Avtor/Urednik     Gogala, Andrej
Naslov     Vloga reber pri nastanku in napredovanju idiopatske skolioze
Prevedeni naslov     Role of the ribs in the onset and progression of idiopathic scoliosis
Tip     članek
Vol. in št.     Letnik 86, št. 9/10
Leto izdaje     2017
Obseg     str. 404-413
ISSN     1581-0224 - Zdravniški vestnik
Jezik     slv
Abstrakt     Patogeneza idiopatske skolioze je še vedno predmet razprave, saj skupni vzrok ni bil odkrit. A pri njenem nastanku in napredovanju obstaja nekaj osnovnih načel. Krivino hrbtenice vedno spremlja zasukanost vretenc in prsnega koša. Če želimo razložiti načela, po katerih se ravna nastanek in napredovanje skolioze, moramo odgovoriti na nekaj vprašanj: 1. Zakaj stransko ukrivljenost hrbtenice vedno spremlja sukanje prsnega koša in vretenc, da so najbolj zasukana vretenca pri vrhu krivine; 2. Ali strukturno skoliozo določa primarna rast kosti v rastnih ploskvah vretenc ali kostno preoblikovanje, s katerim se kosti prilagajajo zunanjim obremenitvam; 3. Zakaj je večina prsnih krivin usmerjenih v desno; in 4. Kaj vodi v napredovanje skolioze? V tukaj predstavljeni teoriji je pozornost namenjena vlogi reber. Someren prsni koš drži vretenca v središčni osi telesa in preprečuje obračanje vretenc z dvojnimi sklepnimi površinami na vsaki strani vretenca. Rebra so povezana z medrebrnimi mišicami in se ne morejo razmakniti na izbočeni strani, ko se hrbtenica upogne. Krivina hrbtenice v prsnem predelu ni možna brez obračanja vretenc in deformacije reber. Rebra pri vrhu krivine povleče navznoter proti vretencem, ker so premaknjena dlje od sredine kot druga rebra. Z obračanjem vretenc pri vrhu krivine, ki jih rebra stiskajo, se prsni obseg zmanjša in napetost v steni popusti. Deformacija postane nepovratna, če nova rast ali razgradnja in preoblikovanje kosti spremenijo obliko reber in vretenc ali če vezi niso dovolj čvrste. Pri utrjevanju strukturne skolioze je preoblikovanje kosti verjetno pomembnejše kot primarna rast kosti. Ko prsni koš in vretenca postanejo strukturno zasukani, vretenca izgubijo ravnovesno podporo reber z obeh strani. Strižne sile reber dodatno obračajo vretenca in potiskajo telesa vretenc na izbočeno stran. Neprenehno napredovanje skolioze se začneThe pathogenesis of idiopathic scoliosis is still a matter of debate as its common cause has not been found. But some basic principles of its onset and progression do exist. The curvature of the spine is always accompanied by rotation of the vertebrae and rib cage. If we want to explain the principles governing scoliosis onset and progression, we should answer some questions. First, why is side curvature of the spine always accompanied by rotation of the rib cage and vertebrae and vertebral rotation is maximal at the curve apex? Second, is structural scoliosis fixed by primary bone growth in growth plates of the vertebrae or by bone remodeling by which bones adapt to external loads? Third, why most of the curvatures are right thoracic? And fourth, what drives the progression of scoliosis? In the theory presented here, attention is given to the role of the ribs. Symmetrical rib cage fixes vertebrae in the midline of the body and prevents rotation of the vertebrae with dual articulating surfaces on each side of the vertebrae. The ribs are connected with intercostal muscles and cannot spread apart on the convex side when the spine bends. Curvature of the spine in the thoracic region is not possible without rotation of the vertebrae and deformation of the ribs. The ribs at the apex of the curve are pulled inwards towards the vertebrae because they are shifted further from the midline than other ribs. With rotation of the vertebrae at the apex of the curve, which are compressed between the ribs, the thoracic circumference diminishes and the tension in the wall is alleviated. The Vloga reber pri nastanku in napredovanju idiopatske skolioze 405 Strokovni članek id 2483 deformation becomes irreversible if new bone growth or resorption and remodeling change shape of the ribs and vertebrae or if ligaments are not firm enough. Bone remodeling is probably more important than primary bone growth in fixing the structural scoliosis. When the rib cage and vertebrae become structurally rotated, vertebrae lose balanced support from the ribs from both sides. Shear forces from the ribs turn vertebrae further and push vertebral bodies toward the convexity. Thus, continuous progression of scoliosis starts.
Proste vsebinske oznake     medicina
deformacije hrbtenice
idiopatska skolioza
patogeneza skolioze
prsni koš
preoblikovanje kosti
medicine
spinal deformities
idiopathic scoliosis
scoliosis pathogenesis
thorax
bone remodeling