脊柱侧凸患者胸主动脉与相邻椎体的解剖关系及临床意义

The clinical significance of anatomical relationship between aorta and thoracic vertebral body in patients with scoliosis

目的:观察胸椎侧凸患者胸主动脉与相邻椎体的解剖关系,并探讨其临床意义。方法:30例胸椎侧凸患者行胸椎CT平扫,测量T4～T12椎体横断面上右侧肋骨小头至主动脉后壁的切线与双侧肋骨小头连线(线RR)的夹角(α)、椎管前缘中点至主动脉中点连线与线RR的夹角(β)、线RR至椎管前壁的垂直距离(a)、左侧肋骨小头前缘至主动脉后壁的距离(b)、椎体横径(c)及椎体旋转角(γ),并与64例无脊柱畸形者对比。结果:从T4～T12,两组的α角、β角和b值均存在先减小后增大的趋势,脊柱侧凸组均较对照组低,且α角在T7～T10、β角在T5～T10和b值在T9、T10显著低于正常对照组。从T4～T12,两组的a值均逐渐降低,且脊柱侧凸组显著低于对照组。两组的c值从T4～T12均逐渐增加,两组间差异无统计学意义。结论:胸椎侧凸患者术前行影像学检查测量胸主动脉与相邻椎体上述指标,可更精确、更安全地放置螺钉。

Objective:To observe the anatomic relationship between the aorta and the vertebral body, and to discuss its clinical significance.Method:Measuring the thoracic vertebral CT scanning of thirty patients with thoracic scoliosis, compared with sixty-four patients without spinal deformity. The transverse profile of vertebral from T4 to T12 was used to measure the parameters,including the angle composed of the line between the left and the right rib heads(Line RR)and the line from the right rib head to the posterior wall of the aorta( angle composed of Line RR and another line from the anterior midpoint of the vertebral canal to the midpoint of the aorta( vertical distance from Line RR to the anterior wall of the vertebral canal (a)?the distance from the left rib head to the posterior wall of the aorta(b)?the vertebral body transverse diameter(c)?and vertebral rotation angle( angle and angle,b value had a tendency of diminishing firstly and then increasing,and were lower in scoliosis group than in control group.Comparing with the control group, angle from T4 to T10, angle from T5 to T10 and b value at T9,T10 were significantly lower in the scoliosis group.A value of both groups was diminished from T4 to T10,while there was a significant difference between two groups.The c value of both groups was increased gradually from T4 to T12,the difference of two groups had no statistically significant.Conclusion:The measurement of above index for thoracic scoliosis on preoperative radiographic image has significance in precisely and safely screw placement.