As alterações posturais da coluna vertebral, em especial a escoliose por ser um problema ortopédico funcional ou estrutural encontrado na infância e na adolescência, trazem riscos de evolução e devem ser diagnosticados e tratados o mais precocemente possível. Nosso objetivo foi avaliar a prevalência de postura escoliótica em escolares de uma escola pública e uma privada do ensino fundamental do município de Guarapuava-PR, bem como identificar a altura e o lado da convexidade das curvaturas escolióticas e a presença de gibosidade em relação à faixa etária e ao sexo dos sujeitos envolvidos. Esta pesquisa é de cunho quantitativo e trata-se de um estudo transversal não experimental. A coleta de dados foi realizada em duas escolas do município de Guarapuava, sendo uma privada e outra pública, em agosto de 2005. Envolveu 964 escolares de ambos os sexos, respeitando-se os princípios éticos estabelecidos na Resolução nº196 do CNS/MS, sendo previamente aprovada pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto-USP. A avaliação postural utilizada no presente trabalho foi elaborada considerando-se o alinhamento vertebral descrito Loudon, Bell Johnston (1999) e a partir de observações clínicas propostas por Santos (2001) e também a pesquisa de gibosidade, preconizada por Cailliet (1977). Quando foi detectada uma alteração postural, os pais ou responsáveis do escolar avaliado receberam uma carta de comunicação, na qual sugerimos a investigação diagnóstica através de exames complementares em consulta a um especialista de sua preferência. Os dados coletados foram descritos através da utilização do Software Statistical Package for Social Siences (SPSS, 1999). Entre os 655 escolares avaliados, detectamos, em ambos os sexos, 26% de posturas escolióticas, sendo 53% de curvaturas torácicas à esquerda e 20% à direita, 13% de toracolombares à esquerda e 6% à direita e 2% de lombares à esquerda. Não detectamos curvaturas lombares à direita como curvas únicas, somente em associações de duplas curvas, que correspondem a 6%. Nossos resultados foram semelhantes aos de outras pesquisas sobre posturas escolióticas e discutidos em relação à literatura referente sobre prevalência de escoliose estruturada ou não. Com base nestes resultados reforçamos a necessidade de programas preventivos como o rastreamento de posturas escolióticas durante a fase escolar, considerando-se que as alterações de postura podem ser uma das causas de agravamento de distúrbios da coluna vertebral na fase adulta, os quais apresentam, no Brasil, um alto índice de afastamento ao trabalho ou aposentadoria por invalidez. Faz-se necessário o estabelecimento de parcerias com outros profissionais da área da saúde para a implantação de ações preventivas e de diretrizes que promovam a saúde do escolar, principalmente sistematizando pesquisas periódicas para detecção de distúrbios vertebrais. / The posture alterations in the vertebral column, especially when there is scoliosis, which may be a functional or structural orthopedic problem found in childhood or adolescence, need to be diagnosed and treated as soon as possible, since there is a chance for scoliosis to develop and get worse. Our aim with the present work was to study the prevalence of scoliosis posture in pupils from a public and a private primary/junior high school in Guarapuava-PR, as well as identify the size of the scoliosis curvatures, the side of their convexity, and if there was gibbosity concerning the participants age and gender. The present research has a quantitative purpose, and it is a transversal and not experimental study. The data were collected in two different schools in Guarapuava-PR (one school is private and the other is public) in August 2005. We studied 964 male/female pupils, respecting the ethical principles of the CNS/MS 196 Resolution, and all the search procedures had the approval of the Ethic Committee of the Nursing School of Ribeirão Preto-USP. The postural evaluation we used in the present work was elaborated from the vertebral alignment described by Loudon and Bell Johnston (1999), from clinical observations suggested by Santos (2001), and from the gibbosity research recommended by Cailliet (1977). If we found a postural alteration in the participant pupil, we sent their parents or the relative in charge of them a letter, advising them to seek a professional of their preference in order to diagnose the problem with complementary examinations. The collected data were described with the help of the Software Statistical Package for Social Sciences (SPSS, 1999). From the 655 female/male participant pupils, we found that 26% of them had scoliosis postures: 53% with thoracic curvatures on the left and 20% on the right, 13% with thoracolumbar on the left and 6% on the right, and 2% with lumber on the left. We didn t find any lumbar curvatures on the right as single curves, but only in association with double curves, which correspond to 6% of the participant female/male pupils having posture problems. Our results were similar to those of other pieces of work related to scoliosis posture, and their discussion was based on the literature about the prevalence of structured or not structured scoliosis. From the results of the present study, we reinforce the necessity of prevention programs such as the diagnosis of scoliosis posture during the primary/junior high school period. We need to consider that the posture alterations may be one of the causes that lead to vertebral column disorders in adulthood. In Brazil, there is a high level of people who stop working or retire due to their disability caused by column disorders. It is necessary to establish partnerships with other health professionals in other to consolidate prevention programs and plans which improve the pupils health, especially by carrying out frequent research that seeks to find vertebral disorders in them.

