuermann’s disease. 一项医学研究发现，一些休门病患者年轻时患有中度骨质疏松（骨量减少）， 但其他研究没有显示患者中存在骨质疏松的问题。这需要更多的研究来证实骨质疏松症在休门氏病中的作用。 Related Document: A Patient’s Guide to Osteoporosis 相关阅读：骨质疏松患者指南（翻译招摹中，有意者言留言） Mechanical Reasons 机械性原因 These include strains from bending, heavy lifting, and using poor posture. This theory makes sense because the back braces used in treating kyphosis work. If a back brace can straighten a bent spine, then perhaps mechanical forces could cause more kyphosis than naturally occurs in the spine. (Back braces are discussed in more detail later.) Some experts think that tight hamstring muscles (along the back of the thigh) pull on the pelvis contributing to spinal deformity. 机械性原因包括弯曲，举重物和使用不良姿势导致的脊柱承受额外应变。 这个理论是有道理的，因为用于治疗驼背的背带有效。 如果背带可以把弯曲的脊柱变直，那么或许有额外机械力承载的脊柱比普通状态下机械力承载的脊柱更容易发生脊柱后凸。 （背部支具在后面有更详细讨论。）一些专家认为，紧绷的腘绳肌（沿着大腿后方）拉动骨盆，导致脊柱畸形。 Scientists are not convinced that mechanical reasons cause the disease; rather, these factors likely aggravate the condition. And in some cases, it is difficult to tell which came first: the mechanical changes causing the deformity or the deformity resulting in the anatomical and thus mechanical changes. 科学家并未确定机械性原因导致休门氏病，但认为机械性因素会加剧病情。 在某些病例中，很难判断哪个是先出现的：是脊柱受到的力学变化导致解剖结构畸形，还是畸形导致脊柱受到的力学改变。 Other Reasons 其它原因 Other theories put forth that might help explain the cause(s) of Scheuermann’s disease include biochemical changes in the collagen that make up the end-plates altering bone growth, above-average disc height, and increased levels of growth hormone. 其它理论可能有助于解释休门氏病的发病原因，这包括：构成终板软骨胶原的生物力学变化，高于平均椎间盘高度和增加的生长激素水平。 Symptoms 症状 What does the condition feel like? 症状表现如何？ Hunched posture or a round back in children usually alerts parents or teachers to the need for a doctor visit. Children don’t typically complain of back pain or other symptoms. 儿童姿势蜷缩或圆背通常提示父母或教师需要去看医生。儿童通常不会抱怨背痛或其他症状。 This is not the case in adolescents who are nearing puberty and have kyphosis in the lowest part of the thorax, near the bottom of the rib cage. In these patients, back pain is the overriding problem. This happens most often to young, active males. Doctors suspect this unique form of the disease occurs because the condition is overlooked during childhood, delaying treatment. 但是在青少年近青春期，伴随下段胸椎近胸廓底部后凸畸形的患者中，情况又有所不同。 对这些患者而言，背痛是最重要的问题。这通常发生于年轻，活动量大的男孩。 医生怀疑疼痛是因为在他们在儿童期病情没有被发现，治疗耽误的结果。 Adults who’ve lived with the hunched posture for many years may note worsening pain. They may be disturbed by the physical changes and deformity that develop.The pain and/or the physical changes typically causes them to seek medical help. 驼背多年的成人疼痛会逐渐加重。逐渐发展的脊柱后凸，对患者外观和日常活动的带来影响。患者常因疼痛或脊柱后凸寻求医生帮助。 Besides having a forward curved spine, most people affected by Scheuermann’s report back pain, stiffness, and loss of flexibility. The neck and low back try to compensate by increasing the natural lordotic curves in these two areas. Since the person cannot straighten the thoracic spine, the cervical and lumbar spines increase their curves to compensate for the round back. All of these changes in posture are usually accompanied by tight shoulder, hip, and leg muscles. 根据Scheuermann报告，休门氏病患者除了脊柱后凸畸形，大多数患者还有胸背部疼痛，肌肉僵硬和柔韧性下降。随着脊柱后凸角度的增加，多数患者会代偿性的增加颈部和腰部的曲度。这是因为患者无法改变胸椎角度，只有增加颈椎和腰椎的曲度来补偿。