解剖学报 ›› 2022, Vol. 53 ›› Issue (2): 225-237.doi: 10.16098/j.issn.0529-1356.2022.02.013

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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

阮彩莲1 郭宏焘2 惠雪枫1 王璐1 朱慧1 赵琳1 刘伯峰1 李小记1*
  

  1. 1.陕西省延安大学医学院解剖学教研室,陕西 延安716000; 2.陕西省延安大学体育学院,陕西 延安  716000
  • 收稿日期:2020-08-10 修回日期:2020-10-09 出版日期:2022-04-06 发布日期:2022-04-06
  • 通讯作者: 李小记 E-mail:E-lxjyxy1994@163.com

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

RUAN Cai-lian1  GUO Hong-tao2  HUI Xue-feng1  WANG Lu1  ZHU Hui1  ZHAO Lin1  LIU Bo-feng1  LI Xiao-ji1*   

  1. 1. Department of Anatomy, Medical College, Yan’an University,Shanxi Yan’an 716000,China; 2. School of Physical Education, Yan’an University, Shaanxi Yan’an 716000, China
  • Received:2020-08-10 Revised:2020-10-09 Online:2022-04-06 Published:2022-04-06
  • Contact: LI Xiao-ji E-mail:E-lxjyxy1994@163.com

摘要:

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,T4~T9相对狭窄,T5、T6最小[男(3.71±0.72) mm,女(3.53±0.60)mm],14~15岁,T4~T6相对狭窄,T4、T5最小[男(4.29±0.93) mm,女(4.27±1.20)mm];PH:12~13岁,T1~T12逐渐增大,T1最小[男(6.19±1.06) mm,女(7.21±2.76)mm],14~15岁,T1~T11逐渐增大,T11~T12减小,T1最小[男(7.51±1.55) mm,女(7.48±2.09)mm];VSL:12~13岁,T1最小[男(29.56±3.24) mm,女(28.25±2.12)mm];T12最大[男(34.80±4.76) mm,女(35.98±3.40)mm],14~15岁,T1最小[男(31.81±3.43) mm,女(29.60±4.78)mm],T12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,T1~T3 横径大于纵径,T4~T7 横径与纵径相似,T7~T12TD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,T5~T12 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,T1~T3快速减小,T4~T7缓慢减小,T7~T12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,T5~T8 θ角最大;PA:ASN 组和AIS 组的PA变化规律相似,先递减后递增,T4~T8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。

关键词: 特发性脊柱侧凸, 胸椎, 椎弓根螺钉, 三维重建测量, DICOM格式, 解剖学, 青少年

Abstract:

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, T4-T9 were relatively narrow, T5,T6 were the smallest[male (3.71 ±0.72) mm, female (3.53 ±0.60) mm];14-15 years old, T4-T6 were relatively narrow, T4,T5 were the smallest [male(4.29 ±0.93) mm, female (4.27 ±1.20) mm];Pedicle height:12-13 years old, T1-T12 gradually increased, T1 was the smallest [male (6.19±1.06) mm, female(7.21±2.76)mm], 14-15 years old, T1-T11 gradually increased, T11-T12 decreased, T1 was the smallest [male (7.51±1.55) mm, female (7.48 ±2.09) mm];Virtual spike length:12-13 years old, T1 was the smallest [male (29.56 ±3.24) mm, female 28.25 ±2.12) mm];14-15 years old, T1 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, T1-T3 TD was larger than LD, T4-T7 TD was similar to LD, T7-T12 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 T5-T12 angle was less than 5°, almost parallel to the sagittal axis. Maximum transverse pedicle angle: the rules of the two groups were similar, T1-T3 decreased rapidly, T4-T7 decreased slowly, T7-T12 increased slowly. The sagittal pedicle angle:The two groups had similar laws, first increasing and then decreasing, and T5-T8 were the largest; Pedicle area:the two groups had similarities in law, first decreasing and then increasing, and T4-T8 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.

Key words:  Idiopathic scoliosis, Thoracic spine, Scoliosis, Pedicle screw, Three-dimensional reconstruction measurement, DICOM format, Anatomy, Adolescent

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