The thesis is foccused on the problematics of the developmental coordination disorder and its presence within the patiens with the idiopathic scoliosis. The theoretical part deals with the explanation of the terms of developmental coordination disorder, sensory integration and idiopathic scoliosis. The experimental part looks for the connection among the idiopathic scoliosis and the dvelopmental dyspraxia. Thirty patients took part in it. Eighteen of them were patiens with the idiopathic scoliosis, these were divided into two groups according to the age. The first group at the age of 7 to 10 years counted four patiens, the other group from 11 to 16 years contained fourteen patiens. The controll group involved twelve children from the fifth class of the common primary school. The children were tested by the standardized Movement Assessment Battery for Children 2 (MABC-2). Furthermore the measurement was completed by two questionnaires for parents. In the DCDQ'07 they assessed the motor abilities of their child compared to children of the same age and gender. The other questionnaire was aimed at closer information obout the pregnancy, development of the child, presence of any disease or impairment, etc. The difference between motor skills of children with the idiopathic scoliosis and the controll group in...

Purpose: The aim of this research was to determine whether there is a difference in the presence of minimal cerebellar signs, hypermobility and dyspraxia in the group of patients with idiopathic scoliosis (IS) and a control group of individuals without IS. Methods: 11 patients have been selected for this research with IS and 11 individuals without IS as a control group. The International Cooperative Ataxia Rating Scale (ICARS) was used for examination of cerebellar signs. Hypermobility was evaluated with ten tests according to Janda. The presence of pendulum reflexes was determined by examination of patellar and triceps reflex, while dyspraxia was analyzed by means of the Czechoslovak test. Results: Patients with IS scored significantly worse in ICARS than the control group (p < 0,05). IS patients presented with significantly more pronounced hypermobility in head rotation (p = 0,0384) and forward bending (p = 0,0409) tests comparing to the control group. No significant difference between the two groups was identified in pendulum reflexes and the Czechoslovak dyspraxia test. Conclusion: The study confirms significantly more positive signs of ataxia and asynergy in a group of patients with IS comparing to control group. Hypermobility was significantly more pronounced in head rotation and forward...

Bakgrund: I dagsläget finns det brist på studier som innefattar hur vårdnadshavare upplever barnens korsettbehandling. Behandlingen är effektiv men barnens psykiska- och fysiska hälsa påverkas negativt. Vårdnadshavare har en essentiell roll i korsettbehandlingen, därför är det betydelsefullt att identifiera de problem som upplevs av dem.   Syfte och frågeställningar: Syftet med studien är att redogöra för barnens upplevelse av korsettbehandlingen, ur vårdnadshavarnas perspektiv. Genom att identifiera det som anses vara mest problematiskt och vilka aspekter som kan åtgärdas kan upplevelsen av korsettbehandlingen förbättras.   Metod: En kvalitativ innehållsanalys i form av semistrukturerade intervjuer utgjorde studien. Fem vårdnadshavare intervjuades i Jönköping. Inklusionskriterierna innefattade vårdnadshavare till barn som behandlats med korsett samt som inte har några funktions- eller kognitiva nedsättningar.   Resultat: Ur analysen identifierades fyra olika huvudteman: destruktiva faktorer, konstruktiva faktorer samt information och tillgänglighet. Vårdnadshavarna uttryckte att korsettens design var den mest problematiska faktorn som påverkade barnets upplevelse av behandlingen.               Slutsats: Samtliga vårdnadshavare upplevde korsettbehandlingen olika. Det genomgående temat för samtliga var destruktiva faktorer som påverkat upplevelsen. Identifiering av problematiken kan förbättra upplevelsen av korsettbehandlingen. / Background: There is a lack of studies that include how parents experience their children's brace treatment. The treatment is effective but contributes to negative impact on children's mental and physical health. Parents have an essential role in the brace treatment, therefore it is important to explore their experience.  Purpose: The purpose of the study is to evaluate the children's experience of the brace treatment, from the parent’s perspective. By addressing what is considered most problematic and what aspects that can be changed, it may improve the experience of the brace treatment.    Method: A qualitative analysis based on semi-structured interviews composed the study. Five parents were interviewed in Jönköping. The inclusion criteria included parents of children treated with brace who had no functional or cognitive impairments.   Results: Four main themes appeared from the analysis: destructive factors, constructive factors, information and accessibility. The design of the brace was expressed as the most problematic factor that affected children's experience of the treatment according to the parents.   Conclusion: All parents experienced the brace treatment differently. The main topic was destructive factors that affected their experience. Future studies should identify problems associated with the treatment so the experience can be improved.

