KYPHOSIS

From Big Medical Encyclopedia

KYPHOSIS (kyphosis; the Greek kyphos bent, curve + - osis) — a rachiocampsis in the sagittal plane camber of a kzada. Distinguish physiological (normal) and pathological To.

Fig. 1. The side roentgenogram of chest department of a backbone with a physiological kyphosis.

Fiziol. To., occupying all departments of a backbone, it is observed only at newborns and children of the first 2 — 3 months of life. In process of growth of the child fiziol. To. remains only in chest (fig. 1) and sacral departments. At the age of 2 — 3 months in cervical department of a backbone, and in 10 — 12 months — in lumbar department bends of a kpereda appear — lordosis (see).

Patol. To. — one of defects of a form backbone (see). It is morfol. and a wedge, a symptom of many diseases oporno - the motive device. In orthopedics the term «kyphosis» is meant, as a rule, as a pathological kyphosis.

Etiology

Fig. 2. Macrodrugs of backbones with the inborn kyphosis caused by an inborn wedge-shaped vertebra — it is specified by shooters.

To. can be inborn and acquired. Inborn To. it is caused by existence of an inborn wedge-shaped vertebra or semi-vertebra (fig. 2). It is observed as well at other anomalies of a backbone, napr, at concrescense (union) of bodies of vertebrae.

To the taken forms To. carry the following: To. at a disease to Kalva (see. to Kalva disease ), at Sheyermann's disease — May (see. Sheyermanna-Mau disease ), at Kyummell's disease (see. Kyummellya disease ), at rickets (see), tubercular spondylitis (see), Bekhterev's diseases (see. Bekhtereva disease ), at destruction of a body of a vertebra osteomiyelitichesky or tumoral process, To. as a result of a compression fracture of bodies of vertebrae, To. later laminectomies (see). Allocate senile (involute) To. owing to wedge-shaped deformation of osteoporotichny bodies of vertebrae. In some cases it is not possible to establish an etiology of a kyphosis — an idiopathic form.

Clinical picture

Clinical picture K. it is characteristic — the arc-shaped or ugloobrazny rachiocampsis camber of a kzada, in the expressed form — in combination with deformation of a thorax and reduction of height of a trunk. Localization, a form and expressiveness To. depend on features patol, the process which caused K.

Tak, at Sheyermann's disease — May of kyphotic deformation is exposed chest department of a backbone, the curvature has the arc-shaped form. At a tubercular spondylitis To. develops in chest or lumbar department of a backbone, deformation happens ugloobrazny — in the form of a sharp-pointed hump. Degree of manifestation of deformation can be various: from the «dot» hump caused by a vystoyaniye of one acantha to «huge», with an acute angle of curvature of a backbone and rough deformation of the last.

Distinguish unstable, mobile (i.e. korrigiruyemy), and the fixed, not mobile kyphosis. An example of mobile deformation is paralytic, and to a certain extent and youthful To. because of Sheyermann's disease — May; the fixed, permanent deformation happens at senile To. and at Bekhterev's disease. To. can be progressing, quickly developing, despite treatment, and not progressing, slow development to-rogo stops as a result of conservative treatment. At a combination To. with scoliosis (see) that especially often happens at a dysplastic rachiocampsis, speak about a kyphoscoliosis.

Inborn To. it is, as a rule, observed in chest department of a backbone. Deformation comes to light soon after the birth and does not give in to correction or change at a postural change of a body (fixed To.).

Fig. 3. The patient having Sheyermann's disease — May: the arc-shaped kyphosis as a result of an osteochondropathy of apophyses of bodies of vertebrae.

At a disease to Kalva, Sheyermann's disease — May in chest department of a backbone arises unstable, the arc-shaped To. — so-called youthful To., which develops usually at the age of 11 — 17 years (fig. 3), a thicket at boys.

At Kyummell's disease it is observed unsharply expressed the arc-shaped To., most often in chest department of a backbone.

