Mechanism of change in the orientation of the articular process of the zygapophyseal joint at the thoracolumbar junction

The orientation of the superior articular processes in thoracic and lumbar vertebrae differs. The present study was undertaken to investigate the possible mechanism for the change from a posterolaterally facing superior articular surface in the thoracic region to a posteromedially facing curved articular surface in the lumbar region. The material of the study consisted of dry macerated bones of 44 adult human vertebral columns. The orientation of the superior articular process and its relation to the mamillary tubercle (process) was examined between T9 and L5 vertebrae in each column. An abrupt change from the thoracic to lumbar type of articular process was observed in 3 columns (7%). Forty-one (93%) columns showed a gradual change extending over either 2 or 3 successive vertebrae. The present study suggests that the change in the orientation of the superior articular process, from the coronal to the sagittal plane (sagittalisation), occurs due to the change in the direction of weight transmission through zygapophyseal joints at the thoracolumbar junction. It was observed that the gradual sagittalisation of the superior articular process in the transitional zone brought it close to the mamillary tubercle which eventually fused with it. Thus the study suggests that the characteristic posteromedially facing concave superior articular process of lumbar vertebrae may have formed because of the fusion of the articular process and the mamillary tubercle.     

Differentiation and classification of thoracolumbar transitional vertebrae

The literature states that transitional vertebrae at any junction are characterized by features retained from two adjacent regions in the vertebral column. Currently, there is no published literature available that describes the prevalence or morphology of thoracolumbar transitional vertebrae (TLTV). The aim of this study was to identify the qualitative characteristics of transitional vertebrae at the thoracolumbar junction and establish a technique to differentiate the various subtypes that may be found. A selection of vertebral columns from skeletal remains (n = 35) were evaluated in this study. Vertebrae were taken based on features that are atypical for vertebrae in each relative region. The transitional vertebrae were qualitatively identified based on overlapping thoracic and lumbar features of vertebrae at the thoracolumbar junction. The following general overlapping characteristics were observed: aplasia or hypoplasia of the transverse process, irregular orientation on the superior articular process and atypical mammillary bodies. The results show that the most frequent location of the transitional vertebrae was in the thoracic region (f = 23). The second most frequent location was in the lumbar region (f = 10). In two specimens of the selection (f = 2), an additional 13th thoracic vertebra was present which functioned as a transitional vertebra. This study concluded that one can accurately identify the characteristics of transitional vertebrae at the thoracolumbar junction. In addition, the various subtypes can be differentiated according to the region in the vertebral column the vertebra is located in and the relative number of vertebral segments in the adjacent regions of the vertebral column. This provides a qualitative tool for researchers to differentiate the transitional vertebrae from distinctly different typical thoracic or lumbar vertebrae at the thoracolumbar junction.     

Shape variation of the neural arch in the thoracic and lumbar spine: characterization and relationship with the vertebral body shape

Quantifying the human vertebral geometry is important for accurate medical procedures. We aimed to characterize the neural arch (NA) shape at T1-L5. All T1-L5 dry vertebrae (N = 4,080) of 240 individuals were measured and analyzed by age, gender, and ethnicity. A 3D digitizer was used to measure the dimensions of the spinous (SP) and transverse (TP) processes, vertebral canal (VC), laminae, and isthmus. Most parameters were independent of age and ethnicity, yet greater in males than in females. Isthmus length increases from T1 (9.8 mm) to T12 (19.87 mm) and decreases from T12 to L5 (9.68 mm) with right > left in the thorax and oppositely in the lumbar region. The SP is longer than its thickness both decreasing in the upper thorax (by ca. 4mm), increasing in the lower thoracic and upper lumbar vertebrae (by 7 mm for length and ca. 14.5 mm for thickness) and decreasing again along the lower lumbar vertebrae (both by 8 mm). The TP length decreases at T1-T12 (by 13 mm) and increases at L1-L5 with left > right at T1-L5 (P < 0.003). The laminar length decreases from T1 (8.72 mm) through T5 (4.76 mm) and increases toward L5 (8.4 mm) with right > left at T1-L5 (P < 0.003). The VC is oval-shaped at T1 and T11-L5 (width > length), rounded-shape at T2 and T10 (width = length), and inverted oval-shaped at T3-T9 (length > width). In conclusion, the NA is systematically asymmetrical and dynamic in shape along the thoracic and lumbar spine. The inter-relationship with the vertebral body and articular facets is discussed.     

