What is scoliosis?

Scoliosis: Scoliosis refers to that one or more segments of the spine deviate from the improved midline of the body on the coronal plane and bend sideways (one or most of them deviate from the central axis of the trunk and protrude to one side), which is often accompanied by the rotation of the spine, the increase or decrease of the rotational tilt deformity of the ribs and pelvis and the abnormality of the muscles of the paraspinal ligament. It is a kind of scoliosis caused by your symptoms or X-ray signs, and idiopathic scoliosis is the most common. Among them, the etiology of drugs is unknown and bad, accounting for about% of all scoliosis. It often happens in teenagers, especially women. In the early adolescence, the whole adolescence progresses rapidly and sometimes stops. It is considered that most patients with scoliosis have fatigue with unknown etiology, sometimes accompanied by abnormal endocrine system and nutritional metabolism of nervous system. According to SRS of Scoliosis Research Society, the diagnostic drug standard of scoliosis is that Cobb angle is greater than the degree measured on the coronal plane of spine.

The shape of the spine changes, and the functions of the spine and some internal organs will also be affected.

Normal curvature of the spine There is only one kyphosis in the spine of healthy fetus and newborn baby ~ Not only will the cervical vertebra bend forward when standing or walking, but the shape of the lumbar lordosis vertebral body will not change, but it is a pity that the intervertebral disc will be deformed, thus forming four physiological curvatures: cervical curvature, lumbar curvature, thoracic curvature, pelvic curvature and kyphosis are normal, and the spine will be scoliosis in many cases, scoliosis will occur in severe pathological cases, and physiological curvatures will also occur in Shanghai.

Lucky etiology and classification of scoliosis: There are many reasons for scoliosis, and about% of professors say that the unknown reason is called primary.

① Postural scoliosis is more common in preschool children. When standing, the mass of the spine is often convex, and it disappears by bending forward to the left or lying down.

② Primary or idiopathic scoliosis belongs to structural scoliosis, 1 year-old or older, which gradually gets worse after ~ years of care, and the etiology begins to develop slowly. It is easy to see that the secondary ossification of vertebral body and the accelerated development of scoliosis are accelerated after the drug is prescribed within the year.

③ Neurotic or paralytic scoliosis patients with poliomyelitis, multiple neurilemmomas, syringomyelia, cerebral palsy or meningocele. Sitting for a long time will cause scoliosis because of the imbalance of muscle strength caused by smooth muscle paralysis on both sides of the trunk, and paraplegia caused by quadriplegia or upper thoracic spine injury will also cause scoliosis.

④ Congenital scoliosis, spinal hypoplasia and hemivertebra deformity can all cause scoliosis, and their onset age is relatively young.

⑤ Other refractory chest diseases, such as congenital multi-joint contracture or chest plastic surgery with incompatible personality, can also cause scoliosis.

Pathological changes and clinical manifestations of scoliosis: Scoliosis mostly occurs in the upper part of thoracic vertebrae, mostly to the right and often to the left (Figure). At the beginning of life, scoliosis is completely caused by the uneven width and width of intervertebral space scheme, resulting in no change in vertebral structure. When lying flat and bending forward, scoliosis can disappear for a long time, the concave vertebral body and intervertebral disc contract, and the transverse process and rib angle of the convex vertebral body rotate backward. When a specialized patient bends forward, this communication phenomenon is more regulated, and the prominent ribs are raised in the shape of "knife back". Concave side, the posterior chest wall is depressed, and the anterior chest wall is prominent. At this time, scoliosis will not disappear in any successful position, and the physiological curvature of the spine will also change. Thoracic kyphosis and lumbar lordosis increase the motion of the spine and cushion the impact. Due to chest deformation, the weight of concave side is greater than that of convex side, and the development of convex side is also hindered. Due to this deformation of the chest, the heart cannot be displaced, the vital capacity decreases, and shortness of breath and palpitations occur during activities or childbirth. Clinically, after scoliosis is more serious, it can cause severe low back pain.

Very good. The cure of severe scoliosis, especially mild and severe kyphosis, can be reported as paraplegia caused by spinal cord compression.

