| Sažetak | U adolescentnoj fazi, koja je obilježena naglim rastom i razvojem, djeca su podložna razvoju deformacija kralježnice. Deformacije kifoze, lordoze i skolioze koje su opisane u ovom radu uglavnom su idiopatske što znači da im uzrok nije poznat. Adolescentne skolioze zahvaćaju 2-3% opće populacije. Najčešća patološka adolescentna kifoza odnosno Scheuermannova bolest zahvaća 1-8% opće populacije dok su patološke lordoze nešto rjeđe. Pretpostavlja se da je najvažniji rizični čimbenik razvoja deformacije nasljedni genetski faktor, a mogući su razlozi još ustaljeno nepravilno držanje, psihološka i patološka stanja, urođeni defekti, usporeni ili nejednaki rast, smanjena mišićna snaga, nedostatak minerala u prehrani i drugo. Gledano sa strane normalna kralježnica ima četiri pravilna zavoja, cervikalnu lordozu, torakalnu kifozu, lumbalnu lordozu i sakralnu kifozu. Intervertebralni diskovi i ligamenti kralježnici daju pasivnu stabilnost dok mišići omogućuju aktivnu stabilnost. Prilikom razvoja deformacija ta stabilnost se narušava i posljedično tome može doći do problema sa srcem i plućima, neuroloških ispada, poremećaja cirkulacije. Pravovremenom dijagnostikom i početkom terapije smanjuje se šansa za povećanje deformacije. Iako postoje neinvazivne metode dijagnostike, poput površinske topografije, u praksi je i dalje zlatni standard za dijagnostiku deformacija kralježnice RTG. RTG-om se također provjerava stupanj okoštavanja ilijačne kosti i otvorenost ili zatvorenost radijalne epifizne hrskavice. Prestankom koštanog rasta nestaje fleksibilnost tijela te je puno teže doći do valjanih rezultata terapije. Stoga je bitno educirati dijete i roditelje o planovima terapije, mogućnostima napretka te naglasiti upornost i konzistentnost kao ključni dio terapije. Kirurška intervencija se primjenjuje u slučaju težih deformacija, a najčešće korištena je konzervativna terapija u smislu tjelovježbe i ortoza. Fizioterapijska procjena se sastoji od antropometrijskih mjerenja (visina, težina, duljina ekstremiteta, itd.), procjene mišićne snage i izdržljivosti, ravnoteže, koordinacije i propriocepcije. Procjenjuje se opseg pokreta te plućni kapaciteti i frekvencije disanja. Fizioterapeut uzima u obzir ritam hoda i način držanja tijela tokom hoda. U proces fizioterapije ubrajaju se istezanja skraćenih grupa mišića, vježbe motoričke kontrole pokreta, vježbe disanja i jačanje muskulature te manualna masaža za opuštanje napete muskulature. |
| Sažetak (engleski) | In the adolescent phase, which is characterized by rapid growth and development, children are susceptible to the development of spinal deformities. The deformities of kyphosis, lordosis, and scoliosis described in this paper are mostly idiopathic meaning that their cause is unknown. Ado-lescent scoliosis affects 2-3% of the general population. The most common pathological adoles-cent kyphosis or Scheuermann's disease affects 1-8% of the general population, while pathological lordosis is somewhat rarer. It is assumed that the most important risk factor for the development of deformity is a hereditary genetic factor, and possible reasons are still irregular posture, psycho-logical and pathological conditions, birth defects, slow or uneven growth, reduced muscle strength, lack of minerals in the diet and more. From a side profile, the normal spine has four regular bends, cervical lordosis, thoracic kyphosis, lumbar lordosis, and sacral kyphosis. The intervertebral discs and ligaments of the spine provide passive stability while the muscles provide active stability. During the development of deformities, this stability is disturbed and, as a result, heart and lung problems, neurological outbursts, and circulatory disorders can occur. Timely diagnosis and the beginning of therapy reduce the chance of increasing the deformity. Although there are non-inva-sive diagnostic methods, such as surface topography, in practice the gold standard for diagnosing spinal deformities are still X-rays. The reason for this may be insufficient financial resources or the habit and reliability of radiological examination. X-rays also check the degree of iliac bone ossification and the openness or closure of the radial epiphyseal cartilage. With the cessation of bone growth, the adaptability of the body to change disappears and it is much harder to get valid therapy results. Therefore, it is important to inform the child and parents about treatment plans, opportunities for progress and emphasize persistence and consistency as a key part of therapy. Surgical intervention is applied in case of severe deformities, and the most applied is conservative therapy using exercise and orthoses. Physiotherapy assessment consists of anthropometric meas-urements (height, weight, limb length, etc.), assessment of muscle strength and endurance, bal-ance, coordination, and proprioception. Movement range and pulmonary capacity and respiratory rate are assessed. The physiotherapist takes into account the rhythm of walking and the body pos-ture during walking. The process of physiotherapy includes stretching of shortened muscle groups, motor control exercises, breathing exercises and muscle strengthening, and manual massage to relax tense muscles. |
