(1) screening principle.
Based on the principle of screening out abnormal curvature of spine, especially scoliosis.
(2) Screening institutions and personnel.
Screening institutions include centers for disease control and prevention, hospitals, community health service centers, township hospitals, maternal and child health care centers and primary and secondary medical and health institutions, and have qualified screening personnel. Screening personnel should be professional and technical personnel who have undergone strict training and passed the examination.
(3) Screening places.
It is suggested that schools should be selected as screening places for abnormal spinal curvature, and the screening places should be bright, clean, neat and quiet. There is a waiting area and an inspection area. Male and female students in the examination area are separated and equipped with examination beds. Windows should be draped, and indoor video surveillance should be turned off.
(4) Screening instruments and equipment.
Trunk rotation measuring instrument and other professional instruments and related equipment.
(5) Precautions for screening.
Before the screening work is carried out, the school will publicize to students and parents, fully inform them of the necessity of screening for abnormal spinal curvature, and issue and recycle informed consent forms and personal information forms. In the process of screening, screening personnel should strengthen publicity and education for students, parents and school teachers, improve their vigilance against abnormal spinal curvature, and make them fully realize the necessity of screening.
Second, the screening points and processes
(1) Scoliosis examination.
1. General inspection.
Male subjects were naked, while female subjects were wearing underwear and shoes, taking a natural standing posture, with their feet shoulder-width apart, their eyes looking straight, their arms drooping naturally and their palms inward.
Look at the customer from behind:
(1) Whether the shoulders are equal in height and whether the head is centered;
(2) Whether the left and right scapula are symmetrical on both sides of the spine and whether the subacromial angle is equal in height;
(3) Whether the lumbar fovea on both sides are symmetrical;
(4) Whether the bilateral iliac ridges are equal in height (i.e. whether the pelvis is horizontal);
(5) Whether the spinous process line is inclined or deviated from the midline.
2. Forward flexion test (Adam test).
In a bright place, the examinee with exposed back will turn his back to the examiner, and the examiner will instruct him to straighten his knees, put his feet together, stand at attention, straighten his arms, cross his hands, bend his head forward slowly to about 90 degrees, and gradually put his hands together between his knees (to avoid false deviation of the examinee's trunk and shoulders). The examiner's eyes should be at the same height as the examinee's back, and the eyes should be parallel to the curvature of the examinee from beginning to end, from thoracic vertebra to lumbar vertebra, and observe whether the two sides of the spine are uneven. If the height of any part of the back is not equal under the buckling test, it is considered as a positive buckling test, which often suggests that there is vertebral rotation, and scoliosis should be highly suspected. Schematic diagram of buckling test is shown in Figure 1. In addition, in the general examination of scoliosis, subjects with different lengths of both lower limbs should adopt sitting position for buckling test.
3. Trunk rotation measuring instrument inspection.
Take the trunk rotation measuring instrument as an example, as shown in Figure 2. The subject continued to maintain the flexion test posture as shown in Figure 1, and measured all segments (thoracic segment, thoracolumbar segment and lumbar segment) of the subject's spine with a trunk rotation measuring instrument, and recorded the maximum deflection angle (ATR) and its position. Scoliosis is highly suspected if the most serious part of the back asymmetry exceeds 5. In the screening, ATR ≥ 5 included most scoliosis with Cobb angle ≥10.
Attention should be paid to during inspection:
(1) observation, the line of sight must be on the same level with the affected part;
(2) When using the measuring instrument, hold the tool with both hands, and don't press it hard;
③ When measuring, the center line of the measuring instrument should be aligned with the spinous process and perpendicular to the ground, and the "0" scale of the measuring instrument should be above the spinous process.
4. Spine exercise test.
Those with abnormal physical examination or positive flexion test or ATR ≥ 5 should do spine exercise test, let them bend, stretch, bend left, bend right and twist left and right twice slowly, and then take a natural stance. The examiner checks the subject again with the trunk rotation measuring instrument.
5. Determination of screening results for scoliosis.
Screening results of scoliosis type determination
There is no abnormality in general inspection and buckling test, and there is no lateral bending if ATR < 5.
Poor posture is generally abnormal or positive in flexion test or ATR ≥ 5, but ATR < 5 is checked by trunk rotation measuring instrument after spinal exercise test.
If I degree of scoliosis is abnormal or flexion test is positive or ATR ≥ 5, the trunk rotation measuring instrument should be checked after spinal exercise test, and 5 ≤ ATR < 7.
For those with abnormal lateral curvature Ⅱ or flexion test or ATR ≥ 5, the trunk rotation measuring instrument should be checked after the spinal exercise test, and ATR ≤ 7 < 10.
For those with abnormal lateral curvature of ⅲ degree, positive flexion test or ATR ≥ 5, check the trunk rotation measuring instrument after spinal exercise test, and ATR ≥ 10.
(2) Examination of abnormal anteroposterior curvature of spine.
1. General inspection.
The client's upper body is bare, and he takes a natural standing posture and looks at the client from the side. Normally, the external auditory canal, acromion and greater trochanter are on the same vertical line. If the external auditory canal is behind the acromion and the vertical plane of the greater trochanter, the spine is excessively lordosis, especially the lumbar vertebrae, and the curvature of the spine is increased, which means that the abdomen is obviously lordosis when standing, and the back of the waist is obviously lordosis, which is a sign of lordosis and may be an abnormality of lordosis.
If the external auditory canal is in front of the acromion and the vertical plane of the greater trochanter, the thoracic curvature of the spine is enlarged, showing that the front chest collapses, the head and neck move forward, and the abdomen sinks back, which is a sign of hunchback and may be an abnormality of hunchback.
2. prone test.
It is generally used to check patients who are suspected of abnormal curvature of the spine, so that they can lie flat and prone on the examination table, relax and observe whether the kyphosis or lordosis of the spine has completely disappeared. If the signs of kyphosis or lordosis still exist obviously, the possibility of kyphosis or lordosis should be considered, and the prone test is positive.
3. Evaluation of abnormal results of anterior and posterior curvature of spine.
See Table 2 for the result evaluation of abnormal anteroposterior curvature of spine.
Screening results of judging the types of anterior and posterior curvature of spine
There is no abnormal anteroposterior curvature of the spine. The general examination of the lateral part of the spine showed no abnormal signs.
The whole body examination of the side with poor posture of the spine showed abnormal signs, but the prone test was negative.
Abnormal curvature of spine, abnormal lordosis, signs of scoliosis, positive prone test.
Abnormal hunchback. Lateral examination of spine showed signs of hunchback, and prone test was positive.
(3) Record the results.
Screening personnel should record the screening results in the Record Form of Abnormal Spine Bending Screening Results in time, and store them in the students' health files.
(5) Utilization of screening results.
Screening institutions shall timely organize and save relevant information to ensure the safety of students' information, and incorporate the screening results of abnormal spinal curvature into students' health records; Timely feedback the inspection results to students, parents and schools, and make suggestions. The screening results are not of diagnostic significance, and should be further examined in medical institutions with valid practice licenses to make a clear diagnosis.
1. Subjects whose assessment results are "normal" need not be referred or intervened, continue to maintain healthy behaviors, improve bad behaviors, follow up regularly, and participate in annual screening and monitoring;
2. If the assessment result is "bad posture", there is no need for referral, and it is necessary to change bad behavior, increase physical exercise and re-examine regularly;
3. For those who are assessed as "scoliosis" or "abnormal lordosis" or "abnormal kyphosis", screening institutions and schools should inform their parents of the abnormal screening results, issue a popular science manual on abnormal scoliosis, and suggest them to see a doctor in a specialized clinic of a regular hospital.