Juvenile scoliosis

Introduction Adolescent idiopathic scoliosis: idiopathic scoliosis is relatively common, with a prevalence of 2% to 4% in adolescents in the 10-16 age group, with a small degree of scoliosis. In patients with scoliosis around 20°, the ratio of male to female is basically equal; in the crowd of scoliosis greater than 20°, female: male exceeds 5:1. The fact that women with scoliosis are more severe suggests that female scoliosis may be more progressive and that they need treatment more than boys.

Cause

(1) Causes of the disease

Because idiopathic scoliosis accounts for the vast majority of scoliosis, if it can understand its cause, it is of great significance for prevention and treatment. Therefore, people have been working on the cause of idiopathic scoliosis for many years, but the exact cause has not been found so far.

In 1979, Herman demonstrated that patients with idiopathic scoliosis had a labyrinthine impairment. In 1984, Yamada also performed a balanced function test on patients with idiopathic scoliosis. Results showed that 79% showed significant balance dysfunction, compared with 5% in the control group. Wyatt also found that patients with scoliosis had significant vibrational imbalances, suggesting a central disorder in the posterior column pathway of patients with scoliosis. However, these studies did not clarify the relationship between idiopathic scoliosis and balance disorders, and did not explain the etiology of idiopathic scoliosis itself.

It was observed that the height of patients with idiopathic scoliosis was higher than that of normal peers. The author's 1984 census is also the result. This prompted people to understand the relationship between growth hormone and idiopathic scoliosis. The results of different authors have different conclusions, and the growth hormone content is still a matter of debate. More literature discusses the relationship between paravertebral muscles and idiopathic scoliosis. The detection of paraspinal muscles includes: muscle spindle, muscle fiber morphology, muscle biochemistry, myoelectricity, calcium, copper, and zinc. Although there were abnormal findings, they did not directly explain the cause. People have also investigated genetic problems from familial investigations, and patients with sacral scoliosis have been investigated, but more patients cannot be explained by a single genetic abnormality. Therefore, the cause of idiopathic scoliosis is still being explored in the future. Important topic.

(two) pathogenesis

The pathological changes of idiopathic scoliosis mainly include the following:

1. Changes in vertebral bodies, spinous processes, lamina and facets

The side convex and concave side vertebral body is deformed and rotates, and the main lateral curved vertebral body and spinous process rotate toward the concave side. The concave side pedicle becomes shorter and narrower, and the lamina is slightly smaller than the convex side. The spinous process is inclined to the concave side to narrow the concave side spinal canal. On the concave side, the facet joint thickens and hardens to form an epiphysis.

2. Changes in the ribs

Rotation of the vertebral body causes the convex side rib to move to the dorsal side, causing the back back to protrude, forming a hump, which is called "razor-back". The convex side ribs are separated from each other and the gap is widened. The concave side ribs are squeezed together and protrude forward, resulting in asymmetrical chest.

3. Changes in intervertebral discs, muscles and ligaments

The concave side intervertebral space narrowed, the convex side widened, and the small muscle on the concave side showed mild contracture.

4 visceral changes

Severe thoracic deformity deforms the lungs. Due to alveolar atrophy, lung expansion is limited, excessive tension in the lungs causes obstruction of the circulatory system, and severe cases can cause pulmonary heart disease.

an examination

Related inspection

Bone MRI examination of bone marrow

Most adolescent idiopathic scoliosi (AIS) patients can live normally. In some cases, the progression of AIS scoliosis is often accompanied by decreased lung function and back pain. If the chest bend is greater than 100°, the forced vital capacity usually drops to 70% to 80% of the expected value. Decreased lung function is usually secondary to restrictive lung disease. If severe scoliosis impairs lung function, the patient may die of pulmonary heart disease in the early stage. According to some scholars, the mortality rate of patients with severe scoliosis is twice that of the general population, and the risk of death in smoking patients is increased. The incidence of intermittent back pain in patients with moderate scoliosis (40° to 50°) is approximately the same as in the general population. The incidence of severe lumbar scoliosis is high, and the incidence of apical vertebrae is significantly higher. .

Differential diagnosis

(1) Congenital scoliosis: due to abnormal development of the spine embryo, the disease is earlier, most of which is found in infants and young children. The pathogenesis is structural abnormality of the spine and imbalance of spinal growth. The differential diagnosis is not difficult. X-ray film can detect structural deformities in the spine. Basic malformations can be divided into three types:

1. Spinal formation disorders, such as hemi-vertebral bodies;

2, poor spine segmentation, such as unilateral unsectioned bone bridge;

3, mixed type. If the conventional X-ray film is difficult to identify, CT can be used.

(B) neuromuscular scoliosis: can be divided into neurological and myogenic, the former includes cerebral palsy of upper motor neuron lesions, syringomyelia and other cerebral palsy of lower motor neuron lesions. The latter includes muscular dystrophy, spinal muscular atrophy and the like. The pathogenesis of this kind of scoliosis is caused by the loss of the nervous system and muscles to control the regulation of the balance of the spine. The cause of the disease often needs careful clinical examination to detect, sometimes it requires nerve-electromyography or nerve-muscle biopsy. To be able to confirm the diagnosis.

(C) neurofibromatosis complicated by scoliosis: neurofibromatosis is an autosomal hereditary disease caused by a single genetic disease (but 50% of patients are from genetic mutations), 2% to 36% of patients with Scoliosis. Diagnosis can be made when the clinical compliance with the following two or more criteria.

1. Patients before maturity have more than 6 skin coffee spots with a diameter of 5 mm or more or a diameter of more than 15 mm after maturity;

2. Two or more forms of neurofibromatosis or plexus neurofibroma;

3. Freckles in the axillary or groin skin;

4. Optic glioma;

5. Two or more scleral hamartomas (Lisch nodules;

6, bone lesions, such as long cortical thinning;

7, family history. The X-ray features of the scoliosis associated with the patient can be similar to idiopathic scoliosis, or can be expressed as "dystrophic" scoliosis, that is, the angulated type of posterior process of the short segment, the spine is severe Rotation, vertebral body depression, etc., such scoliosis continues to progress, treatment is difficult, and the incidence of pseudoarthrosis is high.

(D) mesenchymal lesions complicated by scoliosis: sometimes Marfan syndrome, EhlerS-Danlos syndrome, etc. can be based on scoliosis, detailed physical examination can find other clinical symptoms of these diseases, such as ligament relaxation, chicken breast or funnel Chest and so on.

(5) Osteochondral dystrophy complicated by scoliosis: such as various types of strains of the genus, spinal myelodysplasia.

(6) Metabolic disorders associated with scoliosis: such as various types of mucopolysaccharidosis, homocystinuria and the like.

(7) "Functional" or "non-structural" scoliosis: This type of scoliosis can be caused by irregular posture, nerve root stimulation, and unequal length of the lower limbs. If the original cause can be removed early, the scoliosis can be eliminated by itself. However, it should be noted that a small number of adolescent idiopathic scoliosis may be mistaken for "correct posture" in the early stage because of the small degree, so the so-called "functional" scoliosis before puberty should be closely followed.

(8) Scoliosis for other reasons: such as radiotherapy, extensive laminectomy, infection, and tumor can cause scoliosis.

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