先天性脊柱侧凸患者脊椎畸形及椎管内畸形的特点

Analysis of vertebral deformity and intraspinal anomaly in congenital scoliosis

目的：探讨先天性脊柱侧凸（CS）患者脊椎畸形与椎管内畸形的特点及两者间的关系。方法：对我院2005年9月～2007年5月收治的123例CS患者的影像学资料进行回顾性分析，统计不同类型脊椎畸形及不同类型椎管内畸形的特点，分析两者之间的关系。结果：123例患者的脊椎畸形中，28例（22．8％）为形成障碍（FF），43例（35．0％）为分节障碍（SF），52例（42．2％）为混合型障碍（MT）。28例FF均在胸腰椎，其中前方结构畸形（AM）19例（67．9％），前后方结构畸形（APM）9例（32．1％）；单节段畸形（SM）19例（67．9％），多节段畸形（MM）9例（32．1％）。43例SF中，AM9例（20．9％），后方结构畸形（PM）3例（7．0％），APM31例（72．1％）；SM9例（20．9％），MM34例（79．1％）；214个节段受累，胸椎196个。52例MT中，AM6例（11．5％），APM46例（78．5％）；SM6例（11．5％），MM46例（78．5％）。37例（31．7％）患者有椎管内畸形，其中脊髓纵裂14例，低位脊髓2例，脊髓纵裂合并低位脊髓21例。35例脊髓纵裂患者中34例位于胸椎、腰椎或跨越胸腰椎，33例为SF或MT；23例低位脊髓中21例发生于SF或MT。结论：FF好发于胸椎和腰椎，多为单纯AM，SF和MY好发于胸椎．多为APM．脊椎畸形好发于胸椎．脊髓纵裂好发于胸椎和腰椎，脊髓纵裂和低侍脊髓好发于SF或MT。

Objective：To investigate the characteristics of vertebral deformity and intraspinal anomaly in congenital scoliosis（CS） and the relationship between them.Method：A retrospective study of radiographic data of 123 CS patients was performed,and vertebral deformity and intraspinal anomaly of all types were analyzed statistically in order to find the characteristics of the two types of deformities and the relationship between them.Result： 123 CS patients consisted of 28 patients （22.8%） with formation failure （FF）,43 patients （35.0%） with segmentation failure（SF）,and 52 patients（42.2%） with combination of two disorders（mixed type,MT）.Of the 28 FF cases with thoracolumbar involvement,anterior component malformation（AM） was found in 19 cases （67.9%）, antero-posterior malformation （APM） in 9 cases （32.1% ）, single level malformation （SF） in 19 cases （67.9%）,and muhiple level malformation（MM） in 9 cases（32.1%）.Of the 43 SF cases,AM was found in 9 cases（20.9%）,posterior component malformation（PM） in 3 eases（7.0%）,APM in 31 cases（72.1%）,SM in 9 cases （20.9%）,and MM in 34 cases （79.1%）.Of the total of 214 segments involved,196 segments located at thoracic spine.Of the 52 MT cases,AM was found in 6 cases （ll.5%）,APM in 46 cases （78.5%）,SM in 6 cases（11.5%） ,and MM in 46 cases（78.5%）.Intraspinal anomalies were detected in 37 cases（30.1%）,including 14 cases of diastematomyelia,2 cases of low conus medullaris,and 21 cases of combination of two disorders. Of the 35 cases of diastematomyelia ,thoracic spine, lumbar spine or thoracolumbar spine were involved in 34 cases,33 cases were SF or MT,of the 23 cases with low conus medullaris,21 cases were complicated with SF or MT.Conclusion：As for FF,the predilection sites are thoracic and lumbar vertebrae,and simple AM is more common.Thoracic vertebrae are the predilection site for SF and MT,and APM is more common.For vertebral deformity,the predilection site is thoracic vertebrae,while the predilection site of diastematomyelia is thoracic and lumbar vertebrae.Most of diastematomyelia and low conus medullaris are detected in SF or MT cases.