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20 lipca 2020

Three-dimensional diagnosis of scoliosis - the Zebris computer system for examining body posture.

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Scoliosis is a general term for a group of diseases caused by a change in the shape and position of the spine [6]. According to the Scoliosis Research Society, scoliosis is bending of the spine with the Cobb angle of at least 10° measured on the radiograph [13,19,20]. The condition, which is colloquially called the lateral abnormal curvature of the spine, is actually a three-dimensional deformation [1,4,17].

POLECAMY

Monitoring adverse changes in the structure and posture of the body is an important element of assessing health condition. Measuring the Cobb angle on the radiograph of the spine is the basic way to evaluate the size of scoliosis. However, due to exposure to radiation, the examination cannot be freely repeated which prevents the patient from the possibility of ongoing monitoring [7,21]. The three-dimensional nature of scoliosis suggests a need for specific diagnostics including the evaluation in all three planes.

The Zebris CMS10 apparatus is a modern device for a non-invasive examination of body posture [15]. The use of 3D technology in the assessment of the trunk allows for precise analysis of individual problems in all the planes [10]. The Zebris system is as a useful tool for evaluating the shape of spinal curvatures and parameters describing body posture disorders [3,9,18,23].

The components of the Zebris CMS10 system include: a stand with a receiver, measurement sensors, an ultrasonic pointer consisting of two markers and a triple reference marker - a pelvis belt [24]. The measuring systems provide information about the position of the spine in the three planes. The measurement method is based on determining spatial coordinates for anatomical points located on the patient's body by measuring a delay between the emission of an ultrasonic pulse and its reception by measuring sensors [22].

A posture examination is performed in the standing habitual position and is based on indicating strategic anatomical points using the pointer; the points applied to the computer screen are used to create a three-dimensional spatial image of the patient's silhouette. After completing the examination, the software forms a test protocol for the assessment of individual posture parameters in the form of a report.

The computer analysis includes the following: measurement of the angle of kyphosis and lordosis of the spine, scoliosis deformation and lateral tilt of the trunk. Values of the angles are determined between the vectors running through each of the two adjacent points thus determined. The values are calculated on individual sections of the spine line which corresponds to angle positioning in individual segments [4]. Total angles are calculated using the sum of individual angles for three given vertebrae [24].

According to the Dubousset's concept, too long anterior column in relation to the posterior columns is the main morphological defect in idiopathic thoracic scoliosis. This condition can reduce physiological thoracic kyphosis, and even cause lordotization [2]. Szczygieł et al. [16] point out to a relationship between the angle of spinal curvature in the frontal plane and the size of physiological curvatures of the spine. A larger angle of scoliosis causes a reduction in thoracic kyphosis and lumbar lordosis. On the other hand, children with scoliosis undiagnosed at the age of 11-13 and examined using the Zebris apparatus have a tendency to bigger thoracic kyphosis and lumbar lordosis [22,23]. The same position of the spine was observed in women by Zwierzchowska et al. [25]. These publications indicate a tendency for smaller thoracic kyphosis and lumbar lordosis in children with scoliosis, and the opposite positioning in children without scoliosis. In the research evaluating body posture parameters in children and adolescents carried out by Szczygieł et al. [16], the following parameters were obtained: for scoliosis the Cobb angle of 25-50°, the angle of kyphosis 23.9 and the angle of lordosis 31.17. The authors also indicate that studies of the angle of spinal curvature and sacrum being conducted in the Polish population lack appropriate standards.

In Poland, depending on the measuring method, the ranges of thoracic kyphosis for children aged 11-13 years are as follows: electrogoniometer 20.1-38.9; photogrammetric method 152.3-165.3 and computer examination using the Zebris system 35.8-57.8 [22]. Analyzing the parameters of body posture examination using projection moiré, Mrozkowiak and Strzecha [12] observed discrepancies in the standards for thoracic kyphosis and lumbar lordosis and the lack of norms for comparison of measurement results. Literature discrepancies in standards for spinal curvatures in the sagittal plane were also reported by other authors [5,11].

According to Kotwicki and Śliwiński [8], secondary distortions in primary single-arch thoracic scoliosis (Th5-12) include excessive local kyphotisation of the proximal thoracic spine (Th1-5) and local kyphotisation of the thoracic-lumbar junction of the lumbar spine. Głowacki et al. [2] observed segmental lordotization of the lower thoracic spine in thoracic scoliosis with the low angular value combined with stiffening in the Adams test.

Values of the angle of thoracic kyphosis and lumbar lordosis are presented in the literature as a segment of the circle (convexity and concavity), however a degree of bending of the upper and lower parts of the curvature may be different [14]. Because the Zebris CMS10 system measures the value of thoracic kyphosis from the height of Th1 to Th12, it is worth considering the measurement of thoracic kyphosis at two or three levels of the thoracic spin...

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Przypisy

    Sandra Trzcińska

    dr; Kierownik Fizjoterapii Ośrodka Ortopedyczno – Rehabilitacyjnego dla dzieci i młodzieży w Chylicach Mazowieckiego Centrum Rehabilitacji STOCER w Konstancinie – Jeziornie. Specjalista w dziedzinie fizjoterapii. Absolwent Akademii Wychowanie Fizycznego w Katowicach wydziału Fizjoterapii. W kompleksowym podejściu do zawodu fizjoterapeuty łączy zarówno aspekty praktyczne jako certyfikowany terapeuta licznych szkoleń, jak i merytoryczno – naukowe zdobyte jako wykładowca-asystent kinezyterapii i terapii manualnej Śląskiej Akademii Medycznej w Katowicach. Ukończyła szereg szkoleń z zakresu diagnostyki i leczenia funkcjonalnego narządu ruchu:: leczenie skolioz metodą FED i Lehnert – Schroth, terapię manualną Schmeitzky, wg koncepcji Kaltenborna- Evjentha oraz metodę strukturalnej osteopati i chiropraktyki dr Ackermanna. Certyfikowany terapeuta metody McKenzie, PNF, Kinesiology Taping, SET i Neurac 1. Ukończyła także cykl szkoleń z zakresu: diagnostyki różnicowej, obrazowej RTG i MR oraz leczenia dysfunkcji narządu ruchu. Laureat nagrody przyznanej przez Marszałka Województwa Mazowieckiego za osobisty wkład na rzecz ochrony zdrowia.

    Prelegent wielu konferencji, szkoleń oraz warsztatów dotyczących leczenia wad postawy i skolioz. Członek Komisji Naukowych Konferencji oraz autor licznych artykułów naukowych z zakresu diagnostyki i leczenia dysfunkcji narządu ruchu.

     

    Anna Kuśmirek

    mgr; Ośrodek Ortopedyczno- Rehabilitacyjny dla dzieci i młodzieży, Mazowieckie Centrum Rehabilitacji STOCER