A hemodiluição normovolêmica aguda (HNA) é terapia mundialmente reconhecida como vantajosa em cirurgias que possuem grande potencial para sangramento, mas o edema provocado pela maior infusão de fluidos pode ser danoso em alguns pacientes. No intuito de avaliar as repercussões hemodinâmicas e laboratoriais da utilização da solução salina hipertônica a 7,5% como líquido parcial de reposição na HNA foram estudados 20 pacientes submetidos à artrodese para correção de escoliose de coluna. No grupo 1 (SS 0,9%, n=10) o sangue retirado na HNA, realizada momentos antes da cirurgia, foi reposto por solução salina 0,9% em um volume três vezes maior que o retirado. No grupo 2 (SS 7,5%, n=10) a metade do que foi retirado foi reposto com solução a 0,9% (três vezes o volume retirado) e a outra metade por 4 ml.kg-1 de solução salina hipertônica 7,5%. Nenhum dos pacientes apresentou distúrbios do equilíbrio ácido-básico e as alterações metabólicas (aumento da osmolaridade, sódio e cloro plasmáticos) foram passageiras. Os pacientes mantiveram-se hemodinamicamente estáveis e não foi observado sangramento anormal intra-operatório. A incidência de transfusão sangüínea foi semelhante embora os pacientes do grupo solução hipertônica tenham ficado clinicamente menos edemaciados. Mesmo não sendo objeto do estudo, observou-se menor incidência de infecções pós-operatórias nos pacientes submetidos à infusão de solução hipertônica, o que pode significar potencial efeito protetor da solução. Embora mais estudos com números maiores de pacientes sejam necessários para se comprovar esses efeitos, a solução hipertônica mostrou-se barata, simples e segura como maneira de redução do volume infundido na HNA. / The acute normovolemic hemodilution (ANH) is a therapy recognized as benefic in surgeries that have a great potential for bleeding but the swelling caused by solutions infused intra-operative can be harmful in some kind of patients. Twenty patients submitted to arthrodesis for scoliosis correction were studied in order to evaluate the hemodynamic and laboratory effects of 7.5% hypertonic saline solution as a partial fluid replacement in ANH. In group 1 (SS 0.9%, n = 10) the collected blood in ANH was replaced by saline solution 0.9% in a volume three times greater than the withdrawal. In group 2 (SS 7.5%, n = 10), half of the blood removed was restored by 0.9% solution (three times the amount withdrawn) and the other half by 4 ml.kg-1 of 7.5% solution. None of the patients presented acid-base disorders. Metabolic changes - enhanced of plasmatic levels of sodium, chlorine and osmolarity - were all transitory. Patients remain hemodynamic stable and no abnormal bleeding was observed. They had similar incidence of blood transfusion but the ones in hypertonic solution group were clinically less swollen. Lower incidences of post-operative infections were found in this group, which could mean a possible protector potential of hypertonic solution. SS 7.5% was a cheap, simple and safe alternative to reduce volume infused in ANH.

Concerns, Desires and Expectations Of Surgery For Adolescent Idiopathic Scoliosis: A Comparison Of Patients’, Parents’ & Surgeons’ Perspectives. Master of Science, 2008 Unni G. Narayanan Department of Health Policy, Management & Evaluation University of Toronto ABSTRACT This study explored the concerns, desires (goals) and expectations of adolescents undergoing surgery for idiopathic scoliosis, and contrasted their priorities with those of their parents and surgeons. Parents were more concerned than their children about the consequences of scoliosis and of surgery. With the exception of improving physical appearance, surgeons' goals of surgery were different from those of either the patients or parents. There was little agreement among surgeons about the natural history of scoliosis, other goals of surgery and the likelihood of specific outcomes. Parents wanted and expected more from surgery than their children. Parents and patients had greater expectations of surgery than surgeons. Although adolescents had different priorities from their parents, parents were aware of these differences and reliably predicted their children’s priorities. These findings have important implications on shared decision-making and informed consent, and might contribute to better understanding and measurement of outcomes that matter to patients.

