10~12岁儿童胸椎关节突关节角三维数字化研究及临床意义

Three dimensional digital study and clinical significance of thoracic joint angle in children aged from 10 to 12 years

目的通过薄层CT扫描和三维重建后测量,探索10~12岁儿童胸椎关节突关节角的形态特征和增龄变化规律,为临床胸椎关节相关疾病的早期诊治和预防提供理论依据。方法选取无骨质破坏、畸形、骨折、肿瘤等椎骨形态结构未发生改变及既往未行脊柱相关手术的10~12岁儿童30例,行多排螺旋CT薄层扫描(0.625~1.25 mm),范围T_1~T_(12),将原始数据以DICOM格式导入三维重建软件进行相关指标测量及统计分析。结果关节突矢状位角在侧别间相差均在10°以内,上关节突矢状位角在T_1、T_(11)、T_(12)间、下关节突矢状位角在T_3、T_4、T_9、T_(10)和T_(12)间差异均无统计学意义(P>0.05)外,余差异均有统计学意义(P<0.05)。关节突冠状位角在侧别间差异比较均无统计学意义(P>0.05),上下关节突冠状位角总体呈"尖峰状"趋势,最大值位于T7~T9。上关节突水平位角侧别间仅在T2、T_4、T8、T_10和T_(12)间、下关节突水平位角则在T_7间差异有统计学意义(P<0.05),上关节突水平位角无论左右侧,其在上胸段走势平稳,下胸段则呈递减趋势,下关节突水平位角侧别间除个别椎序外,也总体呈递减趋势,二者均在T_(11)和T_(12)中出现负角。结论 10~12岁儿童胸椎关节突关节角(冠状位角、矢状位角和水平位角)可直观地反映胸椎关节突随年龄增长的发育规律,验证了胸椎关节突关节角从颈椎的近水平位逐渐到胸椎的近冠状位,再到腰椎的近矢状位这一发育规律,且关节突关节角左右侧基本对称,其角度差值均小于10°。

Objective To explore the morphological characteristics and change rule of thoracic joint angles in children aged from 10 to 12 years through thinner CT scanning and 3D reconstruction, and to provide theoretical basis for early diagnosis, treatment and prevention. Methods Totally 30 normal cases aged from 10 to 12 years were admitted into this study. There was no bone destruction,deformity,frac- tures, tumors and spine surgery involved. DICOM 3.0 data of multi-slice spiral CT （0.625 - 1.25 ram） , ranging from T1 to T12, were used for 3D reconstruction,measurement and statistical analysis. Results The difference between left and right sagittal section angle of zygopophysis was less than 10~. There was no significant differences between TI , Tll , and T12for sagittal section angle of upper zygopophysis （P 〉 0.05 ）. So was it between T3 , T4, T9 , Tl0 and T12 for sagittal section angle of lower zygopophysis （ P 〉 0.05 ）. While there were significant differences between others （ P 〈 0.05 ）. The was no significant difference between left and right coronal plane angle of zygopophysis （ P 〉 0.05 ）. Coronal plane angle of lower and upper zygopophysis tended to be ＇ spike-like＇ , and the maximum points were at T7 to Z9. For horizontal plane angle, left and right upper zygopophysis made significant differences between T2, T4, Ts , Tl0 and T^2 only, so did T7 lower zygopophysis （P 〈 0.05 ）. Horizontal angle of upper zygopophysis tended to be stable in the upper thoracic both in the left and right side, while a decreasing trend was shown in lower thoracic. Horizontal angle of lower zygopophysis showed a decreasing trend generally except individual vertebrae. Both upper and lower zygopophysis showed negative angle at Tll and T12 levels. Conclusion Thoracic joint angles （ coronal, sagittal and horizontal an- gle） in children aged from 10 to 12 years can directly reflect the developmental regularity with growth, and it verified the tendency that horizontal facet joints of the cervical spine gradually changes to coronal facet joints （boracic spine and then changes to sagittal facet joints of lumbar spine. And the left and right side facet joints are basically symmetrical with the angle differenee less than 10°.