Radiographic and Magnetic Resonance Imaging Identification of Thoracolumbar Spine Variants with Implications for the Positioning of the Conus Medullaris in Rhesus Macaques

The anatomy of the vertebral column in mammals may differ between species and between subjects of the same species, especially with regards to the composition of the thoracolumbar spine. We investigated, using several noninvasive imaging techniques, the thoracolumbar spine of a total of 44 adult rhesus macaques of both genders. Radiographic examination of the vertebral column showed a predominant spine phenotype with 12 rib‐bearing thoracic vertebrae and 7 lumbar vertebrae without ribs in 82% of subjects, whereas a subset of subjects demonstrated 13 rib‐bearing thoracic vertebrae and 6 lumbar vertebrae without ribs. Computer tomography studies of the thoraco‐lumbar spine in two cases with a pair of supernumerary ribs showed facet joints between the most caudal pair of ribs and the associated vertebra, supporting a thoracic phenotype. Magnetic resonance imaging (MRI) studies were used to determine the relationship between the lumbosacral spinal cord and the vertebral column. The length of the conus medullaris portion of the spinal cord was 1.5 ± 0.3 vertebral units, and its rostral and caudal positions in the spinal canal were at 2.0 ± 0.3 and 3.6 ± 0.4 vertebral units below the thoracolumbar junction, respectively (n = 44). The presence of a set of supernumerary ribs did not affect the length or craniocaudal position of the conus medullaris, and subjects with13 rib‐bearing vertebrae may from a functional or spine surgical perspective be considered as exhibiting12 thoracic vertebrae and an L1 vertebra with ribs. Anat Rec, 300:300–308, 2017. © 2016 Wiley Periodicals, Inc.     

Trajectory architecture of the trabecular bone between the body and the neural arch in human vertebrae

The cancellous structure of vertebrae has been studied to investigate the direction of trabeculae and thus the lines of stress. The trabecular bone of the pedicle, connecting the body to the lamina, differed in different regions of the vertebral column. At C2 level, it was found that trabeculae are involved in transfer of th column. At C2 level, it was found that trabeculae are involved in transfer of the compressive forces from the superior articular surface to the inferior articular process and body. Throughout the thoracic region, trabeculae in the pedicle were inclined anteriorly towards the body, indicating that compressive forces in the thoracic spine are transferred from the neural arch to the body. In the lower lumbar region, trabeculae run from the body towards the neural arch. Trabeculae in the thoracic transverse processes extend from the costal facet to the lamina, suggesting that weight brought by the ribs to the costotransverse articulations is transmitted to laminae through transverse processes.     

The cat vertebral column: stance configuration and range of motion

This study examined the configuration of the vertebral column of the cat during independent stance and in various flexed positions. The range of motion in the sagittal plane is similar across most thoracic and lumbar joints, with the exception of a lesser range at the transition region from thoracic-type to lumbar-type vertebrae. The upper thoracic column exhibits most of its range in dorsiflexion and the lower thoracic and lumbar in ventroflexion. Lateral flexion is limited to less than 5° at all segments. The range in torsion is almost 180° and occurs primarily in the midthoracic region, T4-T11. Contrary to the depiction in most atlases, the standing cat exhibits several curvatures, including a mild dorsiflexion in the lower lumbar segments, a marked ventroflexion in the lower thoracic and upper lumbar segments, and a profound dorsiflexion in the upper thoracic (above T9) and cervical segments. The curvatures are not significantly changed by altering stance distance but are affected by head posture. During stance, the top of the scapula lies well above the spines of the thoracic vertebrae, and the glenohumeral joint is just below the bodies of vertebrae T3-T5. Using a simple static model of the vertebral column in the sagittal plane, it was estimated that the bending moment due to gravity is bimodal with a dorsiflexion moment in the lower thoracic and lumbar region and a ventroflexion moment in the upper thoracic and cervical region. Given the bending moments and the position of the scapula during stance, it is proposed that two groups of scapular muscles provide the major antigravity support for the head and anterior trunk. Levator scapulae and serratus ventralis form the lateral group, inserting on the lateral processes of cervical vertebrae and on the ribs. The major and minor rhomboids form the medial group, inserting on the spinous tips of vertebrae from C4 to T4. It is also proposed that the hypaxial muscles, psoas major, minor, and quadratus lumborum could support the lumbar trunk during stance. Received: 2 January 1997 / Accepted: 23 September 1997     

Functional adaptations of facet geometry in the canine thoracolumbar and lumbar spine (Th10-L6).