而这些姿势的变化通常导致肩部，髋部和腿部肌肉僵硬。 Degenerative spondylosis is also reported as part of the natural history in middle-aged adults with Scheuermann’s kyphosis. Degenerative changes in the spine (usually from aging) can cause bone spurs to form around the spinal joints. The joint spaces start to narrow. This condition is called spondylosis, which can also contribute to pain and stiffness. 退行性脊柱病变也被认为是中年成人休门氏病所致脊柱后凸的伴随改变。脊柱退行性变（通常因为老化）可导致在脊柱关节周围形成骨赘，关节间隙变窄。这种情况被称为脊柱炎，这也会导致疼痛和僵硬。 Patients of all ages who experience pain generally report feeling discomfort along the sides of the spine, slightly below the main part of the abnormal curve. 主诉有疼痛的各年龄患者，不适位置通常位于主要异常曲度的稍下侧方。 Exaggerated kyphosis can lead to an increased lordosis (inward curve) in the low back. This puts extra strain on the tissues of the low back. Over many years, this added wear and tear may produce low back pain. This mainly occurs in adults who have extra lumbar lordosis from years of untreated Scheuermann’s disease. 严重的脊柱后凸可以导致下腰部脊柱代偿性过度前凸（内向曲线）。腰椎前凸的增加使下腰部额外受力。多年后，脊柱前凸带来的额外组织磨损会产生下腰痛。对于存在过度腰椎前凸，而未经治疗的成年人中，下腰痛尤为多见。 In rare cases, the spinal cord is affected. A severe kyphosis stretches the spinal cord over the top of the curve. This can injure the spinal cord. Also, patients with Scheuermann’s disease have a greater chance of having a herniated thoracic disc. This is where the disc material from inside the disc begins to squeeze out and press on the spinal cord. Spinal cord symptoms for both situations include sensations of pins and needles and numbness. The leg muscles may feel weak. Symptoms from an injured spinal cord can also include changes in bowel and bladder function. 少数情况下，休门氏病会导致脊髓损伤。严重的脊柱后凸使脊髓在畸形曲度顶部牵拉。这可能损伤脊髓。 此外，休门氏病患者椎间盘突出的风险更大。椎间盘内部组织突出并压迫脊髓。出现神经症状包括针刺感和麻木感。 腿部肌肉力量可能下降。脊髓损伤的症状也包括大小便功能障碍。 Related Document: A Patient’s Guide to Thoracic Disc Herniations 相关阅读：胸椎间盘突出患者指南（翻译招摹中，有意者留言） When the kyphosis angle exceeds 100 degrees (rare), the sharply bent spine puts pressure on the heart, lungs, and intestines. When this occurs, patients may tire quickly, suffer shortness of breath, feel chest pain, and lose their appetite. 当后凸角超过100度（罕见）时，急剧弯曲的脊柱对心脏，肺和肠道都有影响。 在这种情况下，患者可能表现为容易疲劳，呼吸急促，胸痛，食欲下降。 Diagnosis诊断 How do doctors diagnose the problem? 医生如何诊断这种疾病？ Doctors start with a complete history and physical examination. However, X-rays are the main way to diagnose Scheuermann’s kyphosis. Taken from the side, an X-ray may show vertebral wedging, Schmorl’s nodes, and changes in the vertebral end plates. Doctors use X-ray images to measure the angle of kyphosis. Doctors diagnose Scheuermann’s disease when three vertebrae in a row wedge five degrees or more and when the kyphosis angle is greater than 45 degrees. 医生首先应该了解病史并完善体格检查。 然而X线是诊断休门氏脊柱后凸的主要方法。 从X侧位片上，可以显示椎骨楔形压缩，Schmorl结节和椎骨终板的变化。 医生可以在X侧位片上测量后凸的角度。当有三个椎体楔型角大于5度或以上，或者脊柱后凸角大于45°时，可以诊断休门氏病。
