ShYoYERMANNA - MAU the DISEASE
(H. W. Scheuermann, the Danish radiologist, 1877 — 1960; K. Mai, it is mute. surgeon-orthopedist, 1890 — 1958; synonym; an osteochondropathic kyphosis, a kyphosis of teenagers, a kyphosis of uche-nicknames-journeymen, a youthful kyphosis, Shmorl's disease, a youthful apophysitis of vertebrae, an apophysitis of bodies of vertebrae) — an osteochondropathy of apophyses of chest vertebrae which main display is formation of a kyphosis. The VII—X vertebrae are surprised preferential.
The disease is described by Sheyerman-nom in 1921 and May in 1924.
Its etiology is finally not found out. Assume that in developing of a disease play a role an injury, disturbance of blood circulation, dysfunction of closed glands. There is also a point of view that Sh. — M. it is necessary to carry to group of osteodysplasias (see). Diseases are the cornerstone distro-ficheski-necrotic changes of apophyses of vertebrae, disturbance of ossification of epiphyseal plates and dystrophy of intervertebral disks with formation of protrusions of a cartilage in spongy substance of bodies of vertebrae — Shmorl's hernia (see Sh gauze small knots). At the raised load of the struck department of a backbone typical deformation with formation of a kyphosis develops (see). In development of a disease there are reparative processes to recovery of structure of a bone or signs of the deforming spondylosis appear (see).
III. — M. reveal at children's and teenage age, a thicket at boys of 11 — 17 years; duration of a disease of l1^ — 2kh/2 years and more. At the beginning of a disease pain in a backbone, increased fatigue of muscles of a back, a hypomyotonia appears (see the Tone). In process of strengthening of a compression of the affected vertebras of pain amplify, typical arc-shaped deformation of chest department of a backbone camber of a kzada forms (see fig. 3 to St. Kyphosis, t. 10, Art. 363); can appear in hard cases nevrol. the frustration connected with a prelum of roots of a spinal cord and nerves.
Sh.'s diagnosis — M. the wedge, and rentgenol is based on typical. signs. The X-ray analysis of chest department of a backbone is carried out in two projections. In a direct projection the research is made in position of the patient sitting or standing at the speeded-up shallow breathing that allows to receive more sharp image of each vertebra; in a side projection — in position of the patient lying, also at the speeded-up shallow breathing. Rentgenol. a picture of a backbone at Sh. — M. it is very characteristic: bodies of several average and lower chest vertebrae have more or less expressed wedge-shaped form; usually front sites of bodies of vertebrae are lower back, platforms their uneven, wavy, height of intervertebral disks is not identical (fig.). About 8 vertebrae can be involved in process. Extent of their deformation can fluctuate from scarcely noticeable to sharply expressed.
Fig. The roentgenogram of chest department of a backbone at Sheyermann's disease — May (a side projection): typical deformation of a backbone; bodies of chest vertebrae have the wedge-shaped form, platforms their uneven, wavy, height
of intervertebral disks is not identical.
If growth of a backbone is not finished, then at rentgenol. a research in dynamics progressing of typical deformation of vertebrae and increase in a kyphosis is defined. Therefore final judgment of extent of deformation of separate vertebrae and all backbone can be made only after growth of a backbone ends. The wedge-shaped shape of bodies of vertebrae will remain for the rest of life. Platforms of bodies of vertebrae also remain uneven with wavy contours, intervertebral disks are lower than norm, are uneven on height. Sometimes insignificant wedge-shaped deformation of bodies of vertebrae can be found already in 10 — 11-year age. This deformation develops in the period of active growth of the child and especially at final formation of a backbone at the age of 14 — 18 years quicker.
392 CERVICAL PLEXUS
the Differential diagnosis carry out with a disease to Kalva (see Kaljva a disease), osteomyelitis (see), general diseases of a skeleton (see the Bone, pathology). The disease to Kalva is revealed at children of earlier age; one vertebra is surprised usually.
At osteomyelitis the expressed destruction of a bone tissue radiological decides on sequestration.
Sick children, irrespective of age and a stage of a disease, should sleep on a hard bed. The general and rekliniruyu-shchy gymnastics (see the Kyphosis), hydrotherapeutic procedures with warm water and an alternating douche, walks and outdoor games on air, swimming, skiing, pipits are recommended. Allow children stay in summer camps, participation in sports, campaigns, but overloads shall be excluded. At persistent dorsodynias, secondary the shell to - reshkovom a syndrome, restriction of function of a backbone it is better to carry out treatment in a hospital. Extension (see), physical therapy, drug treatment is shown (vitamins of group B, prozerin, vasodilating pharmaceuticals), the reflexotherapy (see), massage (see) to lay down. gymnastics (see. Physiotherapy exercises as method of treatment).
The forecast at timely begun and systematic treatment favorable. In hard cases and at insufficient treatment constant megalgias in spin are noted, there is a radicular syndrome more often.
Correctly carried out treatment at early stages of a disease prevents development of sharply expressed deformation of a backbone. Bibliography: Clinical rentgenoradtso-
a logiya, under the editorship of G. A. Zedgenidze, t. 3, M., 1984; To about with and N with to and I am N. S. Disturbances of development of the bone and joint device, D., 1966; Reynberg S.A. Radiodiagnosis of diseases of bones and joints, book 2, page 294, M., 1964; Rokhlin D. G. Radiodiagnosis of diseases of joints, L., 1941; Svintsov A. P. and And yes l-masova E. A. Differential diagnosis of an osteochondropathy of a backbone at children and teenagers, Ortop. and herbs mats., No. 5, page 43, 1980; Tager I. L. and Dyachenko V. A. Radiodiagnosis of diseases of a backbone, M., 1971; Chaklin V. D. and And balma owl E. A. Skolioz and kyphosis, M., 1973; Fried K. Die keilformige Variation der Wirbelkorperform, Radiol. Diagn. (Berl.), Bd 4, S. 85, 1963; M an u C. Die Kyphosis dorsalis adolescentium im Pvahmen der Epiphysen-und Epiphysenlinienerkrankun-gen des Wachstumsalters,
Z. orthop. Chir., Bd 46, S. 145, 1924; Scheuermann H. Kyphosis dorsalis juvenilis, ibid., Bd 41, S. 305, 1921; it,
Roentgenologic investigations on development and course of juvenile kyphosis, Hos-pitalstidende, v. 77, p. 85, 1934;
S with h m about r 1 G. Die Pathogenese der juve-nilen Kyphose, Fortschr. Rontgenstr., Bd 41, S. 359, 1930.
E. A. Abalmasova; P. L. Zharkov (rents.).