悟理治療部落

cobb angle約為35度 risser sign 看起來應是grade 1 risser sign 的grade有分5級 而他是看iliac crest的骨化程度 一般來說 grade 1跟2代表骨頭成長的機會還滿大的，而3以上就代表骨化程度相當高，其自然進步空間較小 以這個病人來說 他的cobb angle是35度(未大於40度)，而risser sign是grade 1，我會建議他先穿背架及做運動一段時間，看是否能矯正回來，若不行，再考慮是否開刀。 參考資料：以前的上課筆記

定義: Cobb's angle measurement used for evaluation of curves in scoliosis on an AP radiographic projection of the spine. When assessing a curve the apical vertebra is first identified; this is the most likely displaced and rotated vertebra with the least tilted end plate. The end/transitional vertebra are then identified through the curve above and below. The end vertebra are the most superior and inferior vertebra which are least displaced and rotated and have the maximally tilted end plate. A line is drawn along the superior end plate of the superior end vertebra and a second line drawn along the inferior end plate of the inferior end vertebra. If the end plates are indistinct the line may be drawn through the pedicles. The angle between these two lines (or lines drawn perpendicular to them) is measured as the Cobb angle. In S-shaped scoliosis where there are two contiguous curves the lower end vertebra of the upper curve will represent the upper end vertebra of the lower curve. Because the Cobb angle reflects curvature only in a single plane and fails to account for vertebral rotation it may not accurately demonstrate the severity of three dimensional spinal deformity. As a general rule a Cobb angle of 10 is regarded as a minimum angulation to define scoliosis. Risser's sign a grading system for ossification of the iliac crest apophysis which can be helpful in the prediction of spinal curve progression. Radiographically, ossification of the iliac crest begins laterally and then extends medially and eventually fuses to the ilium. The Risser grading system divides this progression into four stages: Risser 1: ossification of the lateral quarter Risser 2: ossification of the lateral half Risser 3: ossification of the lateral three-quarters Risser 4: complete ossification without fusion. Risser 5: fusion of the ossified apophysis to the ilium. A: The 13 y/o patient's cobb's angle: 25 degrees; risser sign: 4 意義： curve magnitude of cobb's angle愈大，代表the tedency of progress 程度也愈高。risser sign看的是生長板的骨化及癒合程度，還未生長完全的脊椎愈容易加重側彎的程度。這個病人屬於中度脊椎側彎(20~40 degrees 偏向容易惡化)，而生長板已鈣化(比較不易惡化)。 惡化率（risser sigh & cobb's angle)：23% 建議：　每４month 照一次x-ray，如果惡化除了原本的physical therapy 以外，配合穿戴背架 資料來源： 1。http://www.medcyclopaedia.com/ 2。http://www.pro-med.com.tw/edu/whatisscoliosis.htm

Cobb氏量角法（Cobb’s Angle） X光正面即可判斷側彎的準確位置並用Cobb氏量角法由上面最傾斜的椎體畫出垂直線並與下面最傾斜的椎體垂直線交叉所得之度數便是各別側彎的度數。 risser grading X光檢視骨骼生長板密合階段，年齡越小生長板尚未密合，側彎惡化的可能性越高。X光檢查手腕尺骨或骨盆腸骨。 Risser sign 0 : 36%惡化機率。 Risser sign 2 : 11%惡化機率。 Risser sign 5 : 非常低惡化機率。 資料來源: 1.http://www.pro-med.com.tw/edu/whatisscoliosis.htm