The shape, size and transverse distance between contralateral caudal articular processes of caudal thoracic and lumbar vertebrae were evaluated in a sample of 140 macerated canine spines to contribute to the understanding of the development of vertebral misalignment. Dogs were grouped as large, chondrodystrophic, and small breeds. In large dogs, caudal articular surfaces were adapted to higher body-weight by the presence of larger articular surfaces. Additionally, caudal articular surfaces not only covered the lateral, but also the ventral (i.e. ventral facet) and/or caudal aspects (i.e. caudal facet) of the caudal articular processes. Ventral facets, which increase loading capacity of the zygapophyseal joints in normally aligned vertebrae, were more frequently observed in large breeds (p < 0.001) than in small and chondrodystrophic breeds. With some exceptions, caudal facets primarily were present in large dogs, especially at the vertebral levels L3-L5. Their formation is induced by extension of the normal lykphotic thoracic and lumbar spine causing lumbar lordosis and denotes loss in elasticity of the bow-and-string-construction of the trunk. Because ventral and caudal facets are consistent with convexity of the caudal articular surfaces, which to a great degree was noted to result in formation of ball-and-socket joints, spinal stability is supposed to be decreased under such conditions.     

Anatomical relationship and positions of the lumbar and sacral segments of the spinal cord according to the vertebral bodies and the spinal roots

Segments of the spinal cord generally do not correspond to the respective vertebral level and there are many anatomical variations in terms of the segment and the level of vertebra. The aim of this study is to investigate the variations and levels of lumbar and sacral spinal cord segments with reference to the axilla of the T11, T12, and L1 spinal nerve roots and adjacent vertebrae. Morphometric measurements were made on 16 formalin fixed adult cadaveric spinal cords. We observed termination of the spinal cord between the axilla of the L1 and L2 spinal nerve roots in 15 specimens (93.8%). In all cadavers the emergence of the T11, T12, and the L1 spinal nerve roots was at the level of the lower one‐third of the same vertebral body. In 15 specimens (93.8%), the beginning of the lumbar spinal cord segment was found to be above the T11 spinal nerve root axilla and corresponded to the upper one‐third of the T11 vertebral body. The beginning of the sacral spinal cord segment occurred above the L1 spinal nerve root axilla and corresponded to the upper one‐third of the L1 vertebral body. The results of this study showed that when the conus medullaris is located at the L1–L2 level, the beginning of the lumbar spinal cord segment always corresponds to the body of T11 vertebra. This study provides detailed information about the correspondence of the spinal cord segments with reference to the axilla of the spinal nerve roots. Clin. Anat. 27:227–233, 2014. © 2013 Wiley Periodicals, Inc.     

椎板下棘的形态学特点及其临床意义

目的：观测椎板下棘的形态特点，探讨其在显微内窥镜腰椎间盘切除术(MED)中的临床意义。方法：对42具成人干燥椎骨和10件脊柱腰骶段标本的椎板下棘进行观测，分析其对椎间管构成的影响；结合MED术式的通道和操作过程，分析其可能导致的并发症。结果：椎板下棘位于椎板下缘前外近椎弓根下切迹处。可出现于所有胸腰椎，出现率为83．3％；出现率最高在第12胸椎，为52．4％。椎板下棘分布不规则，出现在胸腰段较多。结论：椎板下棘是胸腰椎的骨性结构，有必要给予命名；椎板下棘参与构成神经根管的骨性后壁，可造成神经根受压；后路MED可引起椎板下棘断脱，造成神经根受压或损伤。     