Scheuermann’s disease or kyphosis is diagnosed as either being typical (Type I) or atypical (Type II). These two forms of the disease affect different parts of the spine. The typical form (most common type) has the thoracic kyphotic pattern described in this section. The lower (lumbar) spine compensates by becoming hyperlordotic. Lordosis is the spinal curve exactly opposite of kyphosis. Hyperlordotic means the curve increases beyond what is considered “normal.” 休门氏病被分为典型（I型）和非典型（II型）两类。这两类疾病影响脊柱的不同部位。 休门病（I型）（最常见的类型）具有胸部后凸，这将在本节中描述。腰椎通过前凸代偿。脊柱前凸与后凸是完全相反的脊柱曲线。过度前凸也意味着相对于“正常”曲度的增加。 The atypical form of Scheuermann’s (Type II) affects the low back known as thelumbar spine. The upper lumbar spine (where the thoracic spine transitions to become the lumbar spine) is involved. Type II is seen most often in young boys before puberty who are active in sports activities. They experience pain that goes away with rest and change in position or activity level. 非典型休门病（II型）主要影响腰椎。 其中也包括胸腰段（胸椎过渡到腰椎部分）。常见于青春期前的运动量大的男孩。 疼痛程度常随着休息、姿势改变或运动强度的变化而相应改变。 A side-view X-ray can also show if the spine is flexible or rigid. Patients are asked to bend back and hold the position while an X-ray is taken. The spine straightens easily when it is flexible. In patients with Scheuermann’s disease, however, the curve stays rigid and does not improve by trying to straighten up. X侧位片还可以显示脊柱是柔然还是僵硬的。要求患者脊柱屈伸并保持该位置上摄片。 当脊柱柔软，尝试伸直状态时脊柱曲度改善。 然而，休门氏病患者的脊柱僵硬，尝试伸直状态时曲度仍无法恢复。 From the front, X-rays show if the spine curves from side to side. This sideways curve is called scoliosis and occurs in about one-third of patients with Scheuermann’s kyphosis. X线正位片上可以观察，脊柱是否从一侧弯向另一侧。这种曲线被称为脊柱侧凸，约三分之一的休门氏病患者中有该症状。
X-rays can show signs of wear and tear in adults who have extra lumbar lordosis from years of untreated Scheuermann’s disease. 患病多年的休门氏病脊柱畸形患者，X片可以发现椎体的磨损或损伤。 Computed tomography (a CT scan) may be ordered. This is a detailed X-ray that lets doctors see slices of the body’s tissue. 诊断该疾病还可以运用计算机X线断层摄影（CT）。 CT是更精细 的显示组织断层的X片集合。 Myelography is a special kind of X-ray test. For this test, dye is injected into the space around the spinal canal. The dye shows up on an X-ray. This test is especially helpful if the doctor is concerned whether the spinal cord is being affected. 脊髓造影是一种特殊的X线检测。在该测试中，医生将显影剂注射到椎管中。显影剂可以在X片上显示。这个检查有助于医生明确脊髓是否受到压迫。 Magnetic resonance imaging (MRI) uses magnetic waves rather than X-rays to show the soft tissues of the body. This machine creates pictures that look like slices of the area the doctor is interested in. The test does not require special dye or a needle. 磁共振成像（MRI）使用磁场而不是X射线来显示身体的软组织。该仪器显示的图片可以是医生关注的组织区域的断层图片。该测试不需要特殊的显影剂或注射器。 （滕红林 译）
滕红林，男，主任医师，脊柱外科博士，温州医学院附属第一医院脊柱外科负责人，科室副主任，硕士生导师。任中国抗癌协会脊柱肿瘤学组委员、浙江省骨科学会脊柱外科学组委员、浙江省康复医学会脊柱脊髓损伤协会委员、浙江省老年学学会脊柱关节病专业组委员、中华医学会数字医学分会青年委员、温州医学院中青年学科带头人（脊柱外科）和《脊柱外科杂志》编委。 1996年本科毕业于温州医学院医学系，同年分配至温医一院骨科工作。1999年~2004年在上海第二军医大学长征医院脊柱外科专业攻读临床型硕士、博士。师从上海长征医院脊柱外科专家贾连顺教授。毕业回院后先后赴欧洲荷兰VU大学脊柱肿瘤中心、美国西雅图脊柱微创中心、美国双子城脊柱中心、美国Anderson脊柱肿瘤中心等进修学习脊柱外科微创、脊柱肿瘤和畸形等。2005年初负责并在创立了脊柱外科专业。擅长上颈椎和颈椎手术、脊柱骨折、脊髓损伤、脊柱骨质疏松骨折、脊柱骨肿瘤、脊柱侧凸和后凸畸形矫形等手术。 副主译《麦氏腰背痛》;参编《脊柱肿瘤外科学》并担任学术秘书;另参编、编译脊柱外科专业书籍10余本，如《枕颈部外科学》、《颈椎外科手术图谱》、《颈椎外科学》、《腰椎外科学》、《脊柱创伤外科学》、《脊柱内镜手术学》、《脊柱微创外科学》和《微创脊柱学》等。发表国外SCI论文10多篇，其中第1作者及通讯作者共5篇。2009年关于如何选择颈胸段脊柱手术入路的论文发表在《Journal of Neurosurgery: Spine》，2011年关于脊柱骨肿瘤的论文发表在国际脊柱外科界的权威杂志《Spine》杂志上。参与脊柱骨肿瘤的课题，2004年获得上海市科技进步二等奖(第5)、军队医疗成果二等奖和中华医学科技奖三等奖1项。负责或参加国家级、省部级课题和军队课题5项。 患者指南，图文并茂， 分门别类，构思巧妙。 深入浅出，中英对照， 医患携手，共同探讨。 能力有限，时间仓促， 错误难免，诚惶诚恐。 恳请各位，留言指导， 以利再版，更加周到。 |
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