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主人和客人表达的所有想法和观点都是他们自己的，并不一定反映他们所属机构的观点.
Interviewer: 你的孩子被诊断患有脊柱侧凸, and you're a little worried about what their future looks like. Today we're going to talk about what to do after a scoliosis diagnosis, what you should know, 接下来的步骤是什么.
Dr. Joshua Speirs is a fellowship-trained pediatric orthopedic surgeon at University of Utah Health, 他擅长脊柱侧弯的治疗.
What Is Scoliosis?
我想从, 对于不熟悉脊柱侧凸的人来说, 你会如何向他们描述这种情况? I understand it has something to do with the curvature of the spine, 但你怎么跟病人解释呢?
Dr. Speirs: 是的，完全正确. 最基本的解释是脊柱的弯曲，脊柱在正面和背面都不再是笔直的, 它向一边偏移.
Interviewer: All right. 所以这是一个侧面到侧面的曲率. Because our spine naturally kind of curves from front to back. That's normal.
Dr. Speirs: Exactly. The more detailed way to think about it is it is a three-dimensional deformity, 它稍微旋转一下，向侧面偏移. 这确实会引起肋骨的旋转, and sometimes it actually even makes the shoulders a little bit unlevel. But the, you know, basic front and back view is it's a side curvature.
How Scoliosis Is Detected?
Interviewer: 你通常会看到引荐，对吧? Generally, I'd imagine, from what I understand, 患者最初被诊断为脊柱侧凸, like, 健康检查或儿科检查. 我是说，以前在一些地方，我记得我上学的时候，他们会检查你的脊椎. 我想他们不会再这么做了. But when a patient comes into your office with that diagnosis, what are you seeing?
Dr. Speirs: Yeah, great question. 它通常是由儿科医生发现的. 通常他们会让孩子身体前倾, like they're trying to stretch their hamstrings and touch their toes, 他们在寻找不对称的肋骨或者一个比另一个更突出的肋骨. 这通常会触发x光检查. Sometimes the pediatricians will order it prior to referring, 有时候你来大发娱乐诊所的时候大发娱乐也会给你. But really, the diagnosis is confirmed by getting an X-ray to evaluate the spinal shape.
Mild vs Severe Scoliosis
Interviewer: All right. And generally, 儿科医生做了第一步, 这就是他们参与的结束? 他们通常会建议病人去看像你这样的专家吗?
Dr. Speirs: Yeah. 这取决于x光的结果? So a very small curve, 所以如果你有轻微的脊柱侧凸或者小于10度当大发娱乐开始做x光测量时, 大发娱乐甚至不称之为脊柱侧凸. 他们通常称之为脊柱不对称, 通常儿科医生会注意到这一点并亲自观察因为这不是需要遵循的东西. One in 10 people have a very small, less than 10-degree curve of their spine. So it's exceptionally common and doesn't require treatment. 更大的曲线，大发娱乐现在进入脊柱侧弯的真正定义，被提到大发娱乐大发娱乐.
Interviewer: All right. So, generally, that's who you see, somebody who has a curvature of the spine that's more than 10 degrees.
Dr. Speirs: Yeah. Exactly.
Interviewer: Yeah. Okay. And then when a patient comes into your office beyond that 10-degree curvature, 总的来说，你看到的情况有多严重? 一般是相当严重，还是不太严重? 比如大发娱乐的范围是多少?
Dr. Speirs: Yeah. I mean, we see everything from 11, 12 degrees to 100 degrees. Most of them are small. Like 2% of the population has a curve between 11 and 20 degrees, 所以这是一条非常小的曲线，通常不需要治疗，也没有任何长期影响. But there are definitely some kids and some adolescents who have curvatures much larger.
Interviewer: Okay. So it is possible you might see somebody that has a curvature of 10 to 20 degrees, and even that, then you would say, “这是大发娱乐将密切关注的事情. 现在没什么好担心的." Is that true?