腰椎爆裂骨折椎体松质骨内力学分布特点的有限元研究

目的运用有限元方法模拟腰椎爆裂骨折的过程,观察腰椎在轴向压缩载荷作用下松质骨内的应力分布情况。方法建立正常人体胸腰段(T12~L2)运动节段的三维有限元模型,在T12椎体上表面施加不同等级的压力(0.4、0.6、0.8、1.0、1.2 k N),模拟腰椎爆裂骨折发生时椎体承受的不同等级的轴向压缩载荷。将连接椎体上下终板凹面顶点的连线7等分,在此基础上将L1椎体中的松质骨划分为7个具有统计节点的层面,每个统计层面划分成6个统计区。分别测量L1椎体松质骨内3个层面(第1、4、7层面)18个统计区的平均应力。在同一等级载荷下对3个层面内的平均应力进行单因素方差分析,分析腰椎椎体松质骨内不同载荷作用下的应力分布情况。结果在5个不同等级载荷下,第1、7层松质骨平均应力分别与第4层比较有统计学意义(P0.05),而第1、7层平均应力比较无统计学意义(P0.05)。轴向加载时,相比第1、7层应力,椎体松质骨中间层面(第4层)应力最小。结论腰椎在轴向压缩载荷作用下,椎体松质骨内存在应力集中的现象,接近椎体上下软骨板的松质骨应力较大,而椎体松质骨中间层面应力较小,椎体内应力集中分布在上下软骨板的特点与腰椎爆裂骨折所致终板破裂的生物力学机制相一致,提示腰椎椎体骨结构损伤可能与椎体内应力集中有关。     

Lower axial skeleton of the musk shrew (Suncus murinus)

Macroscopic structure as well as pre- and postnatal development of the lumbar, sacral, and caudal vertebrae of the musk shrew (Suncus murinus, Insectivora) were observed. The lumbar vertebrae possess two pairs of unusual processes, hyperapophyses and hypapophyses. The hyperapophyses are located on the dorsal surface of the caudal articular processes of all the lumbar vertebrae, whereas the hypapophyses are found on the caudal part of the ventral surface of the bodies in the first few lumbar vertebrae. The former gives attachment to the Mm. rotatores lumborum and the latter to the Mm. psoas major and minor. The articular processes of the lumbar vertebrae are oriented more horizontally compared with those in other mammals. The sacrum is very narrow transversely due to poor development of the ventrolateral wing. The auricular surface includes cranial parts of the wing and of the fused vertebral arches as well as the cranial articular process of the first sacral vertebra. In the caudal vertebrae, chevron bones are H-shaped when viewed ventrally, and give attachment to tendons of the caudal muscles. This report describes the relationships between the structural peculiarities of the lower axial skeleton and the locomotive habits of the musk shrew.     

Regional differences in zygapophysial joint cavities: A histological study of human fetuses

Human zygapophysial joints (ZJ) have regional differences in shape and orientation during prenatal growth. However, there is limited knowledge of the synovial recess during fetal development. We examined sagittal and horizontal histological sections of the vertebral columns of 30 human fetuses at gestational ages of 8–37 weeks. Fetuses of all gestational ages had subaxial cervical articular processes that were thicker than in the thoracolumbar regions, and as large as the corresponding vertebral bodies. A small or large synovial recess extending beyond the articular cartilage was evident at most regions. The cervical ZJ had large or deep recesses that extended inferiorly in midterm fetuses and posteromedially along the vertebral pedicle and lamina in near-term fetuses. Likewise, the thoracic ZJ had small recesses that extended superiorly in midterm fetuses and medially in near-term fetuses. The lumbar recesses extended laterally beyond the medially shifted articular cartilage of the upper adjacent vertebrae in near-term fetuses and the lumbar articular surface was smallest in the three regions at all stages. At any region, a deep recess appeared before an area expansion of the ZJ cartilage. A drastic change in direction and size of the prenatal recess seemed to occur depending on a possible minute dislocation of the ZJ. In particular, a deep posteromedial recess of the cervical ZJ, which extended far beyond the articular cartilage, might be necessary to maintain high flexibility suitable for the strong flexion posture in utero.     

The orientation of the articular facets of the zygapophyseal joints at the cervical and upper thoracic region

Knowledge of the orientation of facet joints in the cervical and upper thoracic region is important for understanding the biomechanical properties and clinical conditions relevant to the neck. The study was undertaken on dry macerated bones from 30 adult male human vertebral columns. The orientation of the superior articular facets in relation to their inclination with the sagittal and transverse planes was examined between C3 and T3 vertebrae in each column. The linear dimensions of the superior articular facets and the width/height ratio were also calculated. The results show that all vertebrae at C3 level and 73% at C4 level displayed posteromedially facing superior articular facets. Similarly at T1 level (C7/T1 joint) and below, all columns showed posterolaterally facing superior articular facets. The level of change in orientation, from posteromedial to posterolateral facing superior facets, was not constant and occurred anywhere between C4 (C3/C4 joint) and T1 (C7/T1 joint). The change in orientation followed 2 different patterns, i.e. sudden or gradual. The C6 vertebra (C5/C6 joint) was the most frequent site to show the transition. The shape of the superior articular facets was circular to oval at C3, C4 and C5 levels and gradually changed to a transversely elongated surface at C7 and T1. These findings correlate well with various cervical movements and associated clinical conditions.     