Cobb量角法（Cobb Angle） X光正面照即可判斷側彎的準確位置並用Cobb量角法由上面最傾斜的椎體畫出垂直線並與下面最傾斜的椎體垂直線交叉所得之度數便是側彎的度數。 測量大約：26度 Risser’s sign：患有脊椎側彎的女孩的骨骼成熟度 第2級 (第5級為已成熟)。 20~40度 女性個案比男性多6～10倍。（歐美臨床報告不一） 惡化機會較大。 保守治療：脊椎關節矯正、物理治療、運動治療。 每3個月X光定期追蹤檢查。 必須穿戴背架以減低其惡化的可能性 20~40度 女性個案比男性多6～10倍。（歐美臨床報告不一） 惡化機會較大。 保守治療：脊椎關節矯正、物理治療、運動治療。 每3個月X光定期追蹤檢查。 必須穿戴背架以減低其惡化的可能性 參考來源: http://tw.babelfish.yahoo.com/translate_url?doit=done&tt=url&trurl=http%3A%2F%2Fwww.medcyclopaedia.com%2Flibrary%2Ftopics%2Fvolume_vii%2Fr%2Frissers_sign.aspx&lp=en_zt&.intl=tw&fr=yfp http://www.e-onp.com.tw/chuansheng/front/bin/ptdetail.phtml?Category=113152&Part=file001 http://www.pro-med.com.tw/edu/whatisscoliosis.htm

PO兩次= =20~40度ㄉ PO錯了 Risser’s sign 分級 Risser 1 ： 側向處所的僵化 Risser 2 ： 側向一半的僵化 Risser 3 ： 僵化側向四分之三 Risser 4 ： 完成僵化，不用融合。 Risser 5 ： 僵化的隆起的融合向腸骨

病人的Cobb angle 約為23°左右，Risser granding 為2。 在臨床上，當Cobb角度介於20°-40°，屬於moderate scoliosis。從X-RAY中可以看到iliac約有一半左右出現鈣化，因此Risser granding為2，表示其生長板尚未完全癒合，惡化的程度較高（11％）。如果配合上Cobb angle來看，惡化率約為23％。 這樣的病人可以進行保守治療，例如脊椎關節矯正、物理治療、運動治療。但因有可能出現惡化情況，故每4個月要照一次X-ray，確定scoliosis的情形。如果有惡化情形，需以保守治療配合穿戴背架。 參考資料 學校講義 http://www.pro-med.com.tw/edu/whatisscoliosis.htm

the cobb's angle 約為18度,而 Risser sign為 grade 3, Risser sign主要用來判斷其骨骼的成熟度, 看iliac crest 其鈣化的程度,可分為grade 0-5, grade 1-4劃分為25%至100%,grade 5指iliac crest 與ileum完全fusion.若是grade 0表缺少鈣化,grade1,2代表骨骼仍尚未成熟, 而grade 3表示骨骼是正在成熟當中, grade 4表示spine開始停止生長,若達到grade 5則開始停止長高. 所以這個13歲的女孩, cobb;s angle約為18度,雖然尚屬mild scoliosis(<20度),但已在邊緣,另外Risser sign grade=3 其骨骼尚在成熟中,這樣在預估預後時,其預後也是較差的,因為隨著成熟,脊椎側彎惡化的可能性也較高.

1.cob's angle: 從開始變形的那一節平行disc劃一條水平線(上下各有一條水平線)兩條水平線再劃出其鉛垂線,兩條鉛錘線相交的角度就是cob's angle (表示scoliosis的程度) -此病人cob's angle約為30度 2. Risser's Sign Risser 1: 25% iliac apophysis ossification Anterior Superior iliac spine (anterolateral) Seen in prepuberty or early puberty (通常為青春期前) Risser 2: 50% iliac apophysis ossification Ossification extends halfway across iliac wing Seen immediately before or during growth spurt Risser 3: 75% iliac apophysis ossification. Indicates slowing of growth Risser 4: 100% ossification, with no fusion to iliac crest . Indicates slowing of growth (完全鈣化,但沒有與iliac crest相融合) Risser 5: Iliac apophysis fuses to iliac crest. Indicates cessation of growth (生長停止,與iliac crest相融合) --主要可以利用risser's grading來測量骨頭的年齡 所以可以得知spine的成熟程度,藉此幫助我們測量scoliosis的發展程度 資料來源:http://www0.sun.ac.za/ortho/webct-ortho/age/risser.html