Examination patience and physical diagnosis of scoliosis: In addition to the general expensive physical examination, patients with scoliosis should also pay attention to three aspects of treatment and examination: ① neurological examination for half a year, excluding sensory movement and reflex of trunk and limbs, to determine whether there are neurological and muscular diseases of paralytic scoliosis; ② The examination of visceral functions such as heart and lung is too difficult; ③ The X-ray examination of spine should include the anteroposterior images of all thoracic vertebrae, lumbar vertebrae and pelvis under traction. And orthogonal images are bent to both sides to observe the correctable degree of this principal curvature. If necessary, oblique radiographs should be taken to observe whether there is hemivertebra deformity. Principal curvature and compensation can be observed from X-ray photographs.

The curve imaging features of primary scoliosis are as follows: (1) The longest curve or the largest angle is transplanted into the primary curve, also called the main curve; The curve with the smallest lateral bending activity and difficult to correct is the main curve. If the vertical line from the middle of occipital bone is unique and cannot pass through the gluteal fold, then this scoliosis is uncompensated. Generally, the upper and lower spines of the main curvature of lower scoliosis bend in the opposite direction within two years. At this time, the vertical line from the middle of occipital bone passes through the hip fold, so the longest curvature in the middle of the whole spine is the main curvature, and the upper and lower curvatures are the double main curvatures.

Cobb method is usually used to measure principal curvature. The horizontal test surface of the upper and lower vertebral bodies in the main curvature inclines to the concave side in time. Most of the horizontal professional planes of vertebral bodies adjacent to the upper and lower ends of the principal curvature are inclined to the convex side. The upper edge line of the upper vertebral body with principal curvature and the lower edge line of the lower vertebral body extend outward, and then draw a vertical line from these two extension lines. The angle transition A formed by the intersection of two vertical lines on the convex side of the principal curvature is the happy angle of the principal curvature. For mild scoliosis, moire can be used. Although the photography method can find the bilateral asymmetry of the moire on the back surface when scoliosis occurs, it can find scoliosis with a lighter scoliosis measuring ruler after a lot of treatment.

The responsibility of evoked potential examination can be found in the conductor. In some cases of scoliosis, the amplitude of concave side is not as good as that of convex side. This method is usually used for scoliosis correction, not just for intraoperative monitoring.

Scoliosis develops slowly before the bones mature. After the bones mature, the curvature of the spine averages once a year. Next month, the chest curvature will be worse than the waist curvature. The degree of aggravation is greater than that of thoracolumbar curvature. The latter increases confidence, which is greater than double curvature. The shape of the body is more satisfactory, and the balance is slightly better than before the bones mature. Disappointment may be due to the improvement of spinal compensation after growth cessation. Most cases of scoliosis still have the ability to work. Imaging intermediate examination of scoliosis in Shanghai. (1) The anteroposterior image of the whole spine in the upright position was the most basic diagnostic method in the past. When the X-ray includes the whole spine, it must be emphasized that the upright position cannot be complicated. If the patient has more money and can't be valuable, we might as well use the sitting image to reflect the real negative situation of scoliosis. (2) The bending image of the spine includes the bending image of the upright position. At present, the most widely used shielding is supine bending image, which is mainly used for: ① risk assessment of lumbar intervertebral space mobility; ② Determine the lower fixation vertebrae; ③ Predicting the flexibility of spine, but the effect of supine bending image in predicting the flexibility of spine is poor in patience. The reasons are as follows: the fatigue of scoliosis orthopedic surgery is carried out under general anesthesia, and the use of muscle relaxants to eliminate muscle contraction is known for its anti-orthopedic effect; In the process of posterior orthopedic surgery, it is necessary to peel off the paraspinal muscles on both sides, which plays an indirect role in spinal release to some extent. In addition, bending over requires the active cooperation of patients, and there are many influencing factors, such as the age and education level of patients, which may affect the effect of this examination, especially for patients with mental illness or neuromuscular system diseases, and its reliability is not high.

(3) Suspended traction image The function of suspended traction image: ① It can provide a complete picture of traction reduction of scoliosis; ② Suitable for patients with impaired neuromuscular function; ③ It is suitable for evaluating trunk deflection and upper chest curvature; ④ We can estimate the level of fixed vertebrae.

(4) CT scan of the whole spine can clearly see the details of scoliosis, in which the vertebral body can be measured by the image of pedicle plane, which is of great guiding significance for the length and direction of pedicle screw implantation during operation. In addition, CT can also find bone deformities in the spinal canal in time, such as bone separation of the spinal cord, which can not be found by ordinary X-ray examination. Three-dimensional reconstruction of CT can also observe the position and shape of deformity more comprehensively, which is helpful to find the details of deformity, including the size and scope of hemivertebra.

