先天性脊柱侧凸患者中肋骨畸形和椎管内畸形的特点

Analysis of ribs and intraspinal anomalies in congenital scoliosis

目的探讨先天性脊柱侧凸患者的各类脊椎畸形、肋骨畸形与椎管内畸形的特点及发生情况。方法回顾性分析2010年1月至2011年3月手术治疗的先天性脊柱侧凸患者118例，男性52例，女性66例；年龄3～50岁，平均（14．4-7）岁。统计椎管内畸形、肋骨畸形的总体发生比例及各自的好发部位，运用r检验分析不同类型脊椎畸形、肋骨畸形与椎管内畸形的伴发情况。结果118例先天性脊柱侧凸患者合并椎管内畸形57例（48．3％），多种畸形常并发存在，以脊髓纵裂（32．2％）和脊髓空洞症（21．2％）最为多见。合并肋骨畸形69例（58．5％），以凹侧为多见（68．1％，47／69）。椎管内畸形的发生率在混合型脊柱侧凸（58。3％，35／60）和多脊椎畸形（54．8％，51／93）的患者中较高（，=14．05和27．50，P〈0．01）。伴有肋骨畸形的先天性脊柱侧凸患者中有椎管内畸形的42例（60．9％），无椎管内畸形的27例（39．1％），不伴有肋骨畸形的先天性脊柱侧凸中有椎管内畸形的15例（30．6％），两组相比椎管内畸形的发生率差异有统计学意义钟=10．5，P〈0．01）。结论先天性脊柱侧凸伴发的椎管内畸形以脊髓纵裂和脊髓空洞为多见；肋骨畸形多发生于混合型脊柱侧凸及多脊椎畸形患者，以凹侧多见。脊椎畸形的类型及是否伴有肋骨畸形对椎管内畸形的诊断有重要的提示意义。椎管内畸形与脊椎畸形的好发部位相似，但各种椎管内畸形、脊椎畸形间缺少显著的、特定的对应关系。

Objective To investigate the incidences and characteristics of the ribs and intraspinal abnormalities in surgical patients with congenital scoliosis, Methods We conducted a retrospective study of the medical records and spine radiographs of 118 patients underwent surgical treatment between January 2010 and March 2011 with congenital scoliosis. The average age was 14 years （3-50 years）. Fifty-two were male and 66 were female patients. The rib and intraspinal abnormalities were compared in different vertebral anomalies. Pearson＇sx2 test were used to analyze the incidence of anomalies of the ribs and vertebrae, as well as intraspinal anomalies. Results A total of 57 （48.3%） patients were found to have intraspinal abnormalities. Split cord deformities were identified to be the most common intraspinal anomaly （32.2%）, followed by syringomyelia （21.2%）. Sixty-nine patients （58. 5% ） had rib anomalies, which occurring on the concavity of the scoliosis was most frequent. The patients with mixed deformity and failure of segment were found to have a higher incidence of rib anomaly than those with failure formation （X2 = 14. 05, P 〈 0. 01 ）. The patients with multiple level malformations were found to have significantly higher incidence of rib anomaly than those with single level malformation （X2 = 27.50, P 〈 0. 01 ）. Intraspinal anomalies occurred in 42 of 69 patients （60.9%） with rib anomalies and 15 of 49 patients （30.6%） without rib anomalies in congenital scoliosis. The occurrence of intraspinal malformation has significant difference with or without ribanomalies in congenital scoliosis （X2 = 10. 5, P 〈 0. 01 ）. Conclusions The intraspinal malformation is common in patients with mixed defects and failures of segmentation. The rib anomalies occurring on the concavity of the scoliosis is most frequent. The incidence of intraspinal anomaly is significant higher in the patients with rib anomalies than those without rib anomalies. Both the occurrence and type of rib anomaly, combined with vertebral deformity are helpful in forecasting the occurrence of intrasDinal abnormalis.