仰卧位和俯卧位测量青少年特发性脊柱侧凸患者胸主动脉与椎体毗邻关系的差异  

Difference between supine and prone positions in adjacent relationship of thoracic aorta with vertebral body in adolescent idiopathic scoliosis patients

作　　者：姬勇 肖建如 MILBRANDT Todd A ZHAO Chun-feng LARSON ANoelle 贾连顺 JI Yong;XIAO Jian-ru;MILBRANDT Todd A;ZHAO Chun-feng;LARSON ANoelle;JIA Lian-shun(Department of Orthopaedics,Changzheng Hospital,Navy Medical University,Shanghai 200003,China;Department of Orthopaedics,Mayo Medical Center,Rochester 55901,Minnesota,USA)

机构地区：[1]海军军医大学附属长征医院骨科,上海200003 [2]梅奥医学中心骨科,罗彻斯特55901

出　　处：《脊柱外科杂志》2019年第6期404-408,共5页Journal of Spinal Surgery

摘　　要：目的通过术前仰卧位MRI和术中俯卧位O形臂X线机获得青少年特发性脊柱侧凸(AIS)患者横断面影像学资料,探讨2种体位下主胸弯顶椎与胸主动脉的毗邻关系。方法回顾性分析2013年4月-2018年7月美国梅奥医学中心骨科采用后路手术治疗的18例AIS患者资料。患者术前均行仰卧位全脊柱MRI平扫和术中俯卧位脊柱O形臂X线机平扫,将影像资料上传至临床图像显示系统(Qreads 5.10)。选取主胸弯顶椎为测量平面,测量顶椎椎体旋转角度(AVR),主动脉到椎体距离(a线),主动脉到左侧椎弓根置钉点距离(b线),主动脉到椎管垂直距离(c线),主动脉到椎弓根置钉点连线的垂直距离(d线),主动脉椎体角(AVA),左侧椎弓根置钉点和主动脉内侧切线与椎体中轴线平行线间的夹角(∠α),左侧椎弓根置钉点和主动脉中心点连线与椎体中轴线平行线间的夹角(∠β)。采用配对样本t检验比较2种体位下各参数变化,采用Pearson相关分析对数据进行相关性分析。结果俯卧位AVR、c线均大于仰卧位,差异均有统计学意义(P<0.05),平均差值分别为2.71°、2.24 mm。俯卧位与仰卧位AVA平均差值为4.45°,差异有统计学意义(P<0.05);俯卧位AVR、a线、b线、c线、d线、AVA、∠α、∠β与仰卧位相应指标呈正相关;俯卧位∠β与主胸弯Cobb角呈正相关,与俯卧位及仰卧位AVR均呈负相关;俯卧位d线与主胸弯Cobb角呈负相关,与俯卧位及仰卧位AVR呈正相关。结论相较于仰卧位,脊柱侧凸患者俯卧位时顶椎旋转度增大,主动脉到椎管的垂直距离增大,主动脉向椎体右前方移动。Objective To obtain the cross-sectional imaging data of adolescent idiopathic scoliosis(AIS)patients by preoperative supine position MRI and intraoperative prone position O-arm system,exploring the adjacent relationship between the main thoracic curvature and the thoracic aorta in the 2 positions.Methods A retrospective study was conducted on 18 patients with AIS who underwent posterior surgeries from April 2013 to July 2018 in Mayo medical center.All the patients underwent the whole spine MRI plain scan in supine position at pre-operation and the O-arm system plain scan in prone position during the operation,and the clinical images uploaded to the Qreads 5.10 display system.The main thoracic curvature apex vertebra was selected as the measurement plane.The index included apical-vertebral rotation(AVR),the distance from the aorta to the vertebral body(line a),the distance from the aorta to the left pedicle point(line b),the vertical distance from the aorta to the spinal canal(line c),the vertical distance from the aorta to the connection line of the pedicle points(line d),the aorta-vertebral angle(AVA),the angle between the medial tangential line across the left pedicle screw placement point and the aortic and the parallel line of the central axis of the vertebral body(∠α),the angle between through the left pedicle screw placement point to the center point of the aorta and the parallel line of the axis of the vertebral body(∠β).The paired-sample t-test was used to compare the positional changes of parameters in the 2 positions,and the Pearson correlation analysis was performed to analyze the correlation between the above parameters.Results The AVR and line c in prone position were larger than those in supine position,with significant differences(P<0.05).The mean difference was 2.71°and 2.24 mm,respectively.The average difference of the AVA between prone position and supine position was 4.45°,and the difference was statistically significant(P<0.05).The prone position AVR,line a,line b,line c,line d,AVA,∠

关 键 词：胸椎 脊柱侧凸 放射测量术 

分 类 号：R682.3[医药卫生—骨科学]