40579名中小学生脊柱常规普查分析

Screening for spinal deformities in 40579 students.

目的采用前屈试验普查中小学生脊柱畸形，专科医生用前屈试验和脊柱测量复查，有针对性地进行x线摄片。方法用前屈试验普查29所中小学生脊柱畸形。学校通知家长到专科作进一步检查，当前屈试验阳性，脊柱测量≥5°时，对脊柱作x线检查。结果普查40579名学生，发现脊柱可疑畸形的学生有851人，占学生总数的2．136％。复诊的学生有198人，〈10岁组45人，10-14岁组114人，〉14岁组39人。在各年龄组间比较脊柱测量和前屈试验的阳性率，x2值分别为10．00和10．25，P值均〈0．01，各组间检出率的差别有显著统计学意义。比较x线检查Cobb角〉10°者的阳性率，x2值=1．25，P值〉0.05，各组间差异无统计学意义。结论前屈试验和脊柱测量在学生脊柱畸形的常规体检中简单易行。专科医生把握好前屈试验和脊柱测量的阳性程度，有针对性和选择性地进行x线检查，能够降低学生的x线曝光率。

Objective To screen spinal deformity in Shenzhen Schools by Adam＇s forward bend test and to reexamine suspicious scoliosis students by further bend test, scoliometer （Orthopedic Systems INC, OSI 1995 ） and X-ray. Methods The initial screen was took place in each school physical exam room by senior female nurses from Children＇ s Hospital using Adam＇ s forward bending test. Students with forward bend test positive and scoliometer readings of 5° or more were referred to a standing posterior-anterior radiograph. Results In 2004, a total of 40 579 school children and adolescents were screened in 29 schools in FuTian District, Shenzhen. By initial bend test screening, eight hundreds and fifty one students were taken as suspicious spinal malformation. The total prevalence rate of suspicious scoliosis was 2. 136%. of 851 suspicious spinal deformity students, 198 were referred to pediatric orthopedics clinic and were reexamine with bend test and sooliometer by one of authors（Tang） and those who with bending test positive and 5 or more degree of scoliometer were refereed for further X-ray. In under 10 years group, 8 students （8/45） were detected by scoliometer as 5 degree or more; in 10 - 14 group, 48 （48/114） with 5 or more; in beyond 14 years group, 17 （ 17/39） with 5 or more. The x2 value of incidence of scoliometer 5 degree or more in each age group was 10.00 and p value was significant different. For comparing the prevalence rate difference of Cobb＇ s angle equal or beyond 10 degree, the x2 value was 1.25 and P value was no significant difference. Conclusions It shows that Adams bending test and Scoliometer were simple and effective approach for vertebral malformation screen in school regular physical examination. Those who were detected the back asymmetry by bend test with scoliometer 5 degree or more should be refer to orthopedist who decided whether x-ray should took.