A coluna vertebral desempenha um papel importante no dia a dia oferecendo suporte necessário à movimentação do tronco além da locomoção do ser humano, sendo o seu funcionamento diretamente relacionado com a qualidade de vida; sua disposição e articulação das vértebras proporcionam estabilidade e flexibilidade à coluna vertebral, atributos necessários para o equilíbrio do ser humano. A hipercifose torácica, hiperlordose lombar e escoliose são as patologias posturais mais comuns e podem ser diagnosticadas pela mensuração do ângulo da curvatura da coluna vertebral. Comumente a radiografia é utilizada como método para a mensuração de tais ângulos, porém, além de ser um método caro, é altamente invasivo por causa da exposição à radiação, por isso não é aconselhado praticá-lo muitas vezes, sendo o acompanhamento do tratamento difícil de ser feito. Há diversos métodos não invasivos, porém não combinam praticidade, baixo custo e análise tridimensional da curvatura, sendo eficazes em mensurar apenas a coluna no plano sagital. Por esses motivos, para o uso clínico, o profissional de saúde necessita de um método barato, confiável, prático, que atenda suas necessidades e não invasivo para a mensuração da curvatura da coluna vertebral. O objetivo desse trabalho foi desenvolver e validar com a Cinemetria composto de cinco câmeras infravermelhas uma ferramenta computacional (LoB Analytics) para mensurar esse ângulos, o software terá código aberto e uso gratuito. A média de todos os ângulos obtida pela Cinemetria foi de 43,4±18,5º e pelo LoB Analytics foi de 43,9±17,7º, com uma correlação muito forte de 0,98. Foram feitas regressões lineares que confirmaram que ângulos calculados pelo LoB Analytics são tão confiáveis quanto os calculados pela Cinemetria, que é um método bastante utilizado hoje em dia. Os grandes diferenciais do LoB Analytics sobre a Cinemetria são: o seu baixo custo e a praticidade de usá-lo em laboratórios e clínicas. / The spine has an important role day by day offering the necessary flexibility for movement of the trunk besides support and locomotion of humans and being is directly related to the quality of life. The provision and articulation of the vertebrae are responsible for the stability and flexibility of spine attributes necessary for the balance. The thoracic hiper and hypo kyphosis, lumbar hiper and hypo lordosis and scoliosis are the most common postural pathologies and can be diagnosed by measuring the angle of the curvature of the spine. The radiographic method has been the most popular method for such measurement, however, it is an expensive method and also invasive (because its exposure to radiation), it is not the method more indicated to be used repeatedly, being the monitoring of treatment difficult to be done. There are several noninvasive methods but they do not combine practicality, low cost and three-dimensional analysis of the spine curvature, and they are effective in measuring the spine only in the sagittal plane. For these reasons, the health professional needs a method that has low cost, reliable, practical and noninvasive methods for measurement of the curvature of the spine. The goal of this work was develop and validate, with motion capture system (Cinemetria), a computational tool for this measurement (LoB Analytics), which will be free and open source. The mean of all Cinemetria angles was 43,9±18,5º and LoB Analytics angles was 43,9±17,7, with a very strong correlation coefficient of 0,98. Linear regressions confirmed that LoB Analytics angles are as reliable as those calculated by Cinemetria, which is a method widely used today. The differentials of LoB Analytics on Cinemetria are: low cost and practicality of using it in laboratories and clinics.

