陕西省陕北地区12~15岁特发性脊柱侧凸与脊柱正常的青少年胸椎椎弓根的形态学分析

Morphological analysis of thoracic pedicle of 12-15-year-old idiopathic scoliosis and normal spine in northern Shaanxi province

目的探讨陕西省陕北地区12~15岁青少年脊柱正常与脊柱侧凸患者胸椎的解剖结构特点,为椎弓根螺钉置入提供详细资料,并为科学设计螺钉尺寸提供数据参考。方法根据延安大学医学院第一附属医院提供的影像CT资料,将12~15岁青少年分为两组:青少年脊柱正常组(ASN组,n=120)及青少年特发性脊柱侧凸组(Lenke 1型,AIS组,n=30),将连续扫描的胸椎断层影像原始数据以DICOM格式导入Mimics 21.0软件进行分析与测量。测量指标包括椎弓根宽(PW)、椎弓根高(PH)、模拟钉道长(VSL)、椎管橫径(TD)与纵径(LD)、椎弓根外偏角(α角)、椎弓根最大外偏角(β角)、椎弓根头倾角(θ角)和椎弓根面积(PA)。结果青少年脊柱正常组胸椎椎弓根的形态学指标:PW:12~13岁,T_(4)~T_(9)相对狭窄,T_(5)、T_(6)最小[男(3.71±0.72)mm,女(3.53±0.60)mm],14~15岁,T_(4)~T_(6)相对狭窄,T_(4)、T_(5)最小[男(4.29±0.93)mm,女(4.27±1.20)mm];PH:12~13岁,T_(1)~T_(12)逐渐增大,T_(1)最小[男(6.19±1.06)mm,女(7.21±2.76)mm],14~15岁,T_(1)~T_(11)逐渐增大,T_(11)~T_(12)减小,T_(1)最小[男(7.51±1.55)mm,女(7.48±2.09)mm];VSL:12~13岁,T_(1)最小[男(29.56±3.24)mm,女(28.25±2.12)mm];T_(12)最大[男(34.80±4.76)mm,女(35.98±3.40)mm],14~15岁,T_(1)最小[男(31.81±3.43)mm,女(29.60±4.78)mm],T_(12)最大[男(41.54±3.35)mm,女(40.52±5.58)mm];TD与LD:ASN组和AIS组的TD与LD规律相似,T_(1)~T_(3)横径大于纵径,T_(4)~T_(7)横径与纵径相似,T_(7)~T_(12)TD小于LD;α角:ASN组和AIS组的α角变化规律相似,先递减后递增,T_(5)~T_(12)α角均5°以下,几乎与矢状轴平行,β角:ASN组和AIS组的β角变化规律相似,T_(1)~T_(3)快速减小,T_(4)~T_(7)缓慢减小,T_(7)~T_(12)缓慢增大;θ角:ASN组和AIS组的θ角变化规律相似,先递增后递减,T_(5)~T_(8)θ角最大;PA:ASN组和AIS组的PA变化规律相似,先递减后递增,T_(4)~T_(8)相对狭窄。与脊柱正常组相比,脊柱侧凸组腰椎的凸侧PW比凹侧更窄,VSL更长,α角更大。结论脊柱正常组胸椎各节段置入螺钉的适合尺寸及脊柱侧凸组椎弓根参数特点,可以帮助临床医师掌握胸椎解剖结构,提高置钉准确性。

Objective To study the anatomical structure of normal and scoliotic thoracic vertebrae in adolescents aged 12-15 years in Northern Shanxi Province,to provide detailed information for pedicle screw placement,and to provide data references for screw size design.Methods Totally 120 cases of normal thoracolumbar CT of 120 adolescents aged 12 to 15 years and 30 cases of adolescent idiopathic scoliosis were collected in Northern Shaanxi Province.The raw data of thoracolumbar tomographic images scanned continuously were imported into Mimics16.0 software for analysis and measurement in DICOM format.Measurement indicators:pedicle width,pedicle height,pedicle length,transverse diameter of spinal canal,longitudinal diameter of spinal canal,transverse pedicle angle,maximum transverse pedicle angle,sagittal pedicle angle and pedicle area.Results Pedicle width:12-13 years old,T_(4)-T_(9) were relatively narrow,T_(5),T_(6) were the smallest[male(3.71±0.72)mm,female(3.53±0.60)mm];14-15 years old,T_(4)-T_(6) were relatively narrow,T_(4),T_(5) were the smallest[male(4.29±0.93)mm,female(4.27±1.20)mm];Pedicle height:12-13 years old,T_(1)-T_(12) gradually increased,T_(1) was the smallest[male(6.19±1.06)mm,female(7.21±2.76)mm],14-15 years old,T_(1)-T_(11) gradually increased,T_(11)-T_(12) decreased,T_(1) was the smallest[male(7.51±1.55)mm,female(7.48±2.09)mm];Virtual spike length:12-13 years old,T_(1) was the smallest[male(29.56±3.24)mm,female (28.25±2.12)mm];14-15 years old,T_(1) was the smallest[male(31.81±3.43)mm,female (29.60±4.78)mm];Transverse diameter and longitudinal diameter:the two groups were similar in law,T_(1)-T_(3) TD was larger than LD,T_(4)-T_(7) TD was similar to LD,T_(7)-T_(12) TD was smaller than LD;The transverse pedicle angle:The law of the two groups was similar,decreasing at first and then increasing,and the T_(5)-T_(12) angle was less than 5°,almost parallel to the sagittal axis.Maximum transverse pedicle angle:the rules of the two groups were similar,T_(1)-T_(3) decreased rapidly,T_(4)-T_(7) decreased slowly,T_(7)-T_(12) increased slowly.The sagittal pedicle angle:The two groups had similar laws,first increasing and then decreasing,and T_(5)-T_(8) were the largest;Pedicle area:the two groups had similarities in law,first decreasing and then increasing,and T_(4)-T_(8) were relatively narrow.Compared with the normal spine,compared with the convex side,the concave side pedicle width was narrower,the virtual nail tract length was longer,and the pedicle external deflection angle was greater.Conclusion The analysis of the pedicle parameters of the thoracic spine shows that the appropriate size of the screws for each thoracic spine and the characteristics of the parameters of the scoliotic pedicles can help clinicians master the anatomical structure of the thoracic spine and improve the accuracy of clinical surgery.