Scoliosis at children – the permanent deformation of a spine column which is characterized by its side deviation and a torsiya. Scoliosis at children is followed by the asymmetric provision of nadplechiya, shovels and other bone reference points, a basin distortion, deformation of a thorax, violations from internals. For diagnosis of scoliosis at children polyposition roentgenograms of a backbone with calculation of size of a curvature are carried out. Conservative treatment of scoliosis at children includes the orthopedic mode, massage, corrective gymnastics, physical therapy, carrying an orthopedic corset; according to indications surgical correction of scoliosis is made.
Scoliosis at children
Scoliosis at children – the pathological changes in a pozvonochniyoka and paravertebralny fabrics leading to a curvature of a spine column, its turn around a longitudinal axis, to statiko-dynamic violations and funktsioyonalny changes from internals. Scoliosis – one of the most widespread diseases of the musculoskeletal device in children's orthopedics which is suffered by 5-10% of children and teenagers. Scoliosis occurs at girls considerably more often than at boys; the approximate ratio of floors makes 9:1. Danger of development of scoliosis in the child consists not only in cosmetic defect, but also in a sdavleniye, shift and malfunction of vessels and internals.
Classification of scoliosis at children
Depending on time of manifestation distinguish infantile (infantile) scoliosis at children up to 3 years; children's (juvenile) scoliosis at children of the dopubertatny period (from 3rd to 10 years); juvenile scoliosis at children and teenagers from 10 to 18-20 years, i.e. before the termination of bone growth.
In a form of a curvature of a backbone allocate With-shaped scoliosis - with one arch of a curvature, S-shaped – with two arches of a curvature and Z-figurative – with three arches of curvature.
Backbone curvature size in degrees and expressiveness of deformation is the basis for radiological classification of scoliosis at children. According to these criteria allocate the IV degrees of scoliosis at children:
- Scoliosis of the I degree is characterized by a corner of a side curvature less than 10 ° and insignificant radiological signs of a torsiya;
- Scoliosis of the II degree is characterized by a corner of a curvature from 10 to 25 °, moderately expressed torsiya and deformation of bodies of vertebras at curvature top;
- Scoliosis of the III degree is characterized by a corner of a curvature from 25 to 50 °, existence of sharply expressed torsiya of vertebras (a costal hump), the fixed changes in a backbone;
- Scoliosis of the IV degree is characterized by a curvature corner> 50 °C sharply expressed deformation of a spine column, thorax, shift and a sdavleniye of internals and violation of their functions.
Depending on localization of top of an arch of a curvature distinguish the following types of scoliosis at children: verkhnegrudny (at the level of Th3 - Th4), chest (Th8 - Th9), grudopoyasnichny (Th11 - Th12), lumbar (L1 - L2), lumbar and sacral (L5 - S1), combined (with identical degree of a torsiya in several departments).
On an etiology scoliosis at children is subdivided on congenital and acquired.
The scoliosis reasons at children
The origin of congenital scoliosis at children can be caused by anomalies of development of a backbone (wedge-shaped vertebras and semi-vertebras, sinostozy awned shoots), violation of formation of edges (additional edges, sinostozy edges, etc.), a dysplasia of lumbar and sacral department of a backbone (spondilolizy, a lyumbalization, a sacralization and so forth)
Cases of the acquired scolioses at children, as a rule, are connected with neuromuscular, metabolic, tumoral diseases and injuries. Static scoliosis at children most often is a consequence of a patrimonial trauma, congenital dislocation of a hip, shortening of a nizhyony extremity, contractures of knee and coxofemoral joints. Nevrogenny scolioses at children can arise because of cerebral palsy, poliomyelitis, a siringomiyeliya, Fridreykh's ataxy, injuries of a spinal cord and other pathological states. Genesis of miopatichesky scoliosis at children can be caused by congenital muscular hypotonia, muscular dystrophy, a congenital wryneck.
At children traumatic deformations of vertebralny localization (after spinal fracture, a torakoplastika, a laminektomiya and so forth) or extra vertebral localization can be the cornerstone of scoliosis (after extensive burns of a trunk, a pleura empiyema etc.). Quite often lead metabolic violations to development of scoliosis in children (rickets, , imperfect osteogenesis, Hunter's syndrome), hereditary diseases of connecting fabric (Marfan's syndrome, Elersa-Danlos's syndrome), rheumatic pathology (juvenile rheumatoid arthritis) of a tumor of a spine column and spinal cord, juvenile osteochondrosis, a neurofibromatosis.
However, despite variety of the identified factors promoting development of scoliosis in children, the majority of cases belong to idiopathic, i.e. arising for the unspecified reasons.
Scoliosis symptoms at children
Idiopathic scoliosis usually is found in children in 6-7 years, i.e. during the first jump of growth, when performing routine inspection of the child by the pediatrician or children's orthopedist. Clinical displays of scoliosis at children differ depending on extent of deformation of a backbone.
Scoliosis of the I degree at children can be suspected on the following characteristic signs: to the lowered position of the head, the cramped shoulders, a slanted basin, stoop, asymmetry of nadplechiya and a waist, the outlined turn of vertebras around a longitudinal axis. The arch of a curvature is looked through at an inclination forward and vanishes when straightening a trunk of the child.
At scoliosis of the II degree, except above the listed signs, children have a pathological rotation of vertebras, the muscular roller in lumbar department and protrusion - in chest department on the party of a curvature. Curvature of a backbone does not vanish in any position of a body.