腰椎经旁正中椎板切开复位术有效性及安全性的解剖学研究

目的 通过解剖实验,探讨旁正中椎板切开复位技术应用于腰椎椎管手术的安全性。方法 选用10具经10%甲醛固定的成人尸体标本,进行两部分实验。(1)选取4具标本,分别截取L_1~5 5个椎体,采用去除软组织并代之以柔性彩泥包裹的方法,制作实验模块共计20个,进行椎板撑开实验。将每个椎体单侧椎板依次撑开8、10、12 mm时,测量显露椎管底壁的宽度。继续增加椎板撑开宽度,直至椎管环形骨性结构断裂,记录此时椎板撑开宽度及骨折发生位点。(2)另6具标本分为椎板撑开8 mm组、10 mm组、12 mm组,各2具。各组标本以L₁、L₂为目标节段进行旁正中椎板劈开复位术的模拟手术操作,设定椎板撑开宽度分别为8、10、12 mm,记录不同椎板撑开宽度下,椎管内操作完成度,观察手术节段有无骨折,相邻韧带及关节囊有无撕裂。结果 (1)椎板撑开实验中,当椎板撑开8、10、12 mm时,椎管底壁显露宽度分别为(10.63±0.59)mm、(13.92±0.79)mm、(17.81±1.10)mm,3组间比较差异有统计学意义(F=18.260, P＜0.01)。20个椎体单元因椎板撑开导致骨折的撑开宽度为11.8~16.5(14.26±1.34)mm。其中,5个发生同侧椎弓根骨折,4个为对侧椎板骨折,11个为对侧椎弓根骨折。(2)模拟手术操作,椎板撑开8 mm组,因操作受限,均未能完成手术操作实验。椎板撑开10 mm组和12 mm组,均可以完成椎管内硬脊膜切开及缝合、马尾神经充分探查等操作,后者较前者操作自由度更高。模拟手术操作后,检查手术节段未见骨折和椎体间韧带及关节囊撕裂。结论 旁正中椎板劈开复位术进行腰椎椎管内手术,具有一定可行性和有效性;椎板撑开10～12 mm是相对安全有效的工作距离。     

经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗胸腰椎转移性肿瘤

背景：经皮椎体后凸成形治疗已被广泛用于椎体骨质疏松性压缩性骨折,现在亦被用于治疗椎体转移性肿瘤。 目的：评估采用经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗胸腰椎转移性肿瘤效果。 方法：回顾性分析经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗胸腰椎转移性肿瘤病例共24例38椎,分为椎体压缩≥1/4组9例11椎和椎体压缩< 1/4组15例27椎。在C臂机透视定位下行经皮椎体后凸成形,采用分次灌注、温度梯度灌注方法注射骨水泥。以目测类比评分及Owestry功能障碍指数评估经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗前后疼痛缓解情况,日常功能恢复情况,治疗椎的高度变化。随访时间为12-56个月。 结果与结论：24例患者均成功完成经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗。平均单个胸椎内注射骨水泥(4±1) mL,单个腰椎内注射骨水泥(5±1) mL。治疗后复查X射线片见骨水泥分布良好,无神经根损伤或脊髓压迫症状。两组患者治疗后椎体高度显著高于治疗前(P < 0.05)。所有患者治疗后1 d、治疗后1个月及末次随访时目测类比评分、功能障碍指数值均显著低于治疗前(P < 0.05);两组相同时间点目测类比评分、功能障碍指数评分的改变值差异无显著性意义。结果表明经皮椎体后凸成形分次和温度梯度灌注骨水泥治疗胸腰椎转移性肿瘤,可减少骨水泥渗漏的发生,不论肿瘤转移椎体有无明显压缩,均能迅速缓解疼痛,是治疗椎体转移肿瘤的有效方法。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

Vertebral pattern variation in the North Sea harbor porpoise (Phocoena phocoena) by computed tomography