La scoliose de l’adulte est une pathologie dont la prévalence augmente avec de le vieillissement de la population. De plus, la demande fonctionnelle est de plus en plus importante chez ces patients. De nombreuses études ont montré un bénéfice du traitement chirurgical de la déformation de l’adulte par rapport au traitement médical en termes d’amélioration des scores fonctionnels, de qualité de vie et de satisfaction. Néanmoins, cette chirurgie est associée à de nombreuses complications (jusque 50% dans certaines séries), pour la plupart mécaniques telle la pseudarthrose, la rupture d’implant, la dégradation des étages adjacents. Ainsi, si l’analyse radiographique de la scoliose a bien été explorée, certaines questions demeurent comme les phénomènes responsables d’une aggravation brutale de la déformation chez certains patients ou les causes d’échecs. L’objectif de ce travail était d’analyser la scoliose de l’adulte, en 3D à l’aide de la stéréoradiographie et d’évaluer le système musculaire de ces patients afin de mettre en évidence des relations entre déformations rachidiennes notamment par l’analyse du plan horizontal, et dégénérescence musculaire.La 1e partie de ce travail était consacrée à l’analyse 3D de la scoliose : tout d’abord avec l’analyse de reproductibilité chez l’adulte des mesures 3D effectuées par stéréoradiographie, puis par l’analyse de l’alignement global de ces patients avec une déformation rachidienne, à l’aide d’un nouveau paramètre prenant en compte la position de la jonction cervico-céphalique. Apres avoir analysé l’alignement postural, le système musculaire pelvi-rachidien a été étudié dans la 2e partie. En effet, en plus de l’alignement du squelette, c’est l’activation du système musculaire qui est responsable du maintien d’une posture érigée. Nous avons décrit les caractéristiques musculaires des patients avec une scoliose lombaire et analysé les relations avec les paramètres radiographiques de la déformation, montrant que selon le type de déformation certains groupes musculaires étaient plus touchés par l’atrophie et l’infiltration graisseuse. En les comparant à des sujets jeunes et âgés sans déformation, nous avons observé que les patients avec une scoliose avaient une dégénérescence musculaire à la fois liée à la déformation et au vieillissement. Dans une 3e partie, en faisant le lien entre les données de la posture par la stéréoradiographie et les données musculaires de l’IRM, nous avons utilisé un modèle musculosquelettique personnalisé pour mieux comprendre les contraintes exercées sur les segments vertébraux et donc pour essayer d’expliquer les faillites mécaniques.Ainsi, l’association de mesures 3D radiographiques et de l’analyse musculaire pourrait permettre en comprenant mieux les phénomènes dégénératifs, de mieux prédire l’aggravation de la déformation et donc de la prévenir par une rééducation ciblée. Par exemple, un renforcement des érecteurs du rachis mais aussi des fléchisseurs pourrait permettre de mieux maintenir la posture. Et, un renforcement des érecteurs et fléchisseurs de hanche pourrait permettre d’activer de manière plus efficace, les mécanismes de compensation telle la rétroversion pelvienne. De plus, la mise en évidence de facteur de risque musculosquelettique d’aggravation de la déformation entrainerait une prise en charge plus précoce de ces patients. Une analyse longitudinale serait donc intéressante. / Adult degenerative scoliosis is a pathology whose prevalence increases with the aging of the population. Moreover, the functional demand is more and more important in these patients. Many studies have shown a benefit of surgical treatment of adult spinal deformity compared to medical treatment in terms of improved functional scores, quality of life and satisfaction. Nevertheless, this surgery is associated with many complications (up to 50% in some series), mostly mechanical such as nonunion, implant rupture, degradation of adjacent levels. Thus, if the radiographic analysis of scoliosis has been well explored, some questions remain like the phenomena responsible for a sudden worsening of the deformation in certain patients or the causes of failures. The aim of this work was to analyze adult scoliosis in 3D using stereoradiography and to evaluate the muscular system of these patients in order to highlight the relationships between spinal deformities, particularly by the horizontal plane analysis, and muscle degeneration.The first part of this work was dedicated to the 3D analysis of scoliosis: first, with