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青春期脊柱侧弯：为什么要早发现、适时治疗

为什么脊柱侧弯最常在青春期被发现？关于支具、Schroth训练和按Cobb角处理的最新证据。

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青春期脊柱侧弯：为什么要早发现、适时治疗

脊柱侧弯大多在青春期被发现。孩子仍在生长时，侧弯往往增长很快，因此早发现、适时干预决定了把脊柱恢复到笔直或安全范围的机会。

以下为摘要。完整文章提供越南语和英语版本。

要点

  • 小于15°（生长结束后小于20°）：通常定期观察即可。
  • 生长期15–20°：专项运动，必要时使用夜间支具。
  • 有进展风险的25–40°：支具是证据最好的方法，结果取决于佩戴时长。
  • 成功的关键是依从治疗和孩子的配合。

科学证据

  • 《Frontiers in Pediatrics》2026年9月（Yang等）：13项研究、709名患者的网状荟萃分析——支具和物理治疗运动在短期控制侧弯方面更好；直接比较中，支具优于Schroth训练和传统医学康复。
  • 作者指出证据稀少且异质性高。
How to read: the coloured bar runs left to right with the Cobb angle increasing (0° to 60°). Under each segment is the management usually considered for a child who is still growing (Risser 0–3): under 15° monitoring; 15–25° Schroth/PSSE exercises and close follow-up, a night brace may be considered; 25–40° bracing has the best evidence; 45–60° very rigid brace or casting to try to avoid surgery. The red line at 50° is the threshold at which surgery is usually considered. The segment limits are reference ranges from the 2016 SOSORT guidelines and the 2026 Yang network meta-analysis; because Cobb measurement error is about ±5°, the cut-offs are not rigid. The final decision is individualised by a specialist.
How to read: the coloured bar runs left to right with the Cobb angle increasing (0° to 60°). Under each segment is the management usually considered for a child who is still growing (Risser 0–3): under 15° monitoring; 15–25° Schroth/PSSE exercises and close follow-up, a night brace may be considered; 25–40° bracing has the best evidence; 45–60° very rigid brace or casting to try to avoid surgery. The red line at 50° is the threshold at which surgery is usually considered. The segment limits are reference ranges from the 2016 SOSORT guidelines and the 2026 Yang network meta-analysis; because Cobb measurement error is about ±5°, the cut-offs are not rigid. The final decision is individualised by a specialist.
How the Cobb angle is assessed and what each range means (source: dungcuchinhhinh.vn)
How the Cobb angle is assessed and what each range means (source: dungcuchinhhinh.vn)

实用建议

  • 选择个体化制作的支具。
  • 定期复诊：随着生长和侧弯变化调整支具。
  • 鼓励孩子：心情放松有助于规律佩戴。
  • 按指导将支具与运动结合。

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如果怀疑孩子有脊柱侧弯，请尽早就诊：+84 985 211 888。

参考文献

  1. Yang S, Cai F, Xie R, et al. Adolescent idiopathic scoliosis non-surgical interventions: a systematic review and network meta-analysis of Cobb angle and SRS-22 outcomes. Front Pediatr. 2026;14:1908709.
  2. Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013;369(16):1512–1521.
  3. Negrini S, Donzelli S, Aulisa AG, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018;13:3.
  4. Hình ảnh minh họa / Illustrations: dungcuchinhhinh.vn (website của Lê Hoàn Prosthetics & Orthotics)
  5. Cheng JC, Castelein RM, Chu WC, et al. Adolescent idiopathic scoliosis. Nat Rev Dis Primers. 2015;1:15030 (AIS affects 1–4% of adolescents; more common in girls). PMID 27188385.
  6. Di Felice F, Zaina F, Donzelli S, Negrini S. The natural history of idiopathic scoliosis during growth: a meta-analysis. Am J Phys Med Rehabil. 2018;97(5):346–356. PMID 29493563.

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