Concerns, Desires and Expectations Of Surgery For Adolescent Idiopathic Scoliosis: A Comparison Of Patients’, Parents’ & Surgeons’ Perspectives. Master of Science, 2008 Unni G. Narayanan Department of Health Policy, Management & Evaluation University of Toronto ABSTRACT This study explored the concerns, desires (goals) and expectations of adolescents undergoing surgery for idiopathic scoliosis, and contrasted their priorities with those of their parents and surgeons. Parents were more concerned than their children about the consequences of scoliosis and of surgery. With the exception of improving physical appearance, surgeons' goals of surgery were different from those of either the patients or parents. There was little agreement among surgeons about the natural history of scoliosis, other goals of surgery and the likelihood of specific outcomes. Parents wanted and expected more from surgery than their children. Parents and patients had greater expectations of surgery than surgeons. Although adolescents had different priorities from their parents, parents were aware of these differences and reliably predicted their children’s priorities. These findings have important implications on shared decision-making and informed consent, and might contribute to better understanding and measurement of outcomes that matter to patients.

The purpose of this study was to determine the relationship of spinal deformity with physical function and self-perception in children with spina bifida. Ninety-eight eligible children with scoliosis and spina bifida were identified; 80 of them (82%) consented to participate. Spinal deformity was measured in many ways, including scoliosis, coronal balance, and pelvic obliquity. Measures of physical function included the Sitting Balance Scale, Jebsen Hand Scale, Hoffer Ambulation Scale, the Spine Bifida Spine Questionnaire, and the Activities Scale for Kids (ASK). Self-perception was determined with Harter's Self-Perception Profile. No relationship was found between spinal deformity and overall physical function (ASK). Of all aspects of spinal deformity, only coronal imbalance was significantly related to only one aspect of physical function (ie, sitting imbalance). No aspect of spinal deformity was related to self-perception. In conclusion, surgeons should be clear in their indications for surgery and recognize that in the short term the potential benefit of surgery may be, at best, to improve only sitting balance.

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Η εφαρμογή κηδεμόνα αποτελεί την πιο αποτελεσματική, μη χειρουργική, μέθοδο αντιμετώπισης μετρίων παραμορφώσεων της σπονδυλικής στήλης στους εφήβους. Φαίνεται όμως να έχει σημαντικές επιπτώσεις στην καθημερινή δραστηριότητα των εφήβων. Με την παρούσα μελέτη διερευνήθηκε η αυτοεκτίμηση της κατάστασης της υγείας των εφήβων με τις δύο πιο κοινές παραμορφώσεις της σπονδυλικής στήλης, οι οποίες αντιμετωπίστηκαν με την χρήση κηδεμόνα. Σε εβδομήντα εννέα εφήβους με παραμόρφωση σπονδυλικής στήλης ( ιδιοπαθής σκολίωση, θωρακική κύφωση Scheuermann ) και εξήντα δύο εφήβους χωρίς παραμόρφωση της σπονδυλικής στήλης (ομάδα ελέγχου) τους ζητήθηκε και συμπλήρωσαν το ερωτηματολόγιο Quality Of Life Profile for Spine Deformities. Η παρούσα μελέτη έδειξε ότι οι έφηβοι με παραμόρφωση της σπονδυλικής στήλης είναι, στατιστικώς σημαντικά, λιγότερο πιθανόν να έχουν πόνο στην ράχη όταν αθλούνται σε σχέση με την ομάδα ελέγχου αλλά περισσότερο πιθανό να έχουν δυσκολίες τόσο όταν σκύβουν όσο και στις καθημερινές δραστηριότητές τους και ενώ φορούν τον κηδεμόνα. Οι έφηβοι αυτοί ( με την παραμόρφωση) παραπονούνται ότι ξυπνούν εξ’ αιτίας πόνου στην ράχη και εκνευρίζονται με την εξωτερική τους εμφάνιση. Οι ασθενείς αυτοί αντιμετωπίζουν, συχνά, προβλήματα στις σχέσεις με τους φίλους τους ενώ αναφέρουν δυσκολίες κατά την έγερσή τους από το κρεβάτι αλλά και στον ύπνο κατά τη διάρκεια της νύχτας, συγκριτικά με τους εφήβους χωρίς παραμόρφωση. Επιπλέον καθώς μεγαλώνουν ηλικιακά αισθάνονται μεγαλύτερη ντροπή για το σώμα τους και ανησυχούν για το μελλοντικό αποτέλεσμα της παραμόρφωσης. Όσο δε ο συνολικός χρόνος 56 εφαρμογής του κηδεμόνα αυξάνεται οι έφηβοι με παραμόρφωση έχουν περισσότερες πιθανότητες να εμφανίσουν μειωμένο πόνο στην οσφύ σε σχέση με τους εφήβους της ομάδας ελέγχου. Τα κορίτσια συγκρινόμενα με τα αγόρια, στις ομάδες με παραμόρφωση, έχουν περισσότερες πιθανότητες να εμφανίσουν πόνο