骶骨曲率在先天性肛门直肠畸形分型中的应用分析

Application of sacrum curvature in classifying congenital anorectal malformations

目的评估骶骨发育异常在先天性肛门直肠畸形诊断中的意义。方法收集2015年5月至2019年6月在广州市妇女儿童医疗中心诊断为先天性肛门直肠畸形的316例患儿的病例资料。均为男性,确诊时年龄为(5.09±3.97)个月;低位畸形38例,中位畸形181例,高位畸形97例。将低位畸形患儿作为低位组,将中位畸形患儿作为中位组,将高位畸形患儿作为高位组。通过影像学图像测量各组患儿骶骨指数(sacral ratio,SR)值、D值、R值、骶骨曲率(sacrum curvature,SC)值以及联合指标SR+SC值,统计分析各测量值和各分型的相关性。其中,SR值=BC/AB,在骶尾骨正位X线片上,A线为双侧髂骨上缘的连线,B线为经过双侧骶髂关节下缘的A线的平行线,C线为经过骶尾骨最下缘的A线的平行线,BC为B线到C线的距离,AB为A线到B线的距离。SC值=R值/D值,D值为骨盆侧位X线片中骶骨上端前缘(E点)到骶骨最下端前缘(F点)的距离,P线为骶骨到EF最远的平行线,R值为EF与P线的垂直距离。通过Fisher检验或χ^(2)检验分析分类变量,通过方差分析连续变量。结果低位组的SR值、D值、R值、SC值和SR+SC值分别为0.99±0.38、(6.05±1.19)cm、(1.50±0.40)cm、0.45±0.04、2.03±0.22;中位组数值分别为0.76±0.20,(4.83±1.16)cm,(1.07±0.73)cm,0.22±0.14,2.18±0.18;高位组数值分别为0.72±0.21,(5.38±1.76)cm,(0.92±1.00)cm,0.14±0.18,2.26±0.21。低位组和中位组SR值相比,低位组和高位组D值相比,低位组和中位组R值相比,中位组和高位组SC值相比,中位组和低位组、中位组和高位组的SR+SC值相比,差异均具有统计学意义(P<0.05)。SC值及SR+SC值相对于SR值而言更能分辨出中位和高位畸形。结论SC值可以反映出先天性肛门直肠畸形患儿骶骨发育的异常,可作为术前评价指标。

Objective To assess the significance of sacral dysplasia in the diagnosis of anorectal malformations.Methods Between May 2015 and June 2019,clinical data were collected from 316 boys with a diagnosis of congenital anorectal malformations.The diagnostic age was(5.09±3.97)months.The severity of deformity was low(n=38),moderate(n=181)and high(n=97).Sacral index(SR),D,R,sacral curvature(SC)and SR+SC of each group were measured by images and the correlation between each measurement and classification was statistically analyzed.Where SR=BC/AB,on anteroposterior radiography of sacrococcygeal bone,line A passes through upper edge of ilium,line B a parallel line passing through A line at the lower edge of sacroiliac joint,line C a parallel line passing through A line at the lowest edge of sacrococcygeal bone,line BC the distance from line B to line C and AB the distance from line A to line B.SC=R/D,the distance from anterior edge of upper sacral end(point E)to anterior edge of the lowest sacral end(point F)on lateral pelvic radiography,P line the parallel line farthest from sacrum to EF and R vertical distance between lines EF and P.Categorical variables were analyzed by Fisher's orχ^(2) test while continuous variables processed by analysis of variance.Results SR,D,R,SC and SR+SC of low group were 0.99±0.38,(6.05±1.19)cm,(1.50±0.40)cm,0.45±0.04 and 2.03±0.22;SR,D,R,SC and SR+SC of moderate group 0.76±0.20,(4.83±1.16)cm,(1.07±0.73)cm,0.22±0.14 and 2.18±0.18;SR,D,R,SC and SR+SC of high group 0.72±0.21,(5.38±1.76)cm,(0.92±1.00)cm,0.14±0.18 and 2.26±0.21 respectively.Significant differences existed in SR+SC between low and moderate groups and low and high groups(P<0.05).SC and SR+SC might distinguish between moderate and high malformations relative to SR.Conclusions Reflecting the abnormalities in sacral development,SC may be employed as a preoperative evaluation indicator in children with congenital anorectal malformations.