退变性腰椎侧弯腹部大血管与椎体位置测量

Measurement of positions between abdominal major blood vessel and vertebral body in degenerative lumbar scoliosis

[目的]测量比较退变性腰椎侧弯患者腹部血管位置变化,为手术提供解剖参数。[方法]2017年2月-2020年7月,29例退变性脊柱侧弯患者纳人本研究,依据侧弯方向分为左侧组16例,右侧组13例。此外,32例正常者设为对照组。所有患者术前常规行脊柱X线片和CT检查,测量主动脉-椎体角度(AAVB-A)、主动脉-椎体距离(AAVB-D)和左侧手术窗宽度(SWW),以及下腔静脉-椎体角度(IVCVB-A)、下腔动脉-椎体距离(IVCVB-D)。[结果]三组的AAVB-A角均自L_(1)至L_(4)显著减小(P<0.05),在L_(2、3)平面,左侧组显著小于右侧组和对照组(P<0.05)。三组的AAVB-D均自14至1^显著增加(P<0.05);在L_(2)和L_(3)平面,左侧组显著大于右侧组和对照组(P<0.05)。三组的SWW在L_(1)至L_(4)平面差异均无统计学意义(P>0.05);L_(2)、L_(3)平面,SWW由大至小依次为左侧组>对照组>右侧组,差异均有统计学意义(P<0.05)。三组的IVCVB-A和IVCVB-D自1至1^增大(P<0.05),对照组各平面间IVCVB-D的差异有统计学意义(P<0.05);在L_(1)至L_(4)各平面,三组间IVCVB-A和IVCVB-D的差异均无统计学意义(P>0.05)。[结论]此退变性脊柱侧凸腹部血管与椎体位置关系的测量为手术提供直观模型,左侧弯顶椎区腹主动脉椎前间隙及手术窗较大。

[Objective]To measure the position variation of abdominal blood vessels related to vertebral body in degenerative lumbar scoliosis,and to provide anatomical parameters for surgery.[Methods]From February 2017 to July 2020,29 patients with degenerative scoliosis were included in this study.According to the direction of scoliosis,16 patients fall in the left group,and remaining 13 patients were into the right group.In addition,32 healthy persons were enrolled as the control group.All subjects received routine spinal CT and X-ray examination before operation to measure the abdominal aorta-vertebral body angle(AAVB-A),abdominal aorta-vertebral body distance(AAVB-D)and surgical window width(SWW),as well as the inferior vena cava-vertebral body angle(IVCVB-A),the inferior vena cava-vertebral body distance(IVCVB-D).[Results]In term of aorta position,the AAVB-A decreased significantly from L_(1) to L_(4) in all the 3 groups(P<0.05),which at the L2 and L3 levels were significantly less in the left group than those in the right group and the control group(P<0.05).However,the AAVB-D increased significantly from L_(1) to L_(4) in the 3 group(P<0.05),which proved greater at the L2 and L3 levels in the left group than those in the right group and the control group(P<0.05).The SWW showed no significant differences from L_(1) to L_(4) in the 3 groups(P>0.05),whereas was ranked up-down in order of the left group>the control group>the right group at the L_(2-4) levels,which were all statistically significant(P<0.05).Regarding to position of inferior vena cava,the IVCVB-A and IVCVB-D increased from L_(1) to L_(4) in the 3 groups(P<0.05),but only the difference of IVCVB-D among the levels in the control group was statistically significant(P<0.05).There were no significant differences in IVCVB-A and IVCVB-D among the 3 groups from L_(1) to L_(4)(P>0.05).[Conclusion]This measurement of abdominal blood vessel position related to vertebral body in degenerative lumbar scoliosis by three-dimensional reconstruction might provide an intuitive model for surgery.The left scoliosis has relative larger anterior space and surgical window in the apical vertebrae area between the blood vessel and vertebral body.