Stand or not stand, sit or sit"

"I often do homework while lying on my stomach" "Shoulders are one high and one low"... Around us, we often hear parents describe their children's posture like this.

 In recent years, the problems of high and low shoulders, hunched back, head extension and even scoliosis have become more and more common among adolescents. Problems related to the spine health of children and adolescents have become a new prominent public health problem in my country.

Statistics show that the number of adolescent scoliosis patients in my country exceeds 5 million, and the number is increasing by 300,000 every year.

 "The summer vacation is approaching, because they are worried about their children's scoliosis, the number of parents who come to see a doctor and consult has increased significantly. Every winter and summer vacation is the peak period for scoliosis consultation and orthopedic surgery." Deputy Chief Physician Sein Fei said.

 Abnormal body posture and even scoliosis, why frequently disturb the healthy growth of young people?

It is very important to do a good job of prevention, but how to correctly understand and treat the disease when it occurs?

Reporter conducted an interview.

It is difficult to detect after the onset of "no pain or itching"

  "If it wasn't for a bulging bag on the back of the child when he bent over to pick up things, I would never have imagined that the child would have problems with the spine." Wang Nana, the parent of a second-grade student in a Beijing junior high school, said that the child has never expressed it in life or study. Uncomfortable or where the pain is, so neither she nor the child's father found any abnormality. Only after seeing the doctor did they know that the child was suffering from "idiopathic scoliosis".

  In medicine, scoliosis is often divided into structural scoliosis and non-structural scoliosis, and structural scoliosis is divided into congenital, idiopathic, neuromuscular and syndromic scoliosis.

"Structural refers to the change in the bony structure, and the curvature of the spine in the coronal plane, often accompanied by vertebral rotation." Xiao Bin, deputy chief physician of the spine surgery department of Beijing Jishuitan Hospital, pointed out that idiopathic scoliosis is a case in adolescents. more.

"The so-called idiopathic refers to 'unexplained'. Children and adolescents have two growth peaks, the first is 0 to 5 years old, and the second is puberty after the age of 10. During these two periods, the child's body grows Development is rapid, and the progression of this deformity becomes more pronounced with increasing height. Idiopathic scoliosis occurs mostly around puberty."

  "No pain or itching" is the first feeling many people feel about idiopathic scoliosis.

Compared with congenital scoliosis, the deformity appears earlier, and neuromuscular and syndromic scoliosis is often secondary to other diseases, and idiopathic scoliosis appears to be more insidious.

In the outpatient clinic, some children with scoliosis were found during the school physical examination, some were accidentally discovered when taking X-rays for other reasons, and some were found by parents, and the children themselves were seldom aware of their abnormal appearance.

  At the beginning, Wang Nana also thought similar to many parents. The child's illness may be related to academic pressure. It may be because the child's schoolbag is heavy, or he often leans on his waist and does his homework.

"This is not the case in reality. Incorrect posture and special habits will only cause non-structural scoliosis, which can be simply understood as 'pseudo scoliosis', which is not accompanied by abnormal bony structures." Xiao Bin said, if non-structural scoliosis Sexual scoliosis has not attracted enough attention from children and parents, especially in the rapid growth period of children, it may also develop into structural scoliosis.

  Since idiopathic scoliosis "cause unknown", what kind of children are more likely to be affected?

From the epidemiological survey results may be able to spy a thing or two.

The ratio of males to females with small degrees of scoliosis is 1:1 to 1:2, while the ratio of males to females with large degrees of scoliosis can reach 1:9, and there are significantly more girls than boys.

"Children with idiopathic scoliosis are generally thin, and there is no good explanation as to why the number of girls is higher than that of boys." Xiao Bin said.

  Seinfeld also said that although the specific reasons are still unclear, it is speculated that it may be related to the female estrogen receptor gene, as well as female growth peaks 1 to 2 years earlier than males, and female muscle strength is weaker and other factors.

  "Generally speaking, mild scoliosis has no effect on bodily functions, while moderate scoliosis generally has a more obvious appearance, while severe scoliosis not only has abnormal appearance, but also affects cardiopulmonary, digestive and other functions." Xiao Bin pointed out that scoliosis It may also bring about psychological problems of inferiority.

"Four horizontal and one vertical", forward bending experiment, to achieve early detection, early diagnosis and early treatment

  For early detection, early diagnosis and early treatment, since 2019, the national monitoring of common diseases and health influencing factors of students has included abnormal spinal curvature as a detection index.

  In daily life, it is not "untraceable" to observe whether the child's spine is scoliosis. Many doctors talk about using the method of "four horizontal and one vertical" to check: "four horizontal" means whether the two shoulders are seen from the back of the child. The same height, whether the lower angles of the two scapulae are the same height, whether the lumbar fossa is symmetrical, and whether the height of the iliac crest on both sides of the pelvis is the same; "one vertical" refers to whether the entire line connecting the spinous processes is inclined or deviated from the midline.

In addition to this, a very important and effective diagnostic method is to perform a forward flexion test.

  "The forward flexion experiment is to let the child's feet close together, knees straight, hands naturally drooping and bending over 90 degrees. Parents can check whether the two sides of the child's back are the same height from the back. If there is asymmetry between the two sides, it is called 'in medicine'. Razorback deformity' often indicates the presence of scoliosis, which requires further examination at the hospital." Seinfeld said that there are some early or mild scoliosis, and it may be difficult to judge when standing normally, and doing forward bending movements will appear more obvious.