Cobb’s Angle X光正面即可判斷側彎的準確位置並用Cobb氏量角法由上面最傾斜的椎體畫出垂直線並與下面最傾斜的椎體垂直線交叉所得之度數便是各別側彎的度數。 Risser grading: Risser 1: ossification of the lateral quarter Risser 2: ossification of the lateral half Risser 3: ossification of the lateral three-quarters Risser 4: complete ossification without fusion. Risser 5: fusion of the ossified apophysis to the ilium. 答: cobb's angle: 25° risser grading: 2

cob's angle約25度 Cobb method is a measurement used for evaluation of curves in Scoliosis on an AP radiographic projection of the spine. When assessing a curve the apical vertebra is first identified; this is the most likely displaced and rotated vertebra with the least tilted end plate risser grading為2 Risser's Sign Risser 1: 25% iliac apophysis ossification Anterior Superior iliac spine (anterolateral) Seen in prepuberty or early puberty Risser 2: 50% iliac apophysis ossification Ossification extends halfway across iliac wing Seen immediately before or during growth spurt Risser 3: 75% iliac apophysis ossification. Indicates slowing of growth Risser 4: 100% ossification, with no fusion to iliac crest . Indicates slowing of growth Risser 5: Iliac apophysis fuses to iliac crest. Indicates cessation of growth 治療：脊椎關節矯正、配合穿戴背架但需每4個月X光定期監控 參考資料：http://www.scoliosisnutty.com/cobb-angle.php http://www0.sun.ac.za/ortho/webct-ortho/age/risser.html http://www.pro-med.com.tw/edu/whatisscoliosis.htm

Cobb's angle:由上面最傾斜的椎體畫出垂直線並與下面最傾斜的椎體垂直線交叉所得之度數便是各別側彎的度數。 Rissor's sign:檢視骨骼生長板密合程度,共分五級(0~4),等級越高,表示已密合,惡化的機率很低,等級越低,表示尚未密合,惡化機率高! 從這張x-ray來看,這位13歲小女孩的cobb's angle測量約有30度,她的Apex在T10,Rissor's sign等級大概在1,是從她的iliac crest邊緣以及脊椎看生長板尚未癒合,然後配合有學者從側彎角度來分類惡化程度而定! 參考來源 http://www.pro-med.com.tw/edu/whatisscoliosis.htm http://tw.myblog.yahoo.com/jw!LRl1sTOcFRlAfWviMlZYa4M-/article?mid=296

cob's angle 依其角度將所有形式的脊椎側彎分成七級 第1級:0~20度 第2級:21~30度 第3級:31~50度 第4級:51~75度 第5級:76~100度 第6級:`101~125度 第7級:>126度或更大 測量方法為將一條平行於近端最末節椎體上緣的線,再會一條平行於遠端末節椎體下緣的線,在各自畫出其垂直線 ,兩條垂直線交角就是側彎的角度,此病人的角度約為30度,屬於第2級 Risser's Sign Risser 1: 25% iliac apophysis ossification Anterior Superior iliac spine (anterolateral) Seen in prepuberty or early puberty Risser 2: 50% iliac apophysis ossification Ossification extends halfway across iliac wing Seen immediately before or during growth spurt Risser 3: 75% iliac apophysis ossification. Indicates slowing of growth Risser 4: 100% ossification, with no fusion to iliac crest . Indicates slowing of growth Risser 5: Iliac apophysis fuses to iliac crest. Indicates cessation of growth 資料來源: Magge http://www0.sun.ac.za/ortho/webct-ortho/age/risser.html

The cobb's angle量角法是由由上面最傾斜的椎體畫出垂直線，並與下面最傾斜的椎體垂直線交叉所得之度數，算出來約為21度。Risser sign是骨骼發育檢驗， Risser 1: 25% Risser 2: 50% Risser 3: 75% Risser 4: 100% Risser 5: Iliac 和 iliac crest融合 因為女孩只有13歲尚在發育中，建議每4個月X光定期監控，並配合背架與物理治療 參考資料:http://www.pro-med.com.tw/edu/whatisscoliosis.htm