στην οσφύ μετά από τις καθημερινές δραστηριότητες στο σπίτι ή μετά από την γυμναστική. Οι ασθενείς με τα μεγαλύτερα κυρτώματα δυσκολεύονται πιο πολύ στο να σκύψουν ενώ πονούν πιο συχνά στην ράχη. Οι ψυχολογικές επιπτώσεις από τη εφαρμογή του κηδεμόνα στους εφήβους με παραμόρφωση της σπονδυλικής τους στήλης σχετίζονται κυρίως με τις συναναστροφές των παιδιών στο χώρο του σχολείου και σε συνδυασμό με τον πόνο στην ράχη αποτελούν τις κυριότερες αιτίες χαμηλής συμμόρφωσης. Λεπτομερείς συστάσεις και ψυχολογική υποστήριξη απαιτείται για όλους τους ασθενείς που υποβάλλονται σε θεραπεία με κηδεμόνα ενώ κρίνεται απαραίτητη και η σωματική άσκηση, ιδιαίτερα για τα μεγαλύτερης ηλικίας κορίτσια και όλα αυτά με σκοπό να επιτευχθεί η καλύτερη δυνατή συμμόρφωση στην θεραπεία. / Bracing is the most effective non-operative treatment for mild progressive spinal deformities in adolescence but it has shown a considerable impact on several aspects of adolescents’ functioning. This cross-sectional study investigated the self-perceived health status of adolescents with the two most common deformities, treated with body orthosis. Seventy-nine adolescents with spinal deformities (idiopathic adolescent scoliosis, thoracic Scheuermann kyphosis) and 62 adolescents without spinal deformities were asked to complete the Quality of Life profile for Spine Deformities Instrument. This study showed that adolescents with deformities are significantly less likely to have back pain in training than controls, but more likely to have difficulty in forward bending, and in the most common daily activities while in brace. These individuals claim they wake up because of back pain and feel quite nervous with the external appearance of their body. These patients face often problems with their relations with friends, while they reported difficulties in getting up from bed and sleep at night more often than their counterparts without deformities. As they grow older, patients feel increasing ashamed of their body, as they are more concerned about the future effect of the deformity on their body. As the bracing time increases, patients have much more probability than controls to get low back pain. Girls with deformity have a higher probability than boys to get low back pain while working in the house and while training. Individuals 57 with larger spinal curvatures have more difficulties in bending and increased incidence of back pain than their counterparts with smaller curvatures. Psychological reasons associated mainly with relations at school and back pain are the main causes for low compliance in adolescents with spinal deformities treated with body orthosis. Careful instructions for all individuals who will undergo brace therapy, psychological support for all patients who develop psychological reactions and physical training particularly for older girls should be recommended to increase bracing compliance

Correct posture is the basis for normal development and function of chest box, extremities and internal organs. Irregular posture is one of the most widespread disorders of musculoskeletal system, which might be caused by the low level of culture and lack of education. It has an influence on children‘s health, physical and psychological well-being. Lack of assessment and delay of treatment might worsen situation and progress into complicated forms of disorders. Aim of the work: to evaluate posture of 11–12 years old children in sagittal and frontal planes and effects of physical therapy. Contingent: 96 11–12 years old children were participated in the first assessment: 59 girls and 37 boys. 64 children were participated in the second assessment: 33 girls and 31 boys. Methods: inspection, palpation, cirtometry, scoliometry, SPSS software. Results: Distribution of curves of column in frontal and sagittal planes after physical therapy were the same among boys and girls as well as children of 1’st and 2’nd group. Analyzing data of first and second assessments we can say, that physical therapy had no influence on boy’s kyphosis and lordosis, but it had a statistically significant positive effects on girl’s parameters of kyphosis and lordosis. Conclusions: posture disorders in frontal and sagittal planes are still widespread among schoolchildren. Physical therapy is very important for the correction of schoolchildren’s posture. Special physical exercises had to be used under... [to full text]