脊柱侧凸胸椎椎弓根形态学分型

Morphologic classification of thoracic pedicles in various types of scoliosis

目的研究脊柱侧凸胸椎椎弓根的畸形发生率和畸形特征,并提出形态学分型系统。方法应用Siemens Somatom Sensation 64CT,对60例不同类型脊柱侧凸1440个胸椎椎弓根进行CT轴位扫描。在Lenke椎弓根分型的基础上对其进行量化和适当补充,将椎弓根形态分型为:A型(正常型);B型(狭窄型);C型(峡部硬化型);D型(完全硬化型),D-Ⅰ型(凹陷硬化型),D-Ⅱ型(平直硬化型);E型,椎弓根缺如。按照上述分型标准,对影像学资料进行测量、分析并分型。结果各种类型脊柱侧凸胸椎椎弓根形态分型A、B、C、D-Ⅰ、D-Ⅱ及E型分别占62.12%、24.72%、5.94%、2.75%、3.18%及1.29%,胸椎椎弓根的畸形发生率为37.88%。各种类型脊柱侧凸间胸椎椎弓根的畸形发生率差异有统计学意义(P<0.05),其中神经纤维瘤病性脊柱侧凸胸椎椎弓根的畸形发生率高达60.83%。结论各种类型的脊柱侧凸普遍存在胸椎椎弓根畸形,以狭窄型较为常见。

Objective To study the deformity characteristics,malformation rate and morphological classification of thoracic pedicles in various types of scoliosis. Methods The axial views of 1440 thoracic pedicles performed with Siemens Somatom Sensation 64 CT of 60 patients who were diagnosed as various types of scoliosis were reviewed in this research. A modified Lenke pedicle classification system was designed to make further quantification and appropriate supplement as follows：A type （normal type）,B type （stenotic type）,C type （isthmic sclerosis type）,D type （complete sclerosis type）,D-Ⅰ type （concave sclerosis type） and D-Ⅱ type （straight sclerosis type）,E type,pedicle Absence. According to above standards of classification,image materials were measured,studied and classified. Results The ratios of A type,B type,C type,D-Ⅰ type,D-Ⅱ type and E type according to this pedicle morphologic classification were 62.12%,4.72%,5.94%,2.75% ,3.18% and 1.29% respectively. And the general malformation rate of thoracic pedicles was 37.88%. There was significant difference of thoracic pedicle malformation rate among different types of scoliosis （P〈0.05）. Especially,the malformation rate of scoliosis in neurofibromatosis was up to 60.83%.Conclusion There are thoracic pedicle deformities in various types of scoliosis. The stenotic pedicle is the common type of malformation.