the analysis of reproducibility in the adult of 3D stereoradiographic measurements, then by the analysis of the global alignment of these patients with spinal deformity, using a new parameter taking into account the position of the cervico-cephalic junction. After analyzing the postural alignment, the spino-pelvic muscular system was studied in the second part. Indeed, in addition to the alignment of the skeleton, it is the activation of the muscular system that is responsible for maintaining an erect posture. We described the muscular features of patients with lumbar scoliosis and analyzed the relationships with the radiographic parameters of the deformity, showing that depending on the type of deformity some muscle groups were more affected by atrophy and fatty infiltration. Comparing them to young and elderly subjects without deformity, we observed that patients with scoliosis had muscle degeneration that was both related to deformity and aging. In the third part, by linking stereoradiographic posture data with muscular MRI data, we used a personalized musculoskeletal model to better understand the constraints on vertebral segments and therefore to try to explain the mechanical failures.Thus, the combination of 3D radiographic measurements and muscle analysis could better predict muscle degeneration and worsening of deformity and thus prevent it by targeted rehabilitation. For example, a strengthening of the erectors of the spine but also of the flexors could allow better maintaining the posture. And, a strengthening of the erectors and hip flexors could allow activating more effectively, compensation mechanisms such pelvic retroversion. In addition, the demonstration of a musculoskeletal risk factor worsening the deformity would lead to an earlier management of these patients. A longitudinal analysis would be interesting.

<p>This thesis evaluates surgical correction in patients with paralytic scoliosis with emphasis on function and activity. The thesis includes four studies of 100 consecutive patients preoperatively evaluated and surgically corrected between 1992 and 1996 at Linköping University Hospital. Eighteen different diagnoses were represented. The postoperative follow-ups were at one year and in average seven years. Six patients dropped out during the first year and twelve during the long-term follow-up period. The assessments included general information, lung function, and measurements of radiographs, function and activity - seating posture, ADL, pain, care and need for rest. The patients or relatives view on the effects of surgery were evaluated in follow-up questionnaires.</p><p>The preoperative results of the 100 patients described a heterogeneous group in terms of function and activity. Even when the patients were grouped into subgroups according to the Scoliosis Research Society classification, they remained heterogeneous. In patients who could understand verbal instructions assessments that needed co-operation could be used and in those who could not understand verbal instructions, assessments relied more heavily on measures of function and level of dependence. Preoperative results of weight distribution on the seating surface were explained by thoracolumbar/lumbar spinal imbalance and pelvic obliquity R²=0.45 (n=45).</p><p>The one-year follow-up of 94 patients showed improvements in angle of scoliosis, sitting balance, weight distribution to the seating surface, seating supports in the wheelchair, time needed for rest. The results in subgroups were almost the same as in the whole group. The subjective results for patients or relatives in the follow-up questionnaire showed a positive outcome of surgery. In the comparison between the one-year follow-up and the long-term follow-up there were further improvements in sitting balance, ADL, and care given, but the angle of scoliosis was increased. These results were in line with patients’ and relatives’ assessments in the follow-up questionnaire and in the open-ended questions.</p><p>Due to the heterogeneity of patients with paralytic scoliosis, irrespective of disorder, it is important to focus on different subgroups with regards to the patients’ total situation. The surgically corrected and stabilised spine resulted in the strength to keep the body upright with improvements in function, activity and possibilities to belong in social activities. Further improvements were shown between the one-year follow-up and the long-term follow-up. It is recommended that patients who have been surgically corrected for paralytic scoliosis are followed for more than one year.</p>