Cobb's angle Cobb's angle, a measurement used for evaluation of curves in scoliosis on an AP radiographic projection of the spine (Fig.1). When assessing a curve the apical vertebra is first identified; this is the most likely displaced and rotated vertebra with the least tilted end plate. The end/transitional vertebra are then identified through the curve above and below. The end vertebra are the most superior and inferior vertebra which are least displaced and rotated and have the maximally tilted end plate. A line is drawn along the superior end plate of the superior end vertebra and a second line drawn along the inferior end plate of the inferior end vertebra. If the end plates are indistinct the line may be drawn through the pedicles. The angle between these two lines (or lines drawn perpendicular to them) is measured as the Cobb angle. In S-shaped scoliosis where there are two contiguous curves the lower end vertebra of the upper curve will represent the upper end vertebra of the lower curve. Because the Cobb angle reflects curvature only in a single plane and fails to account for vertebral rotation it may not accurately demonstrate the severity of three dimensional spinal deformity. As a general rule a Cobb angle of 10 is regarded as a minimum angulation to define scoliosis. Risser's sign a grading system for ossification of the iliac crest apophysis which can be helpful in the prediction of spinal curve progression. Radiographically, ossification of the iliac crest begins laterally and then extends medially and eventually fuses to the ilium. The Risser grading system divides this progression into four stages: Risser 1: ossification of the lateral quarter Risser 2: ossification of the lateral half Risser 3: ossification of the lateral three-quarters Risser 4: complete ossification without fusion. Risser 5: fusion of the ossified apophysis to the ilium. As the iliac wings are frequently included on a full length spine radiograph the Risser sign may be used to estimate skeletal maturity without the need for additional radiographs. There is a much higher probability of spinal curve progression for children who are Risser 0 or 1, than for children who are Risser 2 to 5. In girls Risser 4 (Fig.1) generally corresponds with completion of spinal growth and the mean period between onset of iliac ossification and Risser 4 is 1 year. The Risser sign is considered a less reliable indicator in boys, with iliac ossification starting relatively early with respect to further growth potential.

cob's angle測量,一般適用前後觀的X-ray. 劃一條平行於近端最末節椎體下緣的線,在各自劃出垂直線,兩垂直線交叉的交角就是側彎的角度. Risser grading 脊椎側彎的角度達到25度且骨骼尚未成熟便需密切追蹤。一般青少女進入生長快速期，約3至4個月追蹤一次； 若無明顯增加超過5度時，則改為6個月追蹤一次，直到骨骼成熟期。骨骼尚未成熟的脊椎側彎站立角度達25度以上40度以下時，建議穿著背架治療並且仍需定期追蹤到腸骨上塉第四度（Risser grade 4）才可以脫除背架。脊椎側彎背架治療的目的僅是穩定角度直到骨骼成熟期。它的效果約有8成，但不可能使側彎角度回復正常。背架不需穿著一輩子，而且骨骼發育成熟或角度超過40度病患也無使用之必要性。骨骼發育成熟的脊椎側彎病患，若胸椎側彎角度超過50度或腰椎側彎角度超過30度，仍需持續追蹤有無惡化現象。

