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

作　　者：阮彩莲[1] 郭宏焘[2] 惠雪枫[1] 王璐[1] 朱慧 赵琳[1] 刘伯峰[1] 李小记[1] RUAN Cai-lian;GUO Hong-tao;HUI Xue-feng;WANG Lu;ZHU Hui;ZHAO Lin;LIU Bo-feng;LI Xiao-ji(Department of Anatomy,Medical College,Yan’an University,Shanxi Yan’an 716000,China;School of Physical Education,Yan’an University,Shaanxi Yan’an 716000,China)

机构地区：[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

出　　处：《解剖学报》2022年第2期225-237,共13页Acta Anatomica Sinica

基　　金：延安大学研究生教改研究项目(YDYJG2020034,YDYJG2020035)。

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,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) decr

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 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学]