脊柱侧凸顶椎椎体及附件旋转角测量及其临床意义

Axial rotation evaluation of different parts of apical vertebrae in idiopathic scoliosis and its clinical significance

[目的]评估特发性脊柱侧凸患者术前椎体、椎板、棘突旋转角及椎体相对棘突偏移的距离,为指导术中轴状面去旋转及冠状面侧凸矫形提供影像学基础。[方法]选取本院脊柱外科2008年1月～2010年1月收治的30例特发性脊柱侧凸患者,男11例,女19例;平均年龄17.0岁,Cobb角51.9°,术前皆行平卧位顶椎区域CT平扫。测量顶椎椎体、椎板及棘突的旋转角度,然后将椎体、椎板及棘突的旋转角度利用SPSS 13.0进行三组定量资料的两两比较,分析三者间的旋转角差异。同时测量椎体相对椎板的偏移距离,计算出其平均值。[结果]顶椎旋转角:椎体平均为17.3°±8.67°,椎板平均为17.6°±11.14°,棘突平均为11.3°±10.51°。经统计分析椎体、椎板与棘突间的旋转角差异具有统计学意义(P=0.017,P=0.013),而椎体与椎板间的旋转角度无明显统计学差异(P=0.906)。椎体相对椎板偏移的距离平均为(0.19±0.12)cm。[结论]测量脊柱侧凸患者术前CT顶椎椎体、椎板及棘突的旋转度和椎体相对棘突的偏移距离,对术中指导脊柱侧凸的轴状面和冠状面矫形具有一定临床意义。

[Objective]To compare rotational angle versus vertebral body,laminar and spinal processes,and measure the distance between vertebral axis and spinal process axis.[Methods]A restrospective study was performed on 30 patients with idiopathic scoliosis（11 boys,19 girls）,with mean age of 17.0 years（range 10~29 years）.Mean Cobb angle of coronal curve before operation was 51.9°.All patients took CT scaning of apical region before operation was done from January 2008 to January 2010.According to different parts of the apical vertebrae,rotational angel was divided into three groups： vertebral column group,laminar group and spinal process group.[Results]The average rotation angle was 17.3°±8.67°for apical vertebral column group,17.6°±11.14°for laminar group,and 11.3°±10.51°for spinal process group.The rotational angles of the three parts of apical vertebra had significant differences [F=4.116,P= 0.019].Rotational angles of vertebral column and lamina were higher than that of spinal process [P=0.017,P=0.013].There was no significant difference between the rotational angle of vertebral column and the lamina [P=0.906].The distance between apical vertebral axis and spinal process axis was mean 0.19 cm ± 0.12 cm.[Conclusion]Axial rotation data of three different parts on apical vertebrae are obtained from pre-operation CT,which have clinic significance in transversal and coronal correction of scoliosis.