Rachitic To. in former times met considerably more often: it is shown at infantile age when the child begins to sit. In this case To. usually covers all departments of a backbone, happens the arc-shaped, unstable, completely improves in a prone position.

Fig. 4. Some options of a kyphosis depending on localization of tubercular process in a backbone: 1 — verkhnegrudny; 2 — midthoracic; 3 — nizhnegrudny.

Kyphotic deformation of a backbone is typical for a tubercular spondylitis. The vertebra which is most affected with process is displaced kzad, the overlying department of a backbone bends forward, at the same time at various levels of chest department of a backbone the ugloobrazny hump (fig. 4) develops.

At Bekhterev K. disease has the arc-shaped form, it is fixed, arises at the age of 30 — 40 years, is much more often at men. At first deformation develops in chest department; in a final stage of a disease of spin of the patient forms a continuous arch from a base of skull to a sacrum.

At To., caused by destruction of a vertebra osteomiyelitichesky process (see. Osteomyelitis ), symptoms of an acute purulent inflammation prevail, To. more often ugloobrazny, in a chronic stage fistulas are formed.

For clinic To., the backbone caused by primary or metastatic tumors, pains are characteristic, To. develops in a late stage — at destruction and a compression of a body of a vertebra, neurologic disturbances often join.

To. at a considerable traumatic compression of a body of one vertebra has the ugloobrazny form. At a fracture of several vertebras, even at an insignificant compression of each of them, the arc-shaped K. Takoy K. can be formed has the fixed character.

Fig. 5. The scheme of the side roentgenogram of lumbar department of a backbone with the kyphosis formed after traumatic dislocation of a backbone and an expanded laminectomy (shooters specified vertebrae with the resected handles).

To. can develop as a result of an expanded laminectomy with a resection of handles and joint shoots of vertebrae (fig. 5). As a result of the weakened back elements of vertebrae the hump even in lumbar department of a backbone where normal there is a lordosis sometimes develops.

Senile, or involute, To. develops as a result of dystrophic changes of intervertebral disks and reorganization of a bone tissue of bodies of vertebrae. There is it against the background of the expressed osteoporosis of a backbone, and a body of vertebrae at insignificant injuries, and in some cases and without them get a wedge-shaped form, and intervertebral disks become thinner. Such kyphosis has the arc-shaped form.

Complications are observed at the severe progressing forms K. Formation To. leads to narrowing of the vertebral channel, especially at top of a hump, at the expense of a so-called wedge of Urban formed by the remains of the destroyed bodies of vertebrae. The compression of roots develops at first, further there can be paresis and paralyzes of the lower extremities, dysfunction of pelvic bodies. Nevrol, spinal and radicular frustration are seldom connected with a mechanical prelum of the corresponding nervous educations at K. Chashche the secondary peripachymeningitis and a cicatricial prelum of a spinal cord and its vessels takes place.

it is more correct to tell the diagnosis not about diagnosis To., and about recognition of diseases or states, one of symptoms of which is To. Major importance in diagnosis To. along with clinical has rentgenol. research. Pictures make lying, in two projections — perednezadny and side. Make pictures for identification of degree of mobility of a backbone standing and lying, and also at an inclination of a kpereda and a kzada.

Fig. 6. Side roentgenogram of verkhnepoyasnichny department of a backbone of the boy of 12 years: back wedge-shaped L2 a vertebra is specified by an arrow
Fig. 7. Side roentgenogram of lower chest and verkhnepoyasnichny departments of a backbone of the child of 14 years: a kyphosis owing to the inborn Th11-12 and L1-2 block of vertebrae (are specified by shooters).