This thesis evaluates surgical correction in patients with paralytic scoliosis with emphasis on function and activity. The thesis includes four studies of 100 consecutive patients preoperatively evaluated and surgically corrected between 1992 and 1996 at Linköping University Hospital. Eighteen different diagnoses were represented. The postoperative follow-ups were at one year and in average seven years. Six patients dropped out during the first year and twelve during the long-term follow-up period. The assessments included general information, lung function, and measurements of radiographs, function and activity - seating posture, ADL, pain, care and need for rest. The patients or relatives view on the effects of surgery were evaluated in follow-up questionnaires. The preoperative results of the 100 patients described a heterogeneous group in terms of function and activity. Even when the patients were grouped into subgroups according to the Scoliosis Research Society classification, they remained heterogeneous. In patients who could understand verbal instructions assessments that needed co-operation could be used and in those who could not understand verbal instructions, assessments relied more heavily on measures of function and level of dependence. Preoperative results of weight distribution on the seating surface were explained by thoracolumbar/lumbar spinal imbalance and pelvic obliquity R2=0.45 (n=45). The one-year follow-up of 94 patients showed improvements in angle of scoliosis, sitting balance, weight distribution to the seating surface, seating supports in the wheelchair, time needed for rest. The results in subgroups were almost the same as in the whole group. The subjective results for patients or relatives in the follow-up questionnaire showed a positive outcome of surgery. In the comparison between the one-year follow-up and the long-term follow-up there were further improvements in sitting balance, ADL, and care given, but the angle of scoliosis was increased. These results were in line with patients’ and relatives’ assessments in the follow-up questionnaire and in the open-ended questions. Due to the heterogeneity of patients with paralytic scoliosis, irrespective of disorder, it is important to focus on different subgroups with regards to the patients’ total situation. The surgically corrected and stabilised spine resulted in the strength to keep the body upright with improvements in function, activity and possibilities to belong in social activities. Further improvements were shown between the one-year follow-up and the long-term follow-up. It is recommended that patients who have been surgically corrected for paralytic scoliosis are followed for more than one year.

Cette étude a pour but de tester si l’ajout de variables biomécaniques, telles que celles associées à la morphologie, la posture et l’équilibre, permet d’améliorer l’efficacité à dissocier 29 sujets ayant une scoliose progressive de 45 sujets ayant une scoliose non progressive. Dans une étude rétrospective, un groupe d’apprentissage (Cobb: 27,1±10,6°) a été utilisé avec cinq modèles faisant intervenir des variables cliniques, morphologiques, posturales et d’équilibre et la progression de la scoliose. Un groupe test (Cobb: 14,2±8,3°) a ensuite servit à évaluer les modèles dans une étude prospective. Afin d’établir l’efficacité de l’ajout de variables biomécaniques, le modèle de Lonstein et Carlson (1984) a été utilisé à titre d’étalon de mesures. Le groupe d’apprentissage a été utilisé pour développer quatre modèles de classification. Le modèle sans réduction fut composé de 35 variables tirées de la littérature. Dans le modèle avec réduction, une ANCOVA a servit de méthode de réduction pour passer de 35 à 8 variables et l’analyse par composantes principales a été utilisée pour passer de 35 à 7 variables. Le modèle expert fut composé de huit variables sélectionnées d’après l’expérience clinque. L’analyse discriminante, la régression logistique et l’analyse par composantes principales ont été appliquées afin de classer les sujets comme progressifs ou non progressifs. La régression logistique utilisée avec le modèle sans réduction a présenté l’efficience la plus élevée (0,94), tandis que l’analyse discriminante utilisée avec le modèle expert a montré l’efficience la plus faible (0,87). Ces résultats montrent un lien direct entre un ensemble de paramètres cliniques et biomécaniques et la progression de la scoliose