Scoliosis
Introduction
Introduction to scoliosis Scoliosis means that one or more segments of the spine are bent laterally from the midline of the body (viewed from the front and back of the body) to form a curvature of the spine, usually accompanied by rotation and sagittal rotation of the spine. Increase or decrease of posterior or anterior protrusion, as well as anterior and posterior rib height, pelvic rotational tilt deformity and paraspinal ligament and muscle abnormalities. It is a symptom or X-ray sign. Caused by a disease. Scoliosis usually occurs in the cervical spine, the thoracic vertebra, or the spine between the chest and the waist, or it can occur separately in the lower back. The side curve appears on the side of the spine and is "C" type; or appears on both sides, in the "S" shape. Congenital scoliosis is caused by the incomplete segmentation of the spine during the embryonic period, the incomplete development of the bone bridge on one side, or the incomplete development of one side of the vertebral body, resulting in asymmetry in the growth of both sides of the spine. Scoliosis. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: headache Youth hunchback
Cause
Cause of scoliosis
Congenital factors (30%):
Congenital scoliosis is caused by the incomplete segmentation of the spine during the embryonic period, the incomplete development of the bone bridge on one side, or the incomplete development of one side of the vertebral body, resulting in asymmetry in the growth of both sides of the spine. Scoliosis. Often combined with other malformations, including spinal deformity, congenital heart disease, congenital urinary malformations, etc., generally found on the X-ray film of spinal deformity.
Disease factors (32%):
1. Neurofibromatosis with scoliosis. 2. Scoliosis caused by interstitial lesions, such as Ma Fang syndrome, congenital polyarticular contracture and so on. 3. Acquired scoliosis, such as ankylosing spondylitis, spinal fractures, spinal tuberculosis, empyema and thoracoplasty.
Other reasons (20%):
Scoliosis caused by metabolic, nutritional or endocrine causes.
Prevention
Scoliosis prevention
School-age children should pay attention to maintain a good sitting and standing posture, strengthen muscle exercise, the most critical prevention and treatment of scoliosis is early detection, early diagnosis, early treatment, should promote the knowledge of scoliosis prevention and control in schools, regular screening of scoliosis check.
Complication
Scoliosis complications Complications, headache, youth, hunchback
There are many complications of scoliosis, which can cause headache, neck pain, head rotation disorder, arm numbness, arm hair, and upper back pain. After spinal correction, it can relieve or fine the condition. Many patients also have scoliosis, which is generally best in children. The effectiveness of an adult depends on the degree of permanent damage to the spine joints and the number and timing of treatment. Scoliosis is a common disease that affects adolescents and children. If it is not detected in time and treated in time, it can develop into a very serious deformity, and can affect cardiopulmonary function, and even lead to paralysis.
Symptom
Scoliosis symptoms Common symptoms Spinal and limb deformities Children's scoliosis spine posterior spine physiologic flexion disappeared Bamboo spine spine degenerative scoliosis
Shoulder and pelvis tilt, long-term asymmetric posture, dominant hand, lower limb unequal length, muscle convex side tissue tension, concave side tissue weak, pulled. Judging from the symptoms of scoliosis, the damage of this disease is very great. If the scoliosis cannot be detected and treated in time, the condition of a large part of the patient will be aggravated and the average monthly weight will increase. 2 degrees, especially during the period of vigorous growth and development, scoliosis develops faster. The hazard of scoliosis, such as the development of deformity, can eventually lead to severe scoliosis. Causes severe deformity of the trunk. The shoulders are rugged, the back of the back is razor-backed, and one side of the chest collapses. One side is raised, the pelvis is tilted and limp.
Examine
Scoliosis examination
1. Four-slices of the whole spine: the left and right bending images of the lateral and anterior slices. The maximal left and right flexion of the spine under the patient's supine position takes the full spine anterior slice, and the Cobb horn is convex on the X-ray film. The softness of the bend can be estimated compared to the Cobb angle under the standing position. If patients with kyphosis are combined, it is necessary to add a anterior and posterior pole extension.
2, MRI examination of the entire spine is inevitable, used to rule out spinal deformity.
3. CT and three-dimensional reconstruction of the whole spine, excluding the bony mediastinum, and the pedicle scan of each vertebral body to understand the development of the pedicle. For severe, complex or refurbished scoliosis, a three-dimensional reconstruction of the data can be used to reconstruct the 1:1 model in vitro.
4, pulmonary function test combined with blood gas analysis, general scoliosis patients with ventilatory respiratory dysfunction when the lateral curvature is greater than 90 degrees, in the presence of hypoxemia and carbon dioxide retention, beyond the patient's surgical tolerance Should be discussed in conjunction with respiratory and anesthesiology. Ultrasound examination of the whole abdomen and ultrasound of the heart. Some patients with scoliosis, especially those with congenital scoliosis, may have independent kidney or polycystic kidney deformity, or even no uterus, gallbladder, etc. Some patients may also have congenital malformations of the heart, preoperative examination and evaluation. necessary. For patients with scoliosis with lower extremity neurological symptoms, preoperative electromyography is inevitable. It helps to determine the correct positioning of the nerve and whether it is decompressed.
Diagnosis
Diagnosis of scoliosis
Diagnostic criteria
Early diagnosis is important to make early treatment. Therefore, it is necessary to improve the census work of primary and secondary school students and focus on prevention.
(1) medical history
Ask in detail about all conditions related to spinal deformity, such as the patient's health, age and sexual maturity. Also need to pay attention to past history, surgical history and trauma history. Children with spinal deformity should be aware of the health status of their mother during pregnancy, whether there is a history of medication during the first trimester of pregnancy, and whether there are complications during pregnancy and childbirth. Family history should pay attention to the situation of other people with spinal deformity. Family history is especially important in the neuromuscular spine.
