青少年特发性脊柱侧凸患者的椎体及椎间盘楔形变的影像学研究

Imaging study of the wedging changes of vertebral bodies and intervertebral disks in Adolescent idiopathic scoliosis

目的 观察进展型青少年特发性脊柱侧凸支具治疗前及手术治疗前椎体和椎间盘楔形角的变化，并探讨椎体和椎间盘楔形变与侧凸之间的相关性。方法 对2001年6月至2003年8月间37例青少年特发性脊柱侧凸患者支具治疗前和手术治疗前影像学上椎体和椎间盘的楔形变及侧弯的角度进行测量，本组男6例，女31例，年龄11-18岁，平均14．9岁。根据PUMC分型：PUMC Ⅰa8例，PUMC Ⅰb3例，PUMCⅠ c 5例，PUMC Ⅱb1 12例，PUMCⅡb2 3例，PUMCⅡ c1 3例，PUMCⅡc3 1例，PUMCⅡd1 2例。结果 发育成熟（Risser征Ⅳ-Ⅴ）及月经初潮2年以上的患儿支具治疗前后的椎体、椎间盘楔形角与侧凸Cobb角的相关程度较低（r=0．17），而发育不成熟的患儿（Risser征0～Ⅲ，月经未来潮）支具治疗前后的椎体、椎间盘楔形角与侧凸Cobb角的相关程度较高（r=0．69）。随着侧凸的进展，椎体和椎间盘的楔形角明显增加，椎体和椎间盘的楔形变同侧凸的进展明显相关，并与侧凸的程度呈正相关。结论 在侧凸的发生和进展过程中椎体和椎间盘出现明显的楔形变，并随着侧凸的加重而变得更加明显，表明椎体软骨终板的不对称生长可能是导致椎体楔形变的关键因素。

Objective To observe the wedging changes of vertebral bodies and intervertebral disks in progress Adolescent idiopathic scoliosis patients before conservative treatment with braces and operation, and define the correlation between vertebral bodies and intervertebral disks wedging change with scoliosis curve. Methods Thirty-seven consecutive patients with Adolescent idiopathic scoliosis were included in this study from June 2001 to Augest 2003. There are 31 females and 6 males,with the average age of 14.9 years. According PUMC grading system, there were Ⅰ a for 8 cases, Ⅰ b for 3 cases, Ⅰc for 5 cases, Ⅱ b1 for 12 cases, Ⅱ b2 for 3 cases, Ⅱ c1 for 3 ases, Ⅱ c3 for 1 case, Ⅱ d1 for 2 cases. The wedging changes of vertebral bodies and intervertebral disks, and the scoliosis angles were measured before conservative treatment with braces and operation by radiographic evaluation. Results In the patients with mature （Risser sign Ⅳ- Ⅴ, menarche two years or more）, the wedging changes of vertebral bodies and intervertebral disks aggravated with the curve progression, and had a poor significant correlation with the curve degree （r=0.17）. But in developmental immaturity （Risser sign 0-Ⅲ, non-menarehe） patients, there were a significant correlation with the curve degree （r=0.69）. The wedging changes of vertebral bodies and intervertebral disks aggravated with the curve progression, and have a significant corelation with the curve degree. Conclusion The wedging changes of vertebral bodies and intervertebral disks have positive correlation with curve degree, implicating asymmetric growth of cartilaginous endplate may be the primary cause of vertebral wedging change.