idiopathique. Le groupe test a été utilisé pour appliquer les modèles développés à partir du groupe d’apprentissage. L’efficience la plus élevée (0,89) fut obtenue en utilisant l’analyse discriminante et la régression logistique avec le modèle sans réduction, alors que la plus faible (0,78) fut obtenue en utilisant le modèle de Lonstein et Carlson (1984). Ces valeurs permettent d’avancer que l’ajout de variables biomécaniques aux données cliniques améliore l’efficacité de la dissociation entre des sujets scoliotiques progressifs et non progressifs. Afin de vérifier la précision des modèles, les aires sous les courbes ROC ont été calculées. L’aire sous la courbe ROC la plus importante (0,93) fut obtenue avec l’analyse discriminante utilisée avec le modèle sans réduction, tandis que la plus faible (0,63) fut obtenue avec le modèle de Lonstein et Carlson (1984). Le modèle de Lonstein et Carlson (1984) n’a pu séparer les cas positifs des cas négatifs avec autant de précision que les modèles biomécaniques. L’ajout de variables biomécaniques aux données cliniques a permit d’améliorer l’efficacité de la dissociation entre des sujets scoliotiques progressifs et non progressifs. Ces résultats permettent d’avancer qu’il existe d’autres facteurs que les paramètres cliniques pour identifier les patients à risque de progresser. Une approche basée sur plusieurs types de paramètres tient compte de la nature multifactorielle de la scoliose idiopathique et s’avère probablement mieux adaptée pour en prédire la progression. / The purpose of this study is to examine whether the addition of biomechanical variables, such as variables associated with morphology, posture and balance, produce an increase in dissociation efficiency of 29 subjects with progressive scoliosis from 45 subjects with non progressive scoliosis. In a retrospective study, a learning group (Cobb: 27,1±10,6°) was used with five models comprising clinical, morphological, postural and balance variables and scoliosis progression. A testing group (Cobb: 14,2±8,3°) was then used to evaluate the models in a prospective study. In order to establish the efficiency of the addition of biomechanical variables, Lonstein and Carlson’s (1984) model was used as a reference. The learning group was used to develop four classification models. The model without reduction was composed of 35 variables taken from the literature. In the model with reduction, an ANCOVA served as a reduction method to go from 35 to 8 variables and principal component analysis was used to go from 35 to 7 variables. The expert model was composed of eight variables selected according to clinical experience. Discriminant analysis, logistic regression and principal component analysis were applied in order to classify the subjects as progressive or non progressive. Logistic regression used with the model without reduction presented the highest efficiency (0,94), whereas discriminant analysis used with the expert model showed the lowest efficiency (0,87). These results show a direct relation between a group of clinical and biomechanical parameters and idiopathic scoliosis progression. The testing group was used to apply the models developed from the learning group. The highest efficiency (0,89) was obtained with the use of discriminant analysis and logistic regression and the model without reduction, as the lowest (0,78) was obtained with the use of Lonstein and Carlson’s (1984) model. These values suggest that the addition of biomechanical variables to clinical data increases dissociation efficiency between progressive and non progressive scoliotic subjects. In order to verify the precision of the models, the area under the ROC curve was calculated. The largest area under the ROC curve (0,93) was obtained with the discriminant analysis used with the model without reduction, whereas the lowest (0,63) was obtained with Lonstein and Carlson’s (1984) model. Lonstein and Carlson’s (1984) model could not separate the positive cases from the negative cases with the same amount of precision compared with the biomechanical models. The addition of biomechanical variables to clinical data allowed increasing dissociation efficiency between progressive and non progressive scoliotic subjects. These results suggest that factors other than clinical parameters can identify patients at risk of progression. An approach based on many types of parameters takes into account the multi-factorial nature of idiopathic scoliosis and appears to be better adapted to predict it’s progression.