Dr. Speirs: Yeah. Exactly. 比如脊柱侧凸的治疗, 或者说大发娱乐看待问题的方式, 实际上是在试图确定曲线的大小以及曲线随时间变大的风险是多少.
未经治疗的脊柱侧凸的后果
Interviewer: 大发娱乐马上会讲到一些治疗方案和一些常见的问题. But at this point, 我想知道你是否诊断出你认为需要治疗的弯曲, what are the potential repercussions of not treating that scoliosis?
Dr. Speirs: 对此有很多长期的研究, 看看脊柱侧凸的自然历史. 大发娱乐知道有些小曲线会在你的一生中保持很小，几乎没有影响. 大发娱乐知道，在你的一生中，有些弯曲会变得越来越大，并且会继续产生一些影响，因为它们会造成越来越多的脊柱弯曲或越来越多的畸形. 所以这取决于你属于哪个阵营. 如果你有一个小的曲线，它不太可能进步, it may not go anywhere, 你的脊椎可能一辈子都有一个小弧度，影响很小.
Interviewer: That's reassuring, I'm sure, for a patient who maybe just received that diagnosis. 对于更大的曲线，不处理它的潜在影响是什么?
Dr. Speirs: The concern is that it continues to get bigger throughout your life. 我认为大发娱乐做的研究越来越多, we know that curves, 当它们进入40到50度的范围, 似乎在你的一生中变得越来越大. 有些孩子有40度的弯曲, 如果它在你的一生中持续发展, 能每年增加一两个学位吗, and in your teens and 20s, it may stay pretty small. But by the time you're an adult, it could potentially be a fairly sizable curve. Those are the curves that end up requiring further surgical intervention.
Interviewer: 这条曲线对一个人的生活有什么影响?
Dr. Speirs: 部分取决于曲线的位置, 如果是在胸椎, the mid-back, the lumbar spine, or the low back. But it can create some deformity of the chest wall, and some asymmetry of your shoulders. If it gets really big, it does start to impact your heart and lungs. That's usually much bigger curves, you know, in the 75-plus range. But it is possible if the curve gets big, that it can start to affect other things.
Interviewer: 你有没有遇到过这样的病人他们的孩子有一个很大的曲线选择不接受治疗? 他们的理由是什么呢?
Dr. Speirs: It happens occasionally. It can be multifactorial. 脊柱侧凸有不同的类型. Right now, we're mostly talking about what we would call adolescent idiopathic scoliosis, 脊柱侧凸发生在青春期前, 不知什么原因，在十几岁的时候. That's what idiopathic means is we don't know exactly what causes it. There are other types of scoliosis that maybe if you've had a neuromuscular disease, 比如脑瘫和其他疾病. 有时大发娱乐有大的曲线, and the child has other medical problems that may not make the risk of a procedure, you know, 大发娱乐想在那个时候做的事情. 我觉得自己和大多数健康的人一样, kids with no other medical problems than just a curved spine, 大多数人建议并继续进行手术，只是因为避免手术的长期风险会变得更大.
Treating Scoliosis
Interviewer: 您的脊柱侧弯治疗理念是什么? So a patient comes in, it looks like some sort of treatment is going to be necessary. How do you approach that?
Dr. Speirs: Yeah. Well, first we try and make sure everyone understands what scoliosis is. I really sit down, and I review the X-rays with the patient and the family. 我给他们看x射线，我给他们看大发娱乐是如何测量的，这样他们就能看到我所看到的. 一旦大发娱乐确定这是一条更大的曲线曲线可能会变大, 然后大发娱乐讨论不同的治疗方案, 把所有选项都看一遍, 权衡所有的风险和收益, and then come to a mutual, you know, group decision on, "Hey, at this time, 大发娱乐认为这是最好的选择.“这就是大发娱乐前进的方向.
Non-surgical Treatment Options: Bracing and Physical Therapy
Interviewer: Yeah. 我知道有些治疗方法包括物理治疗，支撑，甚至手术. 我把所有的可能性都包括了吗? 然后你如何系统地通过哪一个将适用于一个特定的病人?
