儿童先天性脊柱侧凸平衡型半椎体畸形的影像学分析

Imaging analysis of balanced hemivertebrae in congenital scoliosis in children

中文关键词:  脊柱畸形  儿童  半椎体  影像学

英文关键词:Spinal deformity  Children  Hemivertebrae  Imaging

中文摘要:

  【摘要】 目的：分析儿童先天性脊柱侧凸平衡型半椎体畸形的影像学特点，为临床工作提供指导和依据。方法：回顾性分析2015年12月~2020年6月于我院行手术治疗的52例儿童先天性脊柱侧凸平衡型半椎体畸形患者的临床资料。患者年龄3.5（2.9，7.3）岁，男性28例，女性24例。在术前全脊柱X线片上测量患者冠状面和矢状面参数，冠状面参数包括头/尾端节段性侧凸角及代偿弯、骨盆倾斜角（pelvic tilt，PT）、冠状面骶骨倾斜角（coronal sacral slope，CSS）；矢状面参数包括胸椎后凸角（thoracic kyphosis，TK）、胸腰段后凸角（thoracolumbar kyphosis，TLK）、骶骨倾斜角（sacral slope，SS）、腰椎前凸角（lumbar lordosis，LL）等。通过CT及MRI判断前方半椎体和后方附件的畸形情况，分为协调型和错配型。按照半椎体分布的数量、位置及合并脊柱/肋骨畸形情况，对畸形进行分型并总结其影像学特点。畸形分为4种类型：1型，包含2个半椎体；2型，包含3个半椎体；3型，包含≥4个半椎体；4型，平衡型半椎体同时合并多发脊柱和肋骨畸形（1~3型患者可合并轻度的椎体和肋骨畸形）。将1型畸形定义为非复杂型，2~4型畸形定义为复杂型。采用t检验和秩和检验比较各型畸形的冠状面和矢状面主要参数，采用卡方检验对合并脊柱/肋骨畸形情况进行比较。结果：共计130个半椎体，平均间隔3.4个正常椎体，其中颈椎6个（4.6%），上胸椎29个（22.3%），下胸椎44个（33.8%），腰骶椎51个（39.2%）。协调型半椎体为110个（84.6%），错配型20个（15.4%）。畸形分型：1型31例，2型11例，3型4例，4型6例。患者头端和尾端节段性侧凸角分别为32.7°±8.1°和34.4°±9.0°（t=-0.905，P=0.367），头端和尾端代偿弯分别为12.8°±6.6°和9.7°±6.9°（t=2.308，P=0.023）。复杂型和非复杂型患者头/尾端节段性侧凸角及代偿弯、PT、CSS、TK、SS、LL均无统计学差异（P>0.05）。复杂型和非复杂型TLK分别为16.2°±16.4°和6.4°±22.6°，差异有统计学意义（t=-1.693，P=0.047）。2~4型患者合并肋骨畸形及椎管内结构异常的比例高于1型（52.4% vs 12.9%，χ2=9.506，P=0.002）。3型和4型患者椎板错配率（25.7%）高于1型和2型（11.6%）（χ2=3.926，P=0.048）。结论：儿童先天性脊柱侧凸平衡型半椎体畸形类型复杂，半椎体主要分布于腰骶椎和下胸椎，畸形对患者冠状面影响较小，矢状面主要影响胸腰段力线，半椎体数量越多合并畸形越复杂。

英文摘要:

  【Abstract】 Objectives: To analyze the imaging characteristics of balanced hemivertebrae in children with congenital scoliosis, so as to provide guidance and basis for clinical practice. Methods: The clinical data of 52 congenital scoliosis children with balanced hemivertebrae undergoing surgery between December 2015 and June 2020 in our hospital were retrospectively analyzed. The mean age of the patients was 3.5 years(2.9, 7.3 years). There were 28 males and 24 females. Radiographic parameters were measured on full-spine X-ray before operation, including coronal parameters such as cranial/caudal segmental Cobb angle and compensatory curve, pelvic tilt(PT), and coronal sacral slope(CSS), and sagittal parameters such as thoracic kyphosis(TK), thoracolumbar kyphosis(TLK), sacral slope(SS), and lumbar lordosis(LL). The deformity conditions of anterior hemivertebrae and posterior elements were determined via CT and MRI as unsionous and discordant deformity. Spinal deformity was classified and imaging characteristics were summarized according to the number and position of hemivertebrae and combined spinal/ribs deformity. The deformity was classified into four types: type 1, 2 hemivertebraes; type 2, 3 hemivertebraes; type 3, ≥4 hemivertebraes; type 4, balanced hemivertebrae combined with complicated spine/ribs deformity(Type 1-3 may combine with mild spine/ ribs deformity). Type 1 and 2-4 were classified into non-complicated and complicated deformity, respectively. t test and rank-sum test were applied to compare the main coronal and sagittal parameters, and Chi-square test was used to compare the combined spine/ribs deformity conditions. Results: A total of 130 hemivertebrae with an interval of 3.4 normal vertebrae on average were found in 52 patients including 6(4.6%) cervical, 29(22.3%) upper thoracic, 44(33.8%) lower thoracic, and 51(39.2%) lumbosacral hemivertebrae. Hemivertebraes were separated by mean 3.4 normal vertebrae. Unisonous deformity was found in 110 hemivertebrae(84.6%) in comparison with 20(5.4%) discordant deformity. There were 31 cases classified into type 1, 11 cases into type 2, 4 cases into type 3, and 6 cases into type 4. Cranial and caudal segmental Cobb angle was 32.7°±8.1° and 34.4°±9.0°(t=-0.905, P=0.367), and cranial and caudal compensatory curve was 12.8°±6.6° and 9.7°±6.9°(t=2.308, P=0.023). Data of cranial/caudal segmental Cobb angle and compensatory curve, PT, CSS, TK, SS and LL showed no significant difference(P>0.05) between the complicated and non-complicated types. TLK in complicated and non-complicated deformity was 16.2°±16.4° and 6.4°±22.6°, respectively (t=-1.693, P=0.047). Rib and intraspinal deformity in type 2-4 was higher than that in type 1 (52.4% vs 12.9%, χ2=9.506, P=0.002). The discordant rate of anterior vertebrae and posterior lamina was 25.7% in types 3 and 4 deformity and 11.6% in types 1 and 2 deformity, respectively (χ2=3.926, P=0.048). Conclusions: The deformity of balanced hemivertebrae was complicated and most hemivertebrae distributed in lumbosacral and lower thoracic spine. The influence caused by deformity was less significant in coronal plane than that in sagittal plane, especially in the thoracolumbar region. The bigger the number of hemivertebrae, the more complicated the deformity.