Des anomalies dans la morphologie pelvienne, la posture du tronc et le contrôle de l’équilibre de jeunes filles atteintes de scoliose idiopathique de l’adolescence (SIA) ont souvent été l’objet d’études. Rares sont celles ayant distingué ces troubles en fonction de la sévérité de la déformation vertébrale. De plus, aucune n’a évalué à l’intérieur d’une même étude l’orientation et la distorsion pelvienne, l’asymétrie posturale et l’instabilité en position debout de sujets SIA. Une telle étude permettrait de comprendre le développement de la maladie et de mettre en évidence des facteurs de risque aidant au pronostic. L’objectif général de cette thèse est d’identifier des facteurs biomécaniques associés à la croissance osseuse, la posture et l’équilibre distinguant une SIA modérée d’une sévère. Les positions 3D de 14 repères prises sur 46 filles ayant une SIA droite (modérée et sévère) et 28 sujets témoins ont été captées pour quantifier la morphologie pelvienne et la posture. Un maintien en position debout de 64 s sur une plate-forme de force a aussi été enregistré afin d’évaluer leur équilibre. Les paramètres retenus sont les angles d’orientation pelvienne et du tronc; les distances entre la crête iliaque et S1 mesurant la distorsion pelvienne; la moyenne, l’amplitude et la vitesse du centre de pression (COP) en médiolatéral (ML) et antéropostérieur ainsi que la moyenne et l’amplitude du moment libre. Les différences entre les trois groupes (témoin, SIA modérée et SIA sévère) sont testées par des ANOVA et les relations entre l’angle de Cobb et les paramètres pelviens, posturaux ou d’équilibre, par des coefficients de corrélations. De plus, des régressions multiples exprimant l’angle de Cobb sont effectuées avec les paramètres pelviens, posturaux et d’équilibre afin de déterminer la classe de paramètres prédisant le mieux l’angle de Cobb. Aucune ANOVA n’est significative pour l’orientation pelvienne, bien que des différences de géométrie pelvienne soient notées entre les deux groupes de sujets SIA. Les SIA modérées ont un pelvis gauche moins profond que les SIA sévères et les sujets témoins, tandis que les SIA sévères ont un pelvis droit plus large d’environ 1,5 cm que celui des SIA modérées. Un coefficient de corrélation de -0,54 associe une rotation pelvienne droite à l’augmentation de la largeur de la crête iliaque. Au niveau postural, les SIA sévères démontrent des inclinaisons latérales et antérieures du tronc ainsi qu’une rotation axiale du haut du corps plus marquées que les SIA modérées. Les corrélations entre les paramètres posturaux, l’angle de Cobb et la morphologie pelvienne indiquent que l’attitude posturale est associée à la distorsion pelvienne dans tous les plans anatomiques, tandis qu’elle ne l’est que dans les plans sagittal et horizontal à l’angle de Cobb. Les différences retrouvées entre les deux groupes SIA concernant les troubles d’équilibre résultent en une augmentation de l’amplitude et de la vitesse du COPML. Une régression multiple de 0,896 est observée par l’emploi des paramètres pelviens, posturaux et d’équilibre, bien que ceux se rapportant à la distorsion pelvienne soient les mieux corrélés à l’angle de Cobb. Cette thèse permet de distinguer la morphologie pelvienne de sujets SIA sévères des modérées, soulignant la détection d’une anomalie de croissance avant que l’angle de Cobb ne soit élevé. Bien que les indices de croissance pelvienne soient davantage corrélés à ce dernier, c’est en considérant globalement la morphologie pelvienne, la posture et l’équilibre qu’une détermination précise de la sévérité d’une scoliose est réalisée. La mise en évidence de tels facteurs de prédiction de la SIA peut faciliter le pronostic d’une courbure. / The effect of adolescent idiopathic scoliosis (AIS) on pelvis morphology, body posture and standing balance in young girls has been studied many times. However, only few studies have distinguished the effect associated with moderate AIS from a severe one. Moreover, no one ever assessed within one investigation pelvis orientation and distortions, postural asymmetry and standing imbalance in AIS subjects. This would help understanding the evolution of the disease and to shed light on risk factors that would facilitate the prognostic. The aim of this thesis is to identify biomechanical factors related to bone growth, posture and balance which can distinguish a moderate AIS from a severe one. The 3D coordinates position of 14 body landmarks taken on 46 young girls with right AIS (moderate and severe) curvature and 28 control subjects