Dr. Speirs: Yeah. 选择取决于曲线的大小, size of the curve, 孩子还能长多少, 因为大发娱乐知道，曲线变大的主要风险因素之一是剩余增长, 那么一个孩子会多长多少呢? The more growth they have remaining, the more likely the curve is to get bigger. And kind of those two factors, how big it is and how much more growth they have. 大发娱乐如何决定大发娱乐真正要做什么取决于它.
Smaller curves, you know, 25到40度，孩子还在发育, 大发娱乐的目标是阻止曲线变大. 这就是大发娱乐考虑支撑和物理治疗的时候.
严重病例的手术选择
For larger curves over 45 to 50 degrees, bracing hasn't been shown to be as effective. 如果孩子还有很大的成长空间, then we start to talk about procedures and surgical interventions, 不管这是不是一个节省融合的过程, 比如前椎体系缚或融合来矫正畸形并防止其恶化.
Interviewer: 然后治疗需要多长时间? 我假设它取决于，脊柱的弯曲度，但是给我这个范围.
治疗持续时间和承诺
Dr. Speirs: Totally. 如果大发娱乐进行非手术治疗, 大发娱乐会一直等到它们生长完，因为那时它继续恶化的风险就会降低. 这取决于你什么时候开始? 如果我有一个11岁的男孩，大发娱乐试图支撑他，那可能需要更长的支撑时间. 然而，你知道，如果你有一个13岁的女孩，那么可能需要更短的支撑疗程.
通过脊柱侧凸诊断支持你的孩子
Interviewer: 当你告诉孩子和他们的父母他们的诊断结果时，他们的反应是什么?
Dr. Speirs: Oh, it's very variable. There are families that have multiple people in their family who have scoliosis. They kind of know the drill already, and they're prepared for it.
最难的是那些出现的家庭，他们的曲线更大，30、40、50度. 他们两周前还不知道它在那里. They just got an X-ray. 现在他们在看x光片, and there's a big curve, 还有一点令人震惊的因素, which I think is completely understandable and even kind of expected, you know, to be like, "Man, 两周前，我还以为自己是个完全正常的11岁孩子. 现在你又说我的脊椎都扭了."
Interviewer: Right. 我可能得戴牙套了.
Dr. Speirs: 而且我可能得戴个支架. 大括号响应肯定是它自己的东西，对吧? 在社会上戴牙套对青春期前和青少年来说是很正常的. Everyone wears braces. That's normal. 但现在有人出现在学校里，可能在衣服里戴着一个支架，这对孩子们来说有点可怕, 我认为这也是非常合理的, and we kind of expect it.
关于脊柱侧凸的常见误解
Interviewer: Yeah. 你发现人们对脊柱侧凸有哪些常见的误解, 要么是病情，要么是治疗方法?
Dr. Speirs: Yeah. Many people have specific concerns regardless of the treatment. When it comes to bracing, you know, is the child going to wear the brace? 这个支架多少钱? How much do I have to wear the brace for it to be effective? 另一个问题是，即使我戴着支架，如果弯曲度继续恶化怎么办? Concerns for surgery, obviously, are, "You're doing surgery on my teenage child's back. I know my friend down the road had back surgery, and they're having tons of pain. Is my daughter or son going to be in pain for the rest of their life? Is all their motion going to be taken away, and they're going to be stiff as a board?“这些都是大发娱乐得到的非常常见的反应.
Interviewer: 关于脊柱侧弯的治疗，你想让听众知道的最重要的事情是什么?
Dr. Speirs: 我试图向家属和患者强调，大多数情况下大发娱乐可以避免手术, 从长远来看，大发娱乐可以让你的孩子过上正常而有功能的生活. And even if they're in the rare category that needs surgery, it is not life-ending. You know, I have patients who still ride rodeos, and compete in competitive sports. 大发娱乐可以大发娱乐你的孩子度过难关，他们仍然可以过正常的生活.