Radiodiagnosis inborn To. at children 2 years are younger it is complicated since at this age there is no full ossification of bodies of vertebrae yet. At later age the angular rachiocampsis and existence of a wedge-shaped vertebra (fig. 6) accurately are defined. At concrescense of bodies of vertebrae in a picture the union of several bodies among themselves, generally in front departments, and a kyphotic rachiocampsis (fig. 7) is visible

Fig. 8. The side roentgenogram of chest department of a backbone at a youthful kyphosis: wedge-shaped deformation of bodies of Th6-7 of vertebrae (are specified by shooters), the secondary deforming spondylosis.
Fig. 9. Side roentgenogram of chest department of a backbone of the 72-year-old woman: the strengthened kyphosis of chest department, the increased transparency of bodies of vertebrae (osteoporosis).

At Sheyermann's disease — May is characteristic consolidation of the affected vertebras. In late stages of this disease the secondary deforming spondylosis (fig. 8) develops. Senile To. radiological it is expressed by the arc-shaped curvature of the lower half of chest department (fig. 9). The curvature can extend to an upper half of chest department and to upper lumbar vertebrae. This look To. it is combined with the expressed widespread osteoporosis (see), and it is frequent also with deforming spondylosis (see). Bodies of vertebrae on the side roentgenogram are quite often represented flattened, it is more in their front departments. Involute changes at senile To. occur also in intervertebral disks that on the roentgenogram is displayed in the form of narrowing of intervertebral spaces.

At Bekhterev's disease the arc-shaped kyphosis is only a component rich rentgenol, symptoms of this disease (see. Bekhtereva disease ). Radiodiagnosis at a tubercular kyphosis — see. Spondylitis .

Treatment

Therapeutic actions for an occasion To. are a component of complex treatment of the basic disease which caused kyphotic deformation of a backbone.

At mobile To. effectively conservative treatment: to lay down. physical culture, massage of muscles of a back, physiotherapeutic procedures, a flat bed or a plaster bed with the rekliniruyushchy roller; sometimes appoint a corset.

Fixed To. in some cases it is possible by extension and corrective exercises to transfer to a mobile form. However it is not possible to hold the reached correction without operation practically.

At fresh To. a tubercular etiology Fink's method is effective: constant pressure upon a top of a hump wadded and gauze laying in a plaster bed. The method is applied preferential to treatment of children with initial forms of a tubercular spondylitis.

Fig. 10. Some options of exercises at treatment of a kyphosis: 1 — lifting on socks with a gymnastic stick on shovels; 2 — extension of a backbone with various position of hands; 3 — extension of a backbone in chest department by means of a gymnastic stick; 4 — extension of a trunk with dumbbells in the hands divorced in the parties; 5 — exercise «podlezaniye» in genucubital situation; 6 — exercise in balancing with a ball; 7 — exercise — a pose in front of the mirror for self-posture correction; 8 — correction of a kyphosis situation on a wedge-shaped support.

In treatment To. is of great importance to lay down. physical culture (fig. 10). Correction To. by means of special exercises of LFK it is shown at its many forms, except for kyphotic deformation because of destructive processes (an active tubercular spondylitis, osteomyelitis or a tumor). Physical. exercises at To. are directed to correction of deformation, strengthening of muscles of a back, development of orthostatic position of a body and balance between fiziol, kriviznam of a backbone, improvement of function of the respiratory device, and also fortifying influence.

Exercises carry out, as a rule, lying, i.e. during the unloading of a backbone. The following types physical are shown. exercises: 1) extensions of a trunk («intense flexures»); 2) the exercises mobilizing a backbone in chest department; 3) the exercises extending a backbone; 4) the exercises which are expanding a thorax and stretching retragirovanny pectoral muscles; 5) the exercises developing a correct posture. Mobilization of chest department of a backbone is reached by means of the exercises which are carried out in situation on all fours; use exercises in crawling, and also on site the podlezaniye type. With extension of a backbone

exercises on wall bars (a so-called visa) are among exercises.

For development of a correct posture use exercises in balancing with the straightened trunk — standing still also during the walking with a ball on the head, and also exercises — the poses promoting «self-correction» with visual control in front of the mirror.

Lech. physical culture at To. combine with manual massage of muscles of a back and occupation nek-ry sports. Swimming on spin since it promotes correction To is especially shown., to improvement of function of breath, strengthening of muscles of a back.