Vertebral series in the harbor porpoise (Phocoena phocoena) include cervical, thoracic, lumbar, and caudal. In contrast to studying skeletons from museums, in which small bones can be missed, evaluation of full body computed tomography (CT) scans provides an overview of the vertebral column, while maintaining interrelationship of all structures. The aim of this study was to document variations in vertebral patterning of the harbor porpoise via evaluation of CT images of intact stranded harbor porpoises. The harbor porpoises were divided into age classes, based on developmental stage of reproductive organs on postmortem examination and closure of proximal humeral physis on CT. Numbers of vertebrae per series, fusion state of the syncervical, type of first hemal arch, number of double articulating ribs, and floating ribs were recorded based on CT images. Included in the study were 48 harbor porpoises (27 males and 21 females), which were divided in two age classes (27 immatures and 21 adults). Total vertebral count varied from 63 to 68 with vertebral formula range C7T12-14L12-16Cd29-33. Twenty-five different vertebral formulas were found, of which C7T13L14Ca30 was the most common (n = 8, 17%). Thoracic vertebrae with six, seven, or eight double articulating ribs and zero, one, or two vertebrae with floating ribs were seen. Four different fusion states of the syncervical and four types of hemal arches were recognized. This study showed a great variation in vertebral patterning in the harbor porpoise, with homeotic and meristic variation in the thoracic, lumbar, and caudal vertebral series.     

经肋骨入路椎体强化术适应证的影像解剖学观察及临床应用效果

目的:探讨经肋骨入路行椎体强化术的适应证和治疗效果。方法:回顾性研究。纳入无锡市第九人民医院影像科数据库2019年1—12月100例患者的胸椎CT影像资料,其中男女各50例,年龄20~70岁。利用CT影像模拟经肋骨入路沿通道中心轴插入直径4 mm穿刺针,观察穿刺针在横断面和矢状面上可到达椎体内的位置。纳入2018年1月...     

正常腰椎表观弥散系数值大小及其变化规律

目的探讨正常腰椎表观弥散系数(ADC)值的大小及其腰椎1～5椎体ADC值大小的变化关系,以及腰椎ADC值随年龄变化规律。方法125例正常志愿者,其中男性78例,女性47例;年龄12～68岁,平均年龄43.21岁(标准差11.75岁)。其中≤20岁26例,男性17例,女性9例;20～40岁61例,男性37例,女性24例;>40岁38例,男性26例,女性12例。回顾分析其临床及MRI显示正常的腰椎病例,感兴趣区(ROI)大小分别取33、66、132、165、198、231、264、297mm2,分别测量并计算腰椎1～5椎体的ADC均值及腰椎总均值,按年龄分组分成≤20岁、20～40岁及>40岁3组,计算3组ADC均值,并作统计分析。结果腰椎ADC(×10-4mm2/s)总均值为1.92±0.79;腰椎1～5椎体的ADC(×10-4mm2/s)值分别为2.00±0.76、1.88±0.71、1.87±0.87、1.88±0.83及1.99±0.75。经t检验显示,腰椎1、5椎体间差异无统计学意义,腰椎2、3、4椎体间差异无统计学意义(P>0.05),腰椎1、腰椎5与腰椎2、3、4椎体间差异有统计学意义(P<0.05)。腰椎1～3椎体的ADC值呈逐渐变小趋势,腰椎1与腰椎5椎体的ADC值接近。≤20岁、20～40岁及>40岁3组的ADC(×10-4mm2/s)值分别为1.94±0.77、1.93±0.82、1.89±0.79,3组间差异无统计学意义(P>0.05)。结论腰椎的ADC(×10-4mm2/s)总均值约为1.92±0.79,存在两头大中间小的变化趋势,测量病变腰椎的ADC值时,应选取与其正常情况下ADC值最接近的正常椎体作为对照较为适宜;随年龄增长,腰椎ADC值有下降的趋势。     

