应用多层螺旋CT曲面重建技术评价特发性脊柱侧凸柔韧度

目的 探讨应用多层螺旋CT曲面重建(CPR)技术评价特发性脊柱侧凸的冠状面和矢状面,提出特发性脊柱侧凸柔韧度评价的新方法,确立侧凸脊柱卧位的冠状面和矢状面特征.方法 45例10～18岁特发性脊柱侧凸青少年女孩进行了术前多层螺旋CT脊柱扫描.采用曲面重建技术分别对脊柱进行了冠状面和矢状面的重建,测量了主弯、代偿弯的Cobb角等各项数值,并与患者X线影像结果进行了比较分析.结果 侧凸曲面重建后,冠状面主弯曲面重建(CPR)图像的Cobb角较主弯X线站立位像Cobb角平均小10.17°,冠状面代偿弯CPR的Cobb角较代偿弯X线站立位像Cobb角平均小6.97°.对于侧凸冠状面柔韧度的评价,Fulcrum像方法提供了最大的术前矫正程度.对于主胸弯组和主腰/胸腰弯组的对比没有发现,10～14岁年龄组和15～18岁年龄组间仅术后Cobb角有差别.对于手术矫形率和柔韧度,主胸弯组和主腰/胸腰弯组Bending像两组的柔韧度有差异.不同年龄组比较发现手术矫形率、主弯柔韧度和代偿弯的柔韧度两组比较,10～14岁柔韧度较大.矢状面上,主胸弯组和主腰/胸腰弯组CPR胸后凸(T5～T12)角和CPR上胸弯(T1～T5)角两组之间比较,主胸弯的胸后凸角度较小.按年龄分组中,CPR胸后凸(T5～T12)Cobb角两组之间有差异,10～14岁组的胸后凸Cobb角度较小.相关分析示CPR主弯的柔韧度、Bending像的柔韧度和手术矫形率相关.结论 AIS主弯的卧位CPR柔韧度、Bending像柔韧度和侧凸的手术矫形率呈正相关.10～14岁AIS患者矢状面胸后凸较15～18岁患者减小,主胸弯AIS患者矢状面的胸后凸和上胸弯较主腰/胸腰弯AIS患者减小.脊柱侧凸CT下曲面重建对侧凸类型的诊断和侧凸三维的分析很有帮助,可以在1次扫描后获得对侧凸三维等多方面的评价.

Assessment of flexibility in adolescent idiopathic scoliosis by curved planar reformation using multi-slice spiral CT scanning

Objective To investigate the role of curved planar reformation (CPR)using multi-slice spiral CT scanning to evaluate the coronal and sagittal plane in scoliosis so as to affirm the features of supine coronal and sagittal plane in idiopathic scoliosis. Methods Thoracic and lumbar spine multi-slice spiral CT scanning was undertaken on 45 patients with adolescent idiopathic scoliosis (AIS), all female, age 10-18. CPR was used to reconstruct the spine coronal and sagittai planes respectively. The values of main curve and compensate curve Cobb angles were obtained and compared with those obtained by X-ray films. Results The average CPR coronal main curve Cobb angle was smaller by 10.17° than that obtained by standing position film. The average CPR coronal compensate curve Cobb angle was smaller by 6. 97°than that obtained by standing position film. For scoliosis coronal flexibility assessment, fulcrum-bending method offered better surgical correction result than other methods. Only the post-operational Cobb angle was different between the 10-14 year-old group and 15-18 year-old group. Bending film showed differences in correction rate and flexibility rate between the main thoracic group and main lumbar/thoracolumbar group. The correction rate and flexibility rate of main curve and compensate curve of the 10-14 year-old group were significantly higher than those of the 15-18 year-old group. In the saglttal plane, the CPR thoracic kyphotic angle (T5-T12) and upper thoracic curve kyphosis of the main thoracic group were both smaller than those of the main lumbar/thoracolumbar group. The CPR thoracic kyphotic angle (T5-T12) of the 10-14 year-old group was significantly smaller than that of the 15-18 year-old group. Correlation analysis showed that the CPR main curve flexibility and bonding film flexibility were positively corrected with the surgical correction rate. Conclusion CPR using multi-slice spiral CT scanning is able to obtain multiple three-dimensional assessment by one scanning and is helpful in scoliosis curve type diagnosis and scoliosis 3D analysis.