is captured to quantify pelvis morphology and body posture. An upright standing is recorded during 64 s on a force plate to assess standing balance. From these data, the following parameters are calculated: orientation angle in all 3 planes for pelvis and trunk; distances between S1 and iliac crest to evaluate pelvis distortion; mean position, range and velocity of the center of pressure (COP) in mediolateral (ML) and anteroposterior axis and mean and range of the free moment. Differences between groups (control, AIS moderate and AIS severe) are tested by ANOVA and relationship between Cobb angle and pelvis, postural and balance parameters are calculated by correlation coefficients. Multiple regressions expressing Cobb angle by pelvis, postural and balance parameters are also carried out to determine which class of parameters is able to predict more effectively the Cobb angle’s curvature. No significant ANOVA is found for pelvis orientation, even though differences in pelvis geometry are noticed between the two groups of AIS subjects. Moderate AIS have a left pelvis with a depth less than severe AIS, whereas AIS severe have a larger right pelvis of 1,5 cm than moderate AIS. A correlation coefficient of -0,54 relates a right pelvis rotation to an increase in iliac crest’s width. About postural asymmetries, severe AIS shows lateral and anterior trunk bending and an axial rotation in the upper level of the trunk that are more pronounced compared to moderate AIS. Correlations between postural parameters, Cobb angle and pelvis morphology indicate a relationship between posture and pelvis distortion in all three planes, but only in the sagittal and horizontal plane between posture and Cobb angle. Differences in standing balance between the two groups of AIS show an increase in COPML range and velocity. A multiple regression of 0,896 is found for the Cobb angle using pelvis, postural and balance parameters. Parameters related to pelvis distortion correlate the most with Cobb angle (0,70). This thesis was able to differentiate severe AIS pelvis morphology from those of the moderate one. Pelvis morphology allows detecting a growth abnormality before the Cobb angle becomes high. Even if pelvis growth is more correlated to the Cobb angle, considering globally pelvis morphology, posture and standing balance will allow determining precisely the severity of AIS. Shedding light on such factors during the evolution of the disease helps an AIS curvature prognosis.

L'os humain adulte est le résultat d'un processus de maturation multi échelle complexe et multifactoriel. Concernant la croissance de l'os de l'enfant, les données quantitatives issues de la littérature sont peu nombreuses et souvent discutables. Une caractérisation multimodale de ce matériau (acoustique, mécanique, histologique, biochimique et par l'imagerie) permet de traduire quantitativement les différences observées en pratique clinique avec l'os adulte. Cette étude propose de déterminer les paramètres biomécaniques de l'os cortical au cours de la croissance par une approche multimodale. Différents types d’échantillons ont été utilisés, os long (fibula), os plats (côtes issus de la cage thoracique des patients scoliotiques) en provenance de service de chirurgie orthopédique. Des résultats originaux ont été obtenus, avec des lois reliant les données à différentes échelles. Les résultats ont permis d’infirmer des hypothèses concernant la déminéralisation osseuse dans le cadre des études sur la scoliose idiopathique chez l’enfant, et l’obtention de nouvelles données concernant l’os cortical au cours de la croissance. / Human bone is the result of a multiscale maturation process determined by several factors. Concerning the bone growth, few quantitative data are available in literature and their validity is questionable. A multimodal method (acoustical, mechanical, histological, biochemical and using imagery) characterizing the bone matrix leads to quantify the differences between adult and children based on clinical observations. The goal of this study is to quantify the biomechanical properties of cortical bone during growth by using a multimodal method. Several kinds of samples have been characterized, on one hand from long bone (fibula) and on the other hand from flat bone (extracted from the scoliotic rib hump). Original results have been found with law linking multiscale data. These results weak the hypothesis of bone demineralization in idiopathic adolescent scoliosis and provide new data concerning cortical bone during growth process.