肛门直肠畸形合并先天性脊柱畸形的临床及影像学特征分析  

Clinical and radiological characteristics of congenital spinal deformity associated with anorectal malformation

作　　者：李薇[1] 汪飞 林刚 唐凯 唐维兵[1] 楼跃 Li Wei;Wang Fei;Lin Gang;Tang Kai;Tang Weibin;Lou Yue(Department of Neonatal Surgery,Children's Hospital,Nanjing Medical University,Nanjing 210008,China;Department of Orthopedic Surgery,Children's Hospital,Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院新生儿外科,南京210008 [2]南京医科大学附属儿童医院骨科,南京210008

出　　处：《临床小儿外科杂志》2022年第11期1012-1018,共7页Journal of Clinical Pediatric Surgery

基　　金：南京市卫生科技发展专项资金项目(YKK20123)

摘　　要：目的根据肛门直肠畸形(anorectal malformation,ARM)合并先天性脊柱畸形患儿的临床亚型分析其影像学特征。方法回顾性分析2008年1月至2019年12月在南京医科大学附属儿童医院新生儿外科就诊后至骨科随诊的72例ARM合并脊柱畸形患儿临床资料,其中男38例,女34例。根据合并脊柱畸形涉及区域将患儿分为三组:Ⅰ组为ARM合并单纯胸腰椎畸形,Ⅱ组为ARM合并单纯骶椎畸形,Ⅲ组为ARM同时合并胸腰椎及骶椎畸形。结合影像学资料,比较三组患儿的年龄、性别、ARM类型、胸腰椎畸形类型及分布、骶椎畸形类型、肋骨畸形及合并其他系统畸形情况。采用SPSS 18.0进行统计分析。因本研究中所有的计量资料均不服从正态分布,故计量资料采用M(Q_(1),Q_(3))进行描述,三组间数值比较采用多组比较的KruskalWallis秩和检验,两两比较采用MannWhitney检验。三组间性别比例、肛门直肠畸形类型、合并其他系统畸形、椎体畸形分布、肋骨畸形、骶骨畸形分布对比均采用Fisher精确概率法。P<0.05为差异存在统计学意义。结果Ⅰ、Ⅱ、Ⅲ组ARM患儿分别有30例(41.7%,30/72)、35例(48.6%,35/72)及7例(9.7%,7/72)。Ⅱ组患儿脊柱评估年龄为4.00(3.00,5.00)个月,较Ⅰ组的0.20(0.03,4.00)个月、Ⅲ组的0.70(0.03,5.00)个月年龄偏大(P=0.009)。三组患儿性别比例、ARM类型分布差异无统计学意义(P>0.05)。Ⅰ组胸腰椎畸形好发于主胸段(24/30)及上胸段(17/30),Ⅲ组胸腰椎畸形好发于腰段(6/7)及胸腰段(4/7),两组差异有统计学意义(P=0.002)。Ⅰ、Ⅲ组患儿之间胸腰椎畸形类型、涉及节段数及多发畸形的比例差异无统计学意义(P>0.05)。Ⅱ、Ⅲ组患儿骶椎畸形类型分布差异有统计学意义(P=0.020),Ⅱ组骶椎畸形严重程度高于Ⅲ组。Ⅰ组合并肋骨畸形的发生率高于Ⅱ、Ⅲ组(P=0.002)。Ⅰ组心脏畸形的发生率高于Ⅱ、Ⅲ组(P=0.031),但椎管内畸形的发生率低于Objective To explore the clinical subtypes and radiological characteristics for children with anorectal malformation(ARM)associated with congenital spine deformity.Methods A retrospective review was conducted for 72 ARM children patients who had received treatment between January 2008 and December 2019.There were 38 boys and 34 girls.Based upon the range of vertebral anomalies,they were assigned into GroupⅠ(n=30,41.7%):ARM associated with simple thoracic/lumbar vertebral anomalies;GroupⅡ(n=35,48.6%):those with simple sacral agenesis and GroupⅢ(n=7,9.7%):those with both sacral agenesis and thoracic/lumbar vertebral anomalies.Demographic profiles,ARM type,type/location of vertebral anomalies,sacral agenesis,rib anomalies and concomitant defects of other systems were recorded.SPSS 18.0 was used for statistical analysis.Since all measurement data in this study did not obey normal distribution,M(Q_(1),Q_(3))was used to describe the measurement data.Numerical comparison among three groups was conducted by Kruskal-Wallis rank sum test for comparison of multiple groups,and Nemenyi test was used for pound-wise comparison.Fisher's exact probability method was used to compare the sex ratio,types of anorectal malformations,combined with other systemic malformations,distribution of vertebral malformations,rib malformations,and sacral malformations among the three groups.P<0.05 showed statistical significance.Results The average evaluation age of GroupⅡwas 4.00(3.00,5.00)months and it was greater than GroupⅠ/Ⅲ(P=0.009).No differences existed in gender or ARM type among three groups.Spinal deformity predominated in main thoracic region(24/30)and proximal thoracic region(17/30)in GroupⅠwhereas lumbar region(6/7)and thoracolumbar region(4/7)were affected in GroupⅢ(P=0.002).No significant differences in type/level of vertebral anomaly or percentage of multiple anomalies existed between GroupsⅠandⅢ.Severe sacral agenesis was more common in GroupⅡthan GroupⅢ(P=0.020).The prevalence of associated rib anomalies

关 键 词：肛门直肠畸形 脊柱畸形 临床分型 影像学特征 

分 类 号：R68[医药卫生—骨科学]