Introduction to scoliosis: Scoliosis can be divided into three types of congenital scoliosis and idiopathic scoliosis and neuromuscular scoliosis, general scoliosis occurs in children and adolescents, experts point out that severe scoliosis can cause thoracic rib dysplasia affecting normal cardiopulmonary function, more serious can occur spinal cord compression and paralysis, is a serious impact on the physical health of adolescents. What are the causes of scoliosis? 1, genetic factors: A number of studies have shown that the occurrence of spinal curvature genetic factors. Population studies have shown a family history of the population, the incidence of idiopathic spinal curvature is higher than the general population. A study reported that women with idiopathic spinal curvature gave birth to girls with more than 15° incidence of spinal curvature of 27%. A study on twins showed that the incidence of monozygotic twins with spinal curvature ranged from 73% to 92%, much higher than the 36% to 63% of dizygotic twins. 2, hormonal theory: melatonin deficiency was thought to be the cause of idiopathic spinal curvature. Because of the removal of the pineal gland (the main site of melatonin secretion) in chickens after the spinal curvature occurred. In addition, some studies have found that children with idiopathic spinal curvature have defects in melatonin receptors at night, rather than a deficiency of melatonin itself. If melatonin is indeed the cause, the mechanism that plays into the curvature of the spine is not clear. Growth hormone has also been suggested to play a role in the development of spinal curvature. There have been isolated reports of growth hormone administration causing rapid progression of spinal curvature. Interestingly, melatonin and growth hormone are secreted in a similar manner, but in opposite ways around the clock. 3. Spinal growth and biomechanical theory: The onset and progression of idiopathic scoliosis is related to the timing of rapid growth during puberty. Different growth rates on the left and right sides of the spine produce asymmetric biomechanical loads, and the Huetter-Volkman law states that increased pressure inhibits growth and decreased pressure promotes growth. This theory of mechanically regulated growth can explain the phenomenon of increased deformity in some children during the growth period. 4, tissue abnormality theory: Several theories propose that abnormalities in the structures associated with the spine (muscles, bone, ligaments and/or intervertebral discs) may lead to spinal curvature. This theory is based on the observation that equine Fang syndrome (protofibrinopathy), Duchenne muscular dystrophy (myopathy), and bone fiber dysplasia and other diseases are complicated by spinal curvature. Modern people are increasingly hunched over (including many adolescents) due to long hours of study and ambulatory work. Deformation of the thoracic spine, small joint disorders, ligament and muscle strain is the main cause of thoracic spine, back stubborn pain, and may also cause panic, chest tightness, premature beats, stomach pain and many other diseases. The ancients said, “If your back is straight, you won’t get sick.” This is the truth. Hunchback can cause narrowing of the spinal nerve foramina, which means that the nerve roots are compressed or irritated, resulting in many diseases. Spinal curvature: (1) physiological curvature of the normal human spine has four front-to-back directional curvature, namely, the cervical vertebrae slightly convex, the thoracic vertebrae slightly convex backward, the lumbar vertebrae significantly convex forward, the sacral vertebrae significantly convex backward, similar to the “S” shape, called physiological curvature. Normal people have no scoliosis of the spine in the upright position. The method of checking whether the spine has scoliosis is: the examiner uses his finger to scratch along the tip of the spinous process of the spine with appropriate pressure from top to bottom, and after scratching the skin appears a red line of congestion, using this line as a standard to observe whether the spine has scoliosis. (2) Pathologic deformity of the patient in the standing position, carefully examined for deformities. Three basic deformities are usually seen: 1. kyphosis refers to excessive backward curvature of the spine, also known as hunchback, which occurs mostly in the thoracic spine: (1) pediatric kyphosis is mostly caused by rickets, which is characterized by a significant uniform backward curvature of the thoracic segment in the sitting position, and the curvature can disappear in the supine position. Rickets kyphosis: (2) Tuberculosis of the spine mostly develops in adolescence, and the lesions are often in the lower thoracic vertebrae. In the early stage, only a slight elevation of the local spinous process is seen, such as a button-like; later, it gradually becomes a large elevation, forming an angular deformity, such as a “hump”-like elevation. In order to relieve the pressure on the affected vertebrae in the sitting position, the trunk is often supported with two hands; when walking or standing, the head is tilted and the trunk is tilted back as much as possible. Spinal tuberculosis kyphosis: (3) Uniform kyphosis of the thoracolumbar segment in adolescents can be the result of poor posture during development or of osteochondritis of the spine. Kyphosis: (4) Adults with arcuate (or bow-shaped) kyphosis of the thoracic segment are seen with rheumatoid spondylitis, often with spinal ankylosis fixation, and the spine cannot be flattened even in the supine position. (5) Older people with kyphosis mostly occur in the upper part of the thoracic segment, where the trunk tilts slightly forward, the head extends forward, and the shoulders move forward, caused by bone degeneration and compression of the thoracic vertebrae. (6) Posterior kyphosis caused by trauma to the vertebral fracture can occur in any age group. 