经皮穿刺椎体后凸成形中骨水泥渗漏入椎管与胸腰椎椎体后壁形态的关系

背景:经皮穿刺椎体后凸成形术(percutaneous kyphoplasty,PKP)是治疗骨质疏松性椎体压缩骨折的有效方法,虽然临床效果满意,但骨水泥渗漏仍然为其主要并发症,既往文献报道骨水泥渗漏进入椎管的因素较多,但由于缺少对于胸、腰椎椎体后壁形态的观察,胸腰椎椎体后壁形态差异可能也是导致骨水泥渗漏进入椎管的重要因素之一。目的:探讨胸、腰椎椎体后壁形态对骨质疏松性椎体压缩骨折患者行PKP术骨水泥渗漏入椎管的影响。方法:选取行PKP术治疗的临床资料完整并同时具有T6-L5的CT平扫及三维重建影像资料的骨质疏松性椎体压缩骨折患者98例。采用CT三维重建及多平面重建技术测量非骨折椎体后壁凹入椎体的深度及相应椎体中矢状径,计算各椎体后壁凹入椎体深度占同一椎体中矢状径百分比。将测量椎体分为胸椎组(T6-T12)和腰椎组(L1-L5)进行比较观察。选择同期内行PKP手术治疗无CT三维重建资料的骨质疏松性椎体压缩骨折患者357例(548个椎体),也分为胸椎组和腰椎组观察比较骨水泥渗漏侵占椎管程度。结果与结论:①测量98例患者椎体后壁参数发现,椎体后壁凹入椎体深度在T6-T12逐渐加深,平均4.6 mm;L1-L5逐渐变浅,平均0.6mm,椎体后壁凹入椎体深度占同一椎体中矢状径百分比T6-T12均为16%(1/6);L1-L5平均为3%,腰椎较胸椎明显小于16%(1/6);②观察同期行PKP手术治疗的357例患者发现:胸椎行PKP术骨水泥脉渗漏入椎管渗漏率为10.2%(31/304),腰椎渗漏率为3.7%(9/244)。胸椎组骨水泥渗漏侵占椎管最大矢状径平均为(3.1±0.2)mm,侵占椎管面积平均为(30.8±0.3)mm2,椎管侵占率为(22.5±0.2)%;腰椎组骨水泥渗漏侵占椎管最大矢状径为(1.4±0.1)mm,侵占椎管面积为(14.9±0.2)mm2,椎管侵占率为(11.4±0.3)%,胸椎组骨水泥渗漏发生率、侵占椎管最大矢状径、面积明显大于腰椎组(P<0.05)。③结果证实,中下胸椎行PKP术应尽量避免骨水泥分布达到椎体后16%(1/6),因中下胸椎、腰椎椎体后壁凹入椎体深度差异会对PKP术骨水泥渗漏进入椎管的观察造成影响,可能是导致中下胸椎椎管内骨水泥渗漏率明显高于腰椎的原因之一。该试验获得西南医科大学附属医院伦理委员会批准(批准号:K2018008)。     

Segmental patterns of sagittal spinal curvatures in children screened for scoliosis: Kyphotic angulation at the thoracolumbar region and the mortice joint

This paper reports a segmental analysis of the lateral spinal radiographs of 37 children referred to hospital in a school screening study of 4,890 school children aged 12–13 years. On each lateral radiograph a line was drawn along the posterior surface of each vertebral body from T5-L5 and the angle of this line from the vertical was recorded. After measuring the scoliosis curve (Cobb) angle and using conventional criteria for diagnosis, three groups of patients are defined, namely, 1) a control group (average scoliosis curve angle (Cobb) of 5°, n = 14), 2) a group with lumbar curves (average Cobb angle 21°, n = 7), and 3) a group with thoracic curves (average Cobb angle 19 degrees, n = 10). Individual lateral spinal profiles are also analyzed. The findings show: (1) In the control group, there are different degrees of vertical backward tilt (declivity) from T7–L3, with a maximum tilt at T12 (mean 26°). The most vertical vertebrae are T6 and L4, with forward tilting (proclivity) at each of (T5 and L5.2) In the lumbar curve group, the segmental sagittal tilt is not significantly different from that in the control group. The mean declivity at T12 is 25°. (3) In the thoracic curve group, the segmental sagittal tilt is significantly less than that in the control group at each of T10–L1. The mean declivity at T12 is 17°. A more vertical T12 is associated with a larger Cobb angle. (4) The individual sagittal spinal profiles of the thoracic curve group (but no other group) show lordosis in the region of the lateral spinal curve (scoliosis) and a kyphotic angulation at an average of three vertebrae below the apical vertebrae of the scoliosis curve. (5) It is suggested that as a thoracic lordoscoliosis develops, the appearance of a kyphotic angulation in the thoracolumbar and upper lumbar spine is determined by the compressibility of each disc in relation to the length of the articular processes at the corresponding level. Where the combination of disc weakness to facet length is most adverse, forward flexion occurs, as in a spinal fracture, to produce the kyphotic angulation. © 1992 Wiley-Liss, Inc.