  In the outpatient clinic, the doctor needs to use X-rays to determine the degree of scoliosis.

"Generally speaking, if the degree of scoliosis is above 25 degrees and below 45 degrees, and is in the growth phase and has growth potential, we recommend the treatment of scoliosis correction braces for children at this stage. If the degree is relatively small, Below 20 degrees, we recommend regular observation of these children, and some rehabilitation training can be done. If the degree is greater than 45 degrees, the appearance of deformity is obvious and the body is unbalanced, and some children will have a tendency to aggravate. In this case We recommend surgery." Xiao Bin said.

  The use of braces to treat scoliosis has a long history and is an effective alternative to surgery.

The general brace is corrected by the direction of the fulcrum force.

"It's like wearing an armor." Seinfeld explained that the brace is a "big hard shell" made of polymer plastic, which is customized according to the shape of the side bending. In order to achieve a better therapeutic effect, it needs to be worn for more than 22 hours a day, "this is not easy for children".

  Many parents have asked, can rehabilitation training be used instead of braces for treatment?

Xiao Bin said that if it is idiopathic scoliosis, brace treatment should be performed in accordance with the doctor's order. Rehabilitation training is an auxiliary treatment method, but it cannot replace braces.

For non-structural scoliosis, or postural abnormalities, adjustments can be made through symmetrical movements of the trunk, such as swimming.

  "After the occurrence of scoliosis, very few children's scoliosis angle can improve on their own. The conservative treatment effect we hope to achieve is to keep the children without significant progress during the rapid growth period. It is generally believed that the progression between the two examinations exceeds 5 degrees. , even if the side bend progresses; if it is greater than 10 degrees every year, intervention is required." Sein Fei believes that side bends below 10 degrees have little impact on life, and parents should not be overly worried and anxious, just regular observation and review.

  When a child's puberty growth peak has passed, the progression of scoliosis will basically slow down or stop, but it does not rule out the possibility of further aggravation of scoliosis that occurred in childhood after entering old age.

"It's not because of bone growth, but because of the aging of the intervertebral disc, osteoporosis and other reasons, the degenerative scoliosis has increased." Seinfeld said.

"The key to maintaining posture is not the bones, but the exercise of the core muscles"

  Ma Jun, director of the School Health Center of the Chinese Center for Disease Control and Prevention and director of the Institute of Child and Adolescent Health of Peking University, previously said: "Judging from the current screening results, more than 80% of scoliosis is relatively mild, and also It is postural, which can be solved through exercise or posture correction under the guidance of a professional doctor. The remaining ten percent need braces for correction, and only about 1% are to the extent that they need to be corrected by surgery.”

  After measuring the body posture of 12,638 primary and secondary school students in Beijing, Tianjin, Jiangsu, Liaoning, Guangdong and other places, the research team of the Institute of Sports Science of the State Sports General Administration found that 83.1% of children and adolescents had abnormal body posture, and 68.7% of children and adolescents had abnormal body posture. There are 2 or more abnormal body posture problems, including high and low shoulders, hunched back, and head forward.

  "Regardless of whether there is scoliosis, from the perspective of rehabilitation, the key to maintaining posture is not the bones, but the exercise of the core muscles. If the muscles of the neck, shoulder, back and waist are trained well, the muscle tension will naturally be easy to maintain the normal spine. Curvature." Seinfeld also emphasized the importance of physical exercise, "When studying at a desk, stand up for 5 to 10 minutes every hour. Long-term immobility in one position can easily cause muscle strain and hunched back. At the same time, teenagers should Scheduling the right time for outdoor activities every day can help build muscle, absorb calcium, and prevent myopia.”

  Regarding the problem of "high and low shoulders", Xiao Bin said that high and low shoulders will appear in scoliosis, but high and low shoulders are not necessarily caused by scoliosis, and most of them are postural.

"In life, you should maintain a good standing and sitting posture, use a backpack, and exercise with bilateral symmetry."

  In the process of preventing abnormal body posture of students, the role of schools and parents cannot be ignored.

  "Schools should purchase desks and chairs according to the proportion of students' height in the mid-to-late period to ensure that they are equipped in each class according to the actual needs of students, and the height of students' desks and chairs should be personalized every semester." Beijing. Guo Xin, director of the school health center of the Municipal Center for Disease Control and Prevention, said.

She also reminded parents to equip their children with desks and chairs that match their height, remind them to maintain the correct sitting posture, pay attention not to cross their legs, and accompany their children to strengthen physical exercise, such as swimming, playing ball, and hanging the horizontal bar.

"Parents are the guardians of their children, and they should be the guardians of their children's health."

  Nowadays, popular science activities about spinal health knowledge are gradually increasing, and some hospitals have set up special scoliosis clinics to diagnose and treat students with abnormal screening.

Some primary and secondary schools will also hold "experts into campus" spine health lectures to let students understand the knowledge of spine and scoliosis.

  "The prevention and control of scoliosis is a systematic project, which is inseparable from the efforts of all aspects. In addition to schools and families, the whole society should take action and strive to create "students-family-schools-education-health-sports". An integrated comprehensive prevention and control system for abnormal spinal curvature of students." Guo Xin said.

(Reporter Zhang Yun)