2, lordosis (lordosis) refers to excessive forward projection of the spine curvature: mostly occurs in the lumbar region, the lumbar spine is excessively convex deformity, most clearly observed in the standing position. The upper abdomen is clearly bulging forward, the hips are clearly posteriorly convex, and the pelvic tilt is increased; if the back and hips are against a wall, the gap between the back of the lumbar spine and the wall is seen to increase. Anterior lumbar convexity can be seen in: (1) compensatory anterior convexity due to dorsal muscle weakness such as poliomyelitis, forward slippage of the fifth lumbar vertebra, rickets, progressive malnutrition, and excessive obesity; (2) compensatory anterior convexity due to excessive abdominal weight, such as late pregnancy, massive ascites, and huge abdominal tumors; (3) posterior hip dislocation, hip exostosis, late hip tuberculosis, knee flexion deformity, and excessive posterior convex deformity of the thoracic spine compensatory pronation. 3, scoliosis refers to the deviation of the spine from the median line to both sides: according to the different sites of occurrence can be divided into thoracic scoliosis, lumbar scoliosis and combined thoracolumbar scoliosis. Scoliosis: There are several ways to observe scoliosis: (1) According to the spinous process line to observe the patient standing, the examiner uses the index finger and the middle finger on the patient’s spinous process from the top to the bottom of the rapid pressure scratch, the skin can be seen a red line, this can determine whether the scoliosis and the site and direction of scoliosis. (2) The upper back is elevated, the thorax is full, and the pelvis is lowered on the side of scoliosis, while on the opposite side, the upper back and shoulders are lowered, the thorax is flattened, and the pelvis is elevated. The specific signs are: ① elevation of the peak of the shoulder, the highest point of the posterior axillary crease and the lower angle of the scapula on the side of lateral convexity; ② the shoulder-humeral angle (the angle between the upper arm and the lateral wall of the chest) becomes smaller or disappears; ③ the iliac rib space becomes longer, the iliac crest and the posterior superior iliac spine fall; ④ the concave curve of the waist disappears; ⑤ the highest point of the anterior axillary crease, the nipple and the lower edge of the breast are elevated, and the thorax is full. On the contralateral side of the lateral convexity, the above-mentioned signs are in opposite positions, and there is a deep concave skin fold above the iliac crest. (3) The vertical line observation method uses a long line with a heavy hammer tied underneath, and the upper end of the line is pressed at the midpoint of the external occipital ridge or the cervical 7 spinous process, and the lower part of the line is allowed to fall naturally, but the patient’s standing posture should be adjusted so that this vertical line is exactly aligned with the gluteal fissure. If the spinous process deviates from this line, it indicates its scoliosis, and the type, location and degree of its scoliosis can be observed. The clinical significance of scoliosis is divided into postural and organic scoliosis according to the nature of the scoliosis: (1) Postural scoliosis is characterized by a variable curvature of the spine (especially in the early stages), and a change in position can correct the scoliosis. Scoliosis can disappear when lying down or bending forward. The causes of postural scoliosis are: ① Sitting and standing postures are often improper during childhood development; ② One lower limb is significantly shorter than the other; ③ Intervertebral disc prolapse; ④ Post-polio sequelae, etc. (2) Organic scoliosis is characterized by the inability to correct the scoliosis by changing the position. The causes of organic scoliosis are: ① rickets; ② chronic pleural thickening and pleural adhesions; ③ deformities of the shoulder or thorax, etc. Scoliosis can be divided into two categories depending on the cause: 1. Functional scoliosis: for example, scoliosis caused by abnormal posture, inflammation or unequal lower limbs are functional scoliosis. 2, structural scoliosis: idiopathic, congenital, neuromuscular, etc. belong to structural scoliosis. Idiopathic scoliosis, also known as primary scoliosis, is the most common in scoliosis, accounting for about 75% to 90% of the total number of scoliosis cases, with women predominating, and can be divided into infant, juvenile and adolescent types, with adolescent types being the most common. Scoliosis can also be divided into two categories according to the location of scoliosis: 1. Primary scoliosis: the earliest abnormal curvature, mostly seen in the thoracic spine. Usually the angle of primary scoliosis is greater than the angle of secondary scoliosis. 2, secondary scoliosis: mostly appears below the primary scoliosis, in order to keep the trunk in balance as a compensatory condition.