Clinical symptoms of scoliosis of the III degree at children are characterized by the expressed turn of vertebras well outlined by a costal hump, muscular contractures, weakening of belly muscles, a vypiraniye of costal arches, etc.
At scoliosis of the IV degree the backbone of the child is considerably deformed, paravertebralny muscles are stretched, the costal hump is expressed, edges and muscles in a zone of concavity sink down.
Progressing of pathological changes at scoliosis at children leads to development of functionally significant deformation of the thorax which is followed by a sdavleniye and shift of heart, lungs and a vascular bunch. This state is regarded as a skoliotichesky disease at children.
Scolioses of I and II degrees at children usually proceeds without subjective complaints; at scolioses of III and IV degrees back pains, increased fatigue, short wind, heartaches, tachycardia, constraint of movements can disturb. As complications and consequences of scoliosis at children and teenagers vegeto-vascular dystonia, neurocirculator dystonia, dyskinesia of biliary tract, cholecystitis, etc. can act. At the girls having scoliosis the risk of development of violations of a menstrual cycle, and in the future – spontaneous termination of pregnancy, violations of patrimonial activity is increased (weaknesses, dicoordination, etc.).
Scoliosis at children is quite often combined with other pathology of the musculoskeletal device: a dysplasia of coxofemoral joints, flat-footedness, a backbone curvature in the sagittalny plane (kifozy).
Diagnosis of scoliosis at children
Early detection of scoliosis – the most important problem of dispensary surveys of children of preschool and school age by the pediatrician, children's surgeon, neurologist, children's orthopedist. The correct assessment of a bearing requires consecutive inspection of the child in a standing position (in front, sideways, behind), sitting and lying. At the same time pay attention to height of nadplechiya, asymmetry of skin folds, shovels, a basin, existence of a costal hump and other symptoms of scoliosis at children. Backbone curvature degree in degrees is defined by a skoliozometr. Identification of a deviation of a backbone more than on 5-7 °, is the basis for carrying out a X-ray analysis to the child.
The X-ray analysis of a backbone is carried out in a standing position and lying in 2 projections. On the basis of received calculation of size of a curvature for Fergusson's technique or Kobba, definition of an index of stability of a backbone is made. The x-ray tomography, backbone MPT or KT, a miyelografiya can be applied to more detailed inspection of the interesting department of a backbone. To inspection and dynamic observation of children it is more preferable to apply not beam methods of a research, for example, computer optical topography. An obligatory component of diagnosis of scoliosis at children is photography of the child from various points at all stages of observation.
At development of functional violations from internals according to indications to the child consultations of the children's pulmonologist, children's cardiologist, children's gastroenterologist are held; FVD, the ECG, ultrasonography of abdominal organs of the ave. are carried out.
Treatment of scoliosis at children
The standard tactics assumes the differentiated approaches to holding medical actions to children with various degree of expressiveness of scoliosis. Conservative treatment is carried out with participation of physiotherapists, massage therapists, instructors of LFK, vertebrolog, manual therapists.
Children with not progressing scoliosis of the I-II degree need elimination of the reasons promoting a backbone curvature, reduction of static load of a spine column, the organization of optimum physical activity. For the purpose of prevention of progressing of scoliosis the remedial gymnastics, massage of a back, swimming is recommended to children. An important component of therapy of scoliosis at children is observance of the orthopedic mode – a dream on a board, control of a correct posture, periodic unloading of a backbone in horizontal position.
At the progressing scoliosis of the I-II degree, except the called actions, to children the LFK individual complex, physical therapy (an elektromiostimulyation, magnetotherapy, SMT-therapy, balneotherapy, mud cure, heattreatment), orthopedic massage, soft technicians of manual therapy is appointed. Treatment is supplemented with carrying corrective orthopedic corsets.
As indications to surgical correction of scoliosis at children serve bystry progressing of deformation, despite the carried-out conservative treatment, a backbone curvature corner more than 40 °, violations of work of vitals. The optimum period for expeditious treatment is the age of 10-14 years. Operation consists in implantation of the fixing devices the transthoracic, dorsalny or combined access. The greatest distribution to surgeries of scoliosis was gained by Kazmin's distractors, Harrington, Rodnyansky-Gupalov's endoproofreader, system Kotrelya-Dyubusse, etc. Before surgical intervention extension of a backbone is carried out.
According to indications the corrective bone plastic surgeries (a wedge-shaped resection of vertebras) mobilizing operations (a tenoligamentokapsulotomiya across Shulutko, a diskektomiya), cosmetic interventions (a resection of a costal hump, an ekstraplevralny torakoplastika, a shovel corner resection), etc. can be carried out. After operations long rehabilitation therapy is carried out.
The forecast and prevention of scoliosis at children
The arising deformations of a backbone have the adverse progressing current early (up to 6 years); more favorably scoliosis at children proceeds 10-12 years are more senior. All children with scoliosis have to regularly, not less than 2 times a year to undergo the specialized treatment appointed by the orthopedist. At the expressed scoliosis at children operation can only reduce degree of a curvature of a backbone and suspend its progressing. Therefore the main efforts of adults have to be directed to the prevention of scoliosis at children.
The rational organization of the motive regime of children of the house and in child care facilities, control of deduction of a correct posture, an exception of heavy loads of a backbone and asymmetrical loading of muscles, occupations fitness training and sport, traumatism prevention is necessary. At violations of a bearing courses LFK, the all-strengthening massage, occupation are shown to children by swimming.