【摘要】 背景:胸椎椎弓根是胸椎手术中最主要的内固定方式,但是缺少椎弓根螺钉置入通道的相关形态的参数测量,缺少正常发育青少年与青少年特发性脊柱侧凸患者比较的相关报道。目的:比较在正常发育青少年与青少年特发性脊柱侧凸患者胸椎安全置入椎弓根螺钉相关的椎弓根形态特点。方法:使用三维重建CT图像对35例正常发育青少年和35例青少年特发性脊柱侧凸患者的胸椎椎弓根进行测量。测量的参数包括:1临界距离:从椎弓根螺钉入点到椎板腹侧骨皮质的最短距离。2安全距离:从入点到椎管的切线距离(和椎弓根内侧皮质相切)。3椎弓根螺钉长度。4椎弓根宽度。5椎弓根横向角。危险区域定义为安全距离和临界距离之差。结果与结论:正常发育组临界距离为(9.2±1.0)mm,青少年特发性脊柱侧凸组为(9.4±1.2)mm。正常发育组安全距离为(14.7±0.8)mm,显著小于青少年特发性脊柱侧凸组的(15.4±1.4)mm(P<0.001)。正常发育组危险区域为(5.4±0.7)mm,显著小于青少年特发性脊柱侧凸组的(6.0±1.0)mm(P<0.001)。正常发育组椎弓根螺钉长度为(36.6±4.1)mm,青少年特发性脊柱侧凸组椎弓根螺钉长度为(37.1±5.3)mm。正常发育组椎弓根螺钉宽度为(5.8±1.2)mm,青少年特发性脊柱侧凸组椎弓根宽度为(5.7±1.7)mm。两组临界距离、椎弓根螺钉长度和椎弓根宽度之间差异无显著性意义(P=0.382,0.135,0.293)。两组的椎弓根横向角均从T1到T12逐渐减少。提示正常发育青少年和青少年特发性脊柱侧凸患者置入椎弓根螺钉的胸椎椎弓根形态相关参数有差别,尤其在胸弯顶点附近区域。更多还原

【Abstract】 BACKGROUND:Pedicle screw is the major instrumentation of surgery in thoracic spine.However,there have been few reports about pedicle morphology relevant to screw insertion tracts,and few reports comparing the normal adolescents and adolescent idiopathic scoliosis patients.OBJECTIVE:To compare the morphologic characteristics of the thoracic pedicle with regard to safe thoracic pedicle screw placement in normal adolescents and adolescent idiopathic scoliosis patients.METHODS:Thoracic pedicles of thirty-five normal adolescents and thirty-five adolescent idiopathic scoliosis patients were measured with three-dimensional reconstruction CT images.Measured parameters include(1)critical distance:the shortest distance from an entry point to the ventral cortex of the lamina.(2) Safe distance:the distance from the entry point to the tangent of the spinal canal at the medial wall of the pedicle.(3) Pedicle screw length.(4) Pedicle width.(5) Pedicle transverse angle.The dangerous area was defined as the distance between the critical distance and the safe distance.RESULTS AND CONCLUSION:The mean critical distance was(9.2±1.0) mm for the normal adolescents,and(9.4±1.2)mm for the adolescent idiopathic scoliosis patients.Safe distances were significantly less in normal adolescents(14.7±0.8) mm than that of the adolescent idiopathic scoliosis group(15.4±1.4) mm(P < 0.001).The dangerous area was(5.4±0.7) mm for the normal adolescents,which was significantly less than that of the adolescent idiopathic scoliosis patients(6.0±1.0) mm(P < 0.001).Pedicle screw length was(36.6±4.1) mm for the normal adolescents and(37.1±5.3) mm for the adolescent idiopathic scoliosis patients.Pedicle width was(5.8±1.2) mm for the normal adolescents and(5.7±1.7) mm for the adolescent idiopathic scoliosis patients.No significant difference in critical distance,pedicle screw length and pedicle width was found between the two groups(P=0.382,0.135,0.293).Pedicle transverse angle decreased gradually from T1 to T12 in both groups.These results verify that pedicle morphology of many parameters is different between normal adolescents and adolescent idiopathic scoliosis patients,especially in the apical area of the thoracic curve.更多还原