Chiari畸形合并脊柱侧凸患者的胸椎后凸与椎体旋转有关

目的 本文拟通过分析冠状面弯度匹配而矢状面TK存在较大差异的AIS患者和Chiari畸形合并脊柱侧凸患者,来研究Chiari畸形合并脊柱侧凸患者胸椎后凸与椎体旋转的相关性。方法 回顾性分析2017年7月至2019年7月于南京鼓楼医院行EOS影像摄片的患者。根据主胸弯Cobb角、顶椎节段等进行配对,其中AIS组选取TK减小者入组,而Chiari组则选取存在明显TK的患者入组；现共12对冠状面弯度匹配而胸椎后凸不同的AIS及chiari患者被纳入研究。分别对其摄EOS全身影像并进行三维重建,在EOS三维重建影像上得到每个椎体的旋转角度及胸椎后凸角,并计算主胸弯平均椎体旋转(MTR)。通过相关系数分析来比较正常AIS组和Chiari组患者的影像学参数差异情况。结果 共有24名患者(12对)纳入本次研究。其中AIS组男4例,女8例,Chiari组男5例,女7例；平均年龄分别为：(15.29 VS 21.14,p=0.42)；在矢状面,AIS组TK平均为9.50°,而Chiari组平均TK则为36.58°。两组患者平均主弯区椎体旋转存在显著差异,Chiari组的患者的MTR显著小于AIS组(-0.84 °VS.5.14°, p=0.042),且TK与MTR之间存在显著相关性(r=0.821, p=0.023)。 结论 通过对Chiari及AIS患者的三维分析,本研究发现在相同冠状面的条件下,Chiari畸形患者较大的后凸可能是由于椎体的旋转所造成。提示脊柱外科医生在关注Chiari患者冠状面矫形的同时需要关注矢状面的旋转。

Thoracic kyphosis associated with vertebral rotation in patients with Chiari malformation and scoliosis

Objective: To study the correlation between thoracic kyphosis and vertebral rotation in patients with Chiari deformity and scoliosis by analyzing the matching of coronal curvature and sagittal TK. Methods: Retrospective analysis of patients who underwent EOS imaging from July 2017 to July 2019 in Nanjing Drum Tower Hospital. According to the Cobb angle of the main thoracic curve and the apical segment, the AIS group selected the patients with reduced TK as the group, while the Chiari group selected the patients with obvious TK as the group. Eight pairs of AIS and Chiari patients with different thoracic kyphosis and matched coronal curvature were included in the study. The EOS whole body images were taken and reconstructed. The rotation angle and thoracic kyphosis angle of each vertebral body were obtained on the EOS three-dimensional reconstruction images, and the mean vertebral rotation (MTR) of the main thoracic curve was calculated. The difference of imaging parameters between normal AIS group and Chiari group was compared by correlation coefficient analysis. Results: A total of 24 patients (12 pairs) were included in this study. There were 4 males,8 females in AIS group, 5males and 7 females in Chiari group. The average age of AIS group was (15.29 VS 21.14, p=0.42). On sagittal plane, the average TK of AIS group was 9.50 degrees, while that of Chiari group was 36.58 degrees. The MTR of Chiari group was significantly lower than that of AIS group (-0.84 degree VS.5.14 degree, p=0.042), and there was a significant correlation between TK and MTR (r=0.821, p=0.023). Conclusion: Through three-dimensional analysis of patients with Chiari and AIS, we found that the greater kyphosis in patients with Chiari malformation may be caused by the rotation of the vertebral body under the same coronal plane. It is suggested that spine surgeons should pay attention to sagittal rotation as well as coronal correction in Chiari patients.