(2) Medical examination
Pay attention to three important aspects: deformity, etiology and complications.
First, fully exposed, only wearing shorts and loose outer garments at the back, pay attention to pigmentation of the skin, with or without coffee spots and subcutaneous tissue, and with or without hair and cysts on the back. Pay attention to the development of the breast, whether the thorax is symmetrical, with or without funnel chest, chicken breast and rib bulge and surgical scar. The examiner should carefully observe from the front, side and back.
The patient then faces the examiner and bends forward to see if the back is symmetrical: one side of the ridge indicates the rib tube and the vertebral body rotation deformity. Then the examiner observes whether the waist is symmetrical from the back of the patient and checks whether the lumbar spine is deformed. At the same time, pay attention to whether the shoulders are symmetrical. It is also necessary to measure the distance between the ribs on both sides and the sacrum. The plumb line can also be placed from the spine of the neck 7 and then the distance from the hip to the vertical is measured to indicate the degree of deformity. Then check the range of motion of the flexion, overextension and lateral curvature of the spine. Check the flexibility of each joint, such as the proximity of the wrist and thumb, the overextension of the fingers, and the recurve of the knee and elbow joints.
Finally, the nervous system should be carefully examined, especially in the lower limbs. Those suspected of having a mucopolysaccharidosis should pay attention to the upper jaw. The Marfan syndrome should pay attention to the cornea.
The patient's height, weight, arm spacing, and length of both lower limbs should all be recorded.
(3) X-image inspection
1. Upright position of the full spine of the lateral position: When the X phase is taken, the upright position must be emphasized and the position cannot be lying. If the patient is not standing upright, it is advisable to use a sitting image to reflect the true condition of the scoliosis. It is the most basic means of diagnosis. The X image needs to include the entire spine.
2. The supine position bends and pulls the image to the left and right: it reflects its softness. Cobb's angle is greater than 90 degrees or neuromuscular scoliosis. Because there is no proper muscle correction scoliosis, the traction pattern is often used to check the elasticity to estimate the correction of the lateral curvature and the length required for each column fusion. The softness of the kyphosis needs to be taken over the lateral image of the extension.
3. Oblique image: Check the condition of spinal fusion. The lumbosacral oblique image is used for patients with spondylolisthesis and isthmus.
4. Ferguson image: Check the joint of the lumbosacral joint. In order to eliminate the lumbar lordosis, the male patient's bulb is tilted 30 degrees to the head side and the female is tilted 35 degrees, thus obtaining a true positive lumbosacral joint image.
5. Stagnara image: severe scoliosis patients (greater than 100 degrees), especially with kyphosis, vertebral body rotation, ordinary X images are difficult to see the ribs, transverse processes and vertebral deformities. It is necessary to take a rotating image to get a true front and rear image. Rotate the patient under fluoroscopy, and take the film when the maximum camber occurs. The film is parallel to the inner side of the rib bulge, and the tube is perpendicular to the piece.
6. Tomographic images: examination of congenital malformations with unclear lesions, fusion of bone grafts, and certain special lesions such as osteoid osteomas.
7. Cut image: The patient bends forward and the tube is tangent to the back. Mainly used to check the ribs.
8. Myelography: not routinely applied. Indications are spinal cord compression, spinal cord mass, and suspected lesions in the dural sac. X-like images showed widened pedicle distance, spinal canal regurgitation, longitudinal spinal cord fissure, and syringomyelia. Myocardial angiography is required to understand spinal cord compression when planning a resection of the hemivertebra or a wedge-shaped resection of the hemivertebra.
9. CT and MRI: Very helpful for patients with spinal cord disease. Such as spinal cord fissure, syringomyelia and so on. Understanding the plane and extent of the epiphysis is important for orthopedics, resection of the epiphysis, and prevention of paraplegia. However, it is expensive and should not be routinely checked.
(4) Key points of X-image reading
End vertebrae: the vertebral body at the head and tail of the curvature of the scoliosis.
Top vertebra: The most severe deformity in the bend, the farthest vertebral body off the vertical line.
The main side bend is the primary side bend: it is the earliest bend, and it is also the largest structural bend, with poor flexibility and correctability.
Secondary side bend: that is, compensatory side bend or secondary side bend, which is the smallest bend, the elasticity is better than the main side bend, and it can be structural or non-structural. Located above or below the main side bend, the role is to maintain the body's normal line of force, the vertebral body usually does not rotate. When there are three bends, the middle bend is often the main side bend, the square has four bends, and the middle two are double major bends.
(5) Determination of camber and rotation
Measurement of camber: (1) Cobb's method: The most common angle between the perpendicular line of the upper edge of the cephalic end vertebra and the perpendicular line of the lower edge of the caudal end is the Cobb's angle. If the upper and lower edges of the end vertebrae are unclear, the line connecting the upper and lower edges of the pedicle can be taken, and then the angle of intersection of the perpendicular lines is Cobb's angle. (2) Ferguson method: rarely used, sometimes used to measure mild side bends. Find the midpoint of the end vertebrae and the vertebral body. Then draw two lines from the midpoint of the apical vertebra to the midpoint of the upper and lower vertebrae. The angle of intersection is the side angle.
Determination of vertebral rotation: Nash and Mod are divided into 5 degrees according to the position of the pedicle on the positive X image. 0 degree: pedicle symmetry; I degree: the convex side pedicle moves to the midline, but does not exceed the first grid, the concave side pedicle becomes smaller; II degree: the convex side pedicle has moved to the second grid, The concave side pedicle disappeared; III degree: the convex side pedicle moved to the center, the concave side pedicle disappeared; IV degree: the convex side pedicle crossed the center, close to the concave side.
