青少年特发性胸椎侧凸患者胸椎椎弓根横径的分型及其临床意义

目的 探讨胸椎椎弓根横径的测量及分型在青少年特发性胸椎侧凸患者治疗中的临床意义.方法 对2008年10月至2009年7月收治的30例青少年特发性胸椎侧凸患者(侧凸组)和2008年8月至2009年7月于本院就诊的20例年龄匹配的非侧凸青少年患者(对照组)采用螺旋CT行胸椎连续扫描,在图像编档和通信系统(PACS)上逐层阅片,选择胸椎椎弓根显示最清楚的层面对椎弓根横径进行测量,并根据测量结果将其分为4型.分别对侧凸组凹凸侧和对照组左右侧椎弓根横径进行对比,并对侧凸组与对照组椎弓根分型的构成比进行分析.结果 两组患者胸椎椎弓根横径T1～4逐渐减少,T5～12逐渐增加.对照组同节段双侧胸椎椎弓根横径差异无统计学意义(P>0.05).侧凸组顶椎区凹侧的椎弓根横径明显小于凸侧,差异有统计学意义(P<0.05).侧凸组中4型椎弓根的比例明显高于对照组,1型椎弓根的比例低于对照组,差异均有统计学意义(P<0.05).结论 青少年特发性胸椎侧凸患者胸椎椎弓根横径常较小,术前应根据CT胸椎椎弓根形态制定置钉策略,以减少经胸椎椎弓根置入螺钉的并发症的发生.

Classification of thoracic pedicle according to the transverse diameters in thoracic idiopathic scoliosis patients and its clinical significance

Objectives To explore the clinical significance of the transverse thoracic pedicle diameters measurement and thoracic pedicles classification in thoracic adolescent idiopathic scoliosis patients. Methods Thirty thoracic idiopathic scoliosis patients who were hospitalized during October 2008 and July 2009 and 20 non-scoliosis adolescents who were adopted during August 2008 and July 2009 were included in this study. Successive CT thoracic vertebras scanning of all subjects were obtained. All participants' transverse pedicle diameters of the thoracic vertebras were measured with the software of PACS Client. Classified the pedicle into 4 types according to the transverse pedicle diameters. In control group, the transverse pedicle diameters of bilateral thoracic vertebras were compared using paired-t test. In AIS group,the transverse pedicle diameters of concave and convex side thoracic vertebras were compared using paired-t test. The distribution of pedicle types were compared using Chi-Square test between the control group and AIS group. Results The transverse pedicle diameters showed a decreasing trend from T1 to T4 followed by an increasing trend from T5 to T12 in both groups. The bilateral transverse pedicle diameters had no significant difference in the control group. The transverse pedicle diameters of the concave side at the apex of thoracic curve were found to be significantly thinner than those of convex side. The ratio of Type 4 was higher in thoracic adolescent idiopathic scoliosis patients than the controls, and the ratio of Type 1 was smaller in thoracic adolescent idiopathic scoliosis patients than the controls. Conclusions The thoracic pedicles in thoracic adolescent idiopathic scoliosis patients are often rather thinner. Preoperative CT measurement of thoracic pedicle in the treatment of idiopathic scoliosis is suggested helpful in deciding the correct strategy of pedicle screw insertion and decreasing the risk of clinically relevant neurovascular complications.