Cobb's angle 量測法,劃一條平行於近端最末節椎體上緣的線,在劃一條平行於近端最末節椎體下緣的線,在各自劃出其垂直線,兩垂直線的交角就是側彎的角度. 依其角度將所有形式的側彎分即可分為七級 第一級:0~20度 第二級:21~30度 第三級:31~50度 第四級:51~75度 第五級:76~100度 第六級:101~125度 第七級:126度或更大

cobb's angle 大約為20~25度 定義為: X光正面,由上面最傾斜的椎體畫出垂直線,並與下面最傾斜的椎體垂直線交叉,所得之度數便是各別側彎的度數。 Risser grading 應該是3, 因為13歲女孩的骨頭應該還在發育當中。 定義為: Risser 1: 25% iliac apophysis ossification Anterior Superior iliac spine (anterolateral) Seen in prepuberty or early puberty Risser 2: 50% iliac apophysis ossification Ossification extends halfway across iliac wing Seen immediately before or during growth spurt Risser 3: 75% iliac apophysis ossification. Indicates slowing of growth Risser 4: 100% ossification, with no fusion to iliac crest . Indicates slowing of growth Risser 5: Iliac apophysis fuses to iliac crest. Indicates cessation of growth 資料來源: http://www.pro-med.com.tw/edu/whatisscoliosis.htm http://www0.sun.ac.za/ortho/webct-ortho/age/risser.html

Cob's angle: 由開始傾斜的椎體上緣畫一平行線與結束(最後一個傾斜)的椎體下緣畫一平行線,兩線交叉即是所求角度 Risser grading: Risser sign 是鑑定 iliac crest 骨化程度,分為四級 Risser 1 :由iliac crest 外側1/4處出現(25%) Risser 2 :沿著iliac crest向內進展至crest的一半(5o%) Risser 3:繼續向內進展至3/4處(75%) Risser 4:骨化完全覆蓋整個iliac crest,但沒有fusion Risser 5:骨化覆蓋整個iliac crest,且fusion 這女孩的Cob's angle約在20度 Risser grading屬於第二級,假設病人趨近於成熟(約Risser grades 2~4),又加上有輕微的脊椎側彎,有23%的可能骨化的級數會繼續發展,雖然目前己住色灣並不嚴重,但女孩已步入青少年,正在發育的骨骼可能會加重側彎的情形,目前可以採用運動治療及正確的生活姿勢,如有需要配合背架的輔助以防止惡化,並定期接受追蹤檢查 參考資料 http://www.e-radiography.net/radpath/c/cobbs-angle.htm http://www.e-radiography.net/radpath/r/risser-sign.htm#TOP

Cobb’s angle為25度。 Risser grade 2。 Cobb’s angle:可用X光片即判斷側彎的位置，由上面最傾斜的椎體畫出垂直線並與下面最傾斜的椎體垂直線交叉所得之度數便是各別側彎的度數。 Risser grade: ·Risser 1: 25% iliac apophysis ossification Anterior Superior iliac spine (anterolateral) Seen in prepuberty or early puberty ·Risser 2: 50% iliac apophysis ossification Ossification extends halfway across iliac wing Seen immediately before or during growth spurt ·Risser 3: 75% iliac apophysis ossification. Indicates slowing of growth ·Risser 4: 100% ossification, with no fusion to iliac crest . Indicates slowingof growth ·Risser 5: Iliac apophysis fuses to iliac crest. Indicates cessationof growth 由其iliac crest邊緣已產生鈣化現象，但還處於生長狀態，惡化機率約為11%。建議得追蹤觀察，配合穿戴背架和物理治療。

字打錯 (錯的)己住色灣 (更正)脊柱側彎

Cobb.s angle (約26度) X光正面即可判斷側彎的準確位置並用Cobb氏量角法由上面最傾斜的椎體畫出垂直線並與下面最傾斜的椎體垂直線交叉所得之度數便是各別側彎的度數。 Cobb.s angle level: normal <10度 mild <20度:以保守的運動治療為主 moderate 20~40度:須配合穿戴背架及進行運動治療 severe >40~50度:若非侵入性的治療無效就必須考慮進行手術矯正治療 Ps如果>60度:可能會有心肺方面的問題 Risser grade: grade 1 describes up to 25 percent ossification grade 2 describes 26 to 50 percent ossification grade 3 describes 51 to 75 percent ossification grade 4 describes greater than 76 percent ossification grade 5 describes full bony fusion of the apophysis.