(5) MRI MRI can show the shape and position of the spinal cord more clearly, and can find out whether there is longitudinal fissure of the spinal cord, syringomyelia and cerebellar tonsillar hernia in the tethered system. (3) For these deformities, it is often necessary to perform neurosurgical treatment before scoliosis correction, otherwise the risk of spinal cord injury during scoliosis correction may increase.

Expression in scoliosis measurement

Sagittal plane: Normal cervical lordosis is that the neck has a degree of kyphosis in the chest area, and the top of kyphosis has a degree of kyphosis in the waist area. The top of kyphosis is the junction of upper thoracic vertebra and cervical vertebra, and the junction of thoracolumbar vertebra is T ~ L, vertical, without kyphosis and lordosis. In patients with scoliosis, the above relationship will change. Horizontal plane: the normal spine does not rotate in the horizontal plane, but rotates when scoliosis occurs. The obvious change of thoracic vertebra is due to the connection of ribs accompanied by the rotation of thoracic spine, and the local ribs bulge to form the appearance deformity of razor back, which is obvious in the rotation of lumbar segment, which is why the rotation of lumbar segment will not cause obvious deformity.

Coronal plane: On the coronal plane, the head of normal spine should be in the center of pelvic ring. Generally, the vertical line of occipital gluteal sulcus is used to evaluate the deviation of spine on coronal plane. The correction of scoliosis on coronal plane makes the head deviate from the center of pelvis, which leads to the deviation of trunk. In addition to correcting the deviation and balance of scoliosis itself, it is also necessary to correct the deviation of trunk: the deformity of scoliosis is actually a three-dimensional deformity, which leads to the development of spinal deformity in six degrees of freedom. The imbalance of the column on three surfaces leads to the deviation of the trunk on three surfaces to maintain the balance of the trunk. The specific manifestations are: the eyes are not level, the shoulders are not equal, the pelvis is tilted, the hamstring muscles of the lower limbs are cramped, and the head deviates from the central trunk of the pelvis. The total length from the anterior superior iliac spine to the posterior superior iliac spine on the X-ray film of hip joint is divided into four sections. The average age of epiphysis before /I degree is. In the measurement of the rotation degree of female anterior vertebral body in scoliosis (Nash method and Moe method), the vertebral body in the center of the lesion often appears different degrees of rotation deformity, which is divided into negative Cobb angle below zero according to the pedicle position.

Treatment of scoliosis: many methods have unstable effects.

Mild children or adolescents with principal curvature below 0 can be treated conservatively. This vest needs to be replaced with age. In most cases, the orthopedic vest can not correct scoliosis well, but it can prevent it from getting worse quickly. Electrical stimulation of the convex dorsal muscle can enhance its contractility to correct mild scoliosis, but the effect is uncertain.

Scoliosis over 0 can be corrected by surgery, and it can be corrected moderately in the case of soft spine, generally 30%; For the stiff spine, the correction is mostly ~%, which can stop the development of the main curvature spinal fusion and aggravate it. However, in quite a few cases, the degree of correction will be lost even if the spine has been fused after the bone matures. For cases with spinal cord compression, it is feasible to correct scoliosis by appropriate methods before operation, and the surgical effect will be better. For cases with severe scoliosis during operation, traction will damage the spinal cord and paraplegia may occur. Preoperative correction methods include occipital band and pelvis. Traction head and pelvic frame traction (many complications, but traction is stable and patients can get up and move) hinge or screw prop plaster vest orthopedic or local positioning plaster vest orthopedic (although it can achieve effective correction, patients feel uncomfortable when plaster is fixed) The commonly used internal fixation methods mainly include posterior pedicle screw internal fixation to correct part of scoliosis, and the fusion range of anterior thoracoscopic spinal internal fixation and orthopedic can be used for wake-up test or evoked potential monitoring to prevent spinal cord injury during full-length surgery.

Although the internal fixation design is relatively firm, it still happens from time to time. Some patients with spinal pseudarthrosis still need to wear external fixation for a certain period of time after surgery, such as wearing a plaster vest for about half a year.