Result, the achieved physical. exercises, is set «by treatment situation», i.e. short-term (15 — 20 min.) preservation sick provisions of the reached correction To. The prone position on a breast on wedge-shaped, a support from a tree or on a dense pillow is for this purpose used, or lying on spin with the helpless gesture made in the parties on a small cotton roll in the interscapular area.

Fig. 11. Diagrammatic representation of a segmented vertebrotomiya: 1 — wedge-shaped excision of intervertebral disks with bone switching plates, adjacent to them (the dotted line designated borders of excision); 2 — a backbone after a segmented vertebrotomiya; 3 — a backbone after implementation of bone transplants in the formed defects between bodies of vertebrae
Fig. 12. Diagrammatic representation of a vertebrektomiya: 1 — a kyphosis owing to a tubercular spondylitis (the white dotted line designated borders of excision of the affected vertebras); 2 — a backbone after removal of the most affected vertebras (in black color the remains of cavities are designated); 3 — a backbone after reclination (in black color the remains of destructive cavities are designated).

The first attempts of operational treatment ugloobrazny To. treat the end of 19 century and belong to Khalo (J. - F. Calot) who with a tubercular spondylitis applied stage reclination (wedging) by a section of disks at top of deformation to treatment of patients. Modern operational correction To. comes down also to reclination of a backbone. However at the same time carry out wedge-shaped excision of several intervertebral disks on an arch of deformation or one affected vertebra at top of deformation (fig. 11 and 12). Make also fixing of the operated segment of a backbone in the straightened situation with the help of bone transplants or metal designs. In all cases after operation appoint more or less long bed rest and carrying a corset.

The forecast at not progressing To. favorable. The progressing forms at irregular, unsystematic treatment result in disability.

For prevention To. at children apply physical. exercises in a complex about a dignity. - gigabyte. actions (a dream on a flat bed, the correct pose at studies, rational educational furniture, etc.) in combination with active exercises and sport.



Bibliography Abalmasova E. A. and Luzina E. V. Inborn deformations of a musculoskeletal system and reason of their origin, page 70, Tashkent, 1976; Kazmin A. I. and Fishchenko P. Ya. Surgical treatment of patients with a kyphosis, in book: Malformations of top and bottom extremities, under the editorship of P. Ya. Fishchenko, page 113, L., 1972; To and Friday of e of l and A. F N. Recovery treatment (physiotherapy exercises, massage and work therapy) at injuries and deformations of a musculoskeletal system, page 237, M., 1969; Kornev P. G. Surgery of bone and joint tuberculosis, p.1 — 3, L., 1971; Medical physical culture, under the editorship of V. V. Vasilyeva, page 266, M., 1970; JI I am a N d r e with 3. A. A kyphosis at not - the blocked back wedge-shaped vertebrae at children and their operational treatment, in book: Patol, a backbone, under the editorship of P. Ya. Fishchenko, page 43, L., 1975; Makar about in M. S. Complex treatment of a kyphosis of a tubercular origin, M., 1972, bibliogr.; Movshovich. And. irits. A. Radiodiagnosis and principles of treatment of scoliosis, M., 1969, bibliogr.; Moshkov V. N. Active correction of deformations of a backbone and flat-footedness at children and teenagers, page 133, M., 1949; Tsivyan Ya. L. Operational treatment of humps, M., 1973, bibliogr.; Chaklin V. D. and Abalmasova E. A. Skolioz and kyphosis, M., 1973, bibliogr.; Orthopadisch-chirurgischer Operationsatlas, hrsg. v. M of Hackenbroch u. A. Y. Witt, Bd 3, Stuttgart, 1974; Scheuermann H. W. Kyphosis dorsalis juvenilis, Ugeskr. Laeg., Bd 82, S. 385, 1920.


I. A. Movshovich, B. H. Kleymenov; A. F. Kaptelin (to lay down. physical.), S. A. Sviridov (rents.).

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