腰段半椎体畸形及其远端椎体的影像学特点

Radiological imaging characteristics and the clinical significance of sacrum and vertebra below the lumbar hemivertebra

中文关键词:  先天性脊柱侧凸  半椎体  腰椎  影像学

英文关键词:Congenital scoliosis  Lumbar  Hemivertebra  Radiological imaging

中文摘要:

  【摘要】 目的：分析腰段半椎体畸形及其远端腰椎和骶骨的影像学特点，为远端融合椎的选择及手术策略提供依据。方法：对93例手术治疗的腰段半椎体畸形患者的术前影像学资料进行回顾性分析。其中男46例，女47例，年龄10.5±7.2岁（2~42岁）。所有病例均行全脊柱X线片及三维CT检查，测量侧后凸的节段性Cobb角及冠状面、矢状面平衡；通过CT三维重建，对半椎体畸形进行分型；测量站立正位及凹侧Bending像上L4、L5和 S1椎体的倾斜度（即相应椎体上终板与双侧髂嵴最高点连线的夹角），计算L4和L5倾斜的柔韧性。根据年龄将患者分为三组：A组，年龄≤6岁，B组，年龄7~12岁，C组，年龄≥13岁，对各组患者数据进行统计学分析。结果：88例（94.6%）患者为单个半椎体，5例患者为2个半椎体。其中55个（56.1%）半椎体为完全分节型，43个半椎体为不完全分节型。节段性侧凸Cobb角42.5°±15.9°（12°~93°），柔韧性为（26.6±17.9）%（0~90%），顶椎椎体偏距为22.4±14.5mm（2~72mm）。51例（54.8%）患者有局部后凸，Cobb角度为20.5°±20.3°（2°~94°）。13例患者冠状面失平衡，19例患者矢状面失平衡。L4、L5和S1椎体在站立位正位X线片上的倾斜度分别为23.5°±10.2°、17.2°±9.0°和9.8°±5.9°；18例S1椎体倾斜度≥15°，其中5例倾斜度≥20°。L4和L5在凹侧Bending像上的倾斜度分别为14.5°±10.6°和12.0°±8.8°，椎体倾斜的柔韧性分别为（43.4±29.1）%和（39.3±29.5）%。A、B、C三组L4椎体在Bending像上的倾斜度和柔韧性在分别为7.6°±6.6°、13.9°±10.5°、21.1°±9.8°和（59.1±34.0）%、（42.9±25.7）%、（31.4±22.0）%，L5椎体在Bending像上的倾斜度和柔韧性分别为7.0°±6.6°、11.1°±8.5、17.2°±8.7°和（41.8±33.8）%、（39.1±23.4）%、（25.6±21.9）%，三组L4、L5椎体在Bending像上的平均倾斜度和柔韧性有显著性差异（P<0.05）。结论：腰段半椎体畸形常伴有远端椎体的倾斜，L4和L5在Bending像上的倾斜度随年龄增加而增加，但柔韧性随年龄增加而减低。术前对L4、L5和S1椎体倾斜度以及L4和L5倾斜的柔韧性测量对决定远端融合椎及矫形策略具有重要意义。

英文摘要:

  【Abstract】 Objectives: To analyze the radiological imaging characteristics of sacrum and vertebra below lumbar hemivertebra in congenital scoliosis, and to provide data for the decision of distal fusion level. Methods: The preoperative radiographs were retrospectively reviewed in 93 patients(46 males and 47 females) with lumbar hemivertebra who underwent surgeries. The average age was 10.5±7.2 years(range, 2-42). All cases had routine radiographs and 3-D CT scan of the whole spine. Segmental scoliosis and kyphosis Cobb angle, coronal and sagittal balance were measured. Tilting of L4, L5 and S1 on standing anteroposterior and concave bending films were measured and the flexibilities of L4 and L5 were calculated. The indexes among 3 groups were also statistically analyzed by using SPSS 19.0 software. P value less than 0.05 was considered as statistically significant. Results: There was 1 hemivertebra in 88 patients and 2 hemivertebrae in 5 patients. 55 were fully segmented and 43 were semi-segmented. The mean local scoliotic curve was 42.5°±15.9°(range, 12°-93°) and flexibility was (26.6±17.9)%(range, 0-90%). The mean apical translation was 22.4±14.5mm(range, 2-72). 51 cases had focal kyphosis and the mean Cobb angle were 20.5°±20.3°(range, 2°-94°). 13 cases had coronal decompensation and 19 cases had sagittal imbalance. The mean tilting of L4, L5 and S1 on standing films was 23.5°±10.2°, 17.2°±9.0° and 9.8°±5.9° respectively. There were 18 cases in which the tilting of S1 equal to or greater than 15°, and 5 cases in which the tilting of S1 equal to or greater than 20°. The mean tilting of L4 and L5 on concave bending films was 14.5°±10.6° and 12.0°0±8.8° respectively. The mean flexibility of L4 and L5 was (43.44±29.1)% and (39.3±29.5)% respectively. The mean tilting on bending films and flexibility of L4 in 3 groups(A, age≤6 years; B, age between 7 to 12 years and C, age≥13 years) were 7.6°±6.6° and (59.11±34.0)%, 13.9°±10.5° and (42.9±25.7)%, 21.1°±9.8° and (31.4±22.0)%, respectively. The mean tilting on bending films and flexibility of L5 in 3 groups were 7.0°±6.6° and (41.8±33.8)%, 11.1°±8.5° and (39.1±23.4)%, 17.2°±8.7° and (25.6±21.9)%, respectively. The mean tilting on bending films and flexibility of L4 and L5 among 3 groups had statistical significances(P<0.05). Conclusions: Lumbar hemivertebra often causes tilting of the vertebra below it. The tilting of L4, L5 on bending films increase with age while flexibility decrease with age. The preoperative measurement of L4, L5 and S1 tilting and flexibility of L4 and L5 are very important for the decision of distal fusion level.