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"Тrauma" Том 16, №3, 2015

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Evaluation of the musculoskeletal system functional state in patients with different variants of the Scheuermann’s disease

Authors: Kolesnichenko V.A., Fischenko V.A., Dniprovska A.V.

Categories: Traumatology and orthopedics

Sections: Clinical researches

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Background. Evaluation of the musculoskeletal system functional state in patients with Scheuermann's disease allows to develop a selective program of physiotherapy and objectively evaluate the results of treatment.

Material and methods. Group A - patients with the classic form of the disease with Scheuermann kyphosis of the thoracic spine (n = 50); group B - patients with atypical variant of the disease with lumbar spine and flattening the physiological curves of the spine (n = 50). All male patients aged 18-24 years (mean age 20,6 ± 0,3 years).

Studied: 1) the mobility of the thoracic fnd lumbar spine in flexion with Schober’s method, range of motion in the hip joints; 2) the intensity of low back pain on a visual analog scale (VAS); 2) disability index (ODI) as a result of back pain with Oswestry Disability Questionnaire, version 2.0; 3) the level of anxiety and fear associated with the anticipation of pain (PASS), on a scale of Pain and Anxiety Symptoms Scale - 20; 3) the thoracic kyphosis and the lumbar lordosis magnitude was measured in the lateral view thoracic and lumbar spondylograms standing by method Cobb; 4) gait temporal and spatial parameters was studied on mat GAITRite (CIR Systems Inc. Clifton, NJ 07012).

During the statistical research we used the t-criteria (Student’s method), during the analysis the method of  Pearson was used.  

Results. It was found that patients with the Sheurmann’s disease both forms a change in the sagittal contour of the spine to the development of muscle imbalance was revealed. In patients both groups showed limited mobility of the thoracic and lumbar spine and hip reduction excursions in the sagittal and frontal planes. Structural and functional changes in the lumbar-pelvic region led to a disorders in the studied spatial and temporal parameters of walking, aimed at limiting the rotational movement of the trunk and pelvis during the forward movement.

Reduced speed and tempo of walking, and the stride length helps to reduce the reaction force and correspondingly, the forces of the front and posterior pushes in the support phase. Thus, reduced and the compression force acting on the support joints of the spine and of the lower extremities. 

The increase in the support base and a decrease in the angle of the left foot rotation shows a parallel staging of the foot when walking, while maintaining the normal position of the right foot. Along with this, in some cases a shift of the path of the floor reaction force and increase the support surface contour of the foot right was observed. These changes may indicate biomechanical inexpedient movement patterns of gait. A risk factor for the development of the one is the asymmetry of gait parameters.

Conclusion. The functional state of the musculoskeletal system in patients with Scheuermann's disease is determined by the characteristics of the sagittal contour of the spine, the degree of retraction of the antigravity muscles and the nature of the structural changes in the lumbar motion segments.


Bibliography

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