[A twenty-year research on the pathogenesis of functional disorders of the respiratory tract in children and adolescents with idiopathic scoliosis].

The aim of this study was to assess functional efficiency of the respiratory tract in relation to the progression of idiopathic scoliosis. Within twenty years examinations were carried out in a group of 300 children aged 10-19 years with idiopathic scoliosis grade I according to Cobb (spinal curvature up to 30 degrees) and in the group of 100 children aged 12-19 years with progressive scoliosis grades II, III, IV (from 50 to 100 degrees according to Cobb). All the children were the patients of the Orthopaedic and Outpatient Rehabilitation Clinic. The control group were healthy children at the same age as the studied group without ailments of the respiratory tract as well as the osseous--muscular and nervous system. The children with scoliosis grade I according to Cobb were first assessed psychologically and then subjected to anthropometric examination. All the children were participants of Scout Healthcare Camps. Before and after a four-week rehabilitation camp and after paediatric examination spirometric measurements were done using Vitalograph and the following indexes were determined FVC, FVC%N, FEF1, FEF1%N, FEV1%FVC, MMEF, MMEF%N and PEF, PEF%N. During the stay at the camp the children did intensive physical and pulmonary exercises. On the basis of 5-year observations and spirometric examinations disorders in somatic development were shown in children in the initial stage of idiopathic scoliosis. In the studied group of children in the initial stage of scoliosis no disturbances in basic spirometric indexes were found. Vital capacity (FVC) and forced expiratory volume in one sec. (FEV1) were within the norm. Peak Expiratory Flow (PEF) is the first index indicating the dysfunction of the upper respiratory tract in children with scoliosis grade I. Intensive exercise and daily pulmonary rehabilitation improved ventilatory lung indexes FVC, FEV1. However, changes in the peripheral respiratory tracts defined by MMEF did not improve despite intensive pulmonary rehabilitation. Apart from this, in children with progressive scoliosis pletysmographic measurements were performed using Body-Master-Laab, Jaeger. The following indexes were defined: residual volume-RV, Intrathoracic gas volume-ITGV and total lung capacity-TLC. Total resistance of the bronchial tree was measured. In children with idiopathic scoliosis grades II, III (mean 63 degrees according to Cobb) statistically significantly decreased values of lung capacity and volume were determined: TLC, ITGV, FVC and FEV1, PEF. The reduced values of all measured indexes of flow volume curve MEF75%VC, MEF50%VC, MEF25%VC were shown. Maximum expiratory flows in relation to total lung capacity TLC and vital capacity FVC, determined as so called compensatory indexes, were calculated.