强直性脊柱炎患者中下胸椎椎弓根的影像学特征及临床意义
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摘要
目的 :比较强直性脊柱炎(ankylosing spondylitis,AS)患者与非AS患者T5～T12椎弓根CT扫描的影像学参数,为AS患者椎弓根螺钉置钉提供参考依据。方法:选取2003年1月～2017年6月我科收治的具有完整临床资料及中下胸椎CT平扫和三维重建的AS男性患者40例(AS组),年龄34～53岁(40.5±4.2岁);选取同期我科收治的具有完整临床资料及中下胸椎CT平扫和三维重建的胸椎骨折男性患者40例(非AS组),年龄32～48岁(38.5±3.7岁)。分别测量T5～T12的椎弓根宽度(pedicle width,PW)、椎弓根高度(pedicle height,PH)、椎弓根与椎体正中矢状面夹角即内倾角(pedicle transverse angle,PTA)、椎弓根间距(pedicles distance,PD)和椎弓根钉道长度(pedicle screw path length,PL)。比较两组患者的测量结果。结果:AS组和非AS组PW从T5～T12逐渐增大,AS组PW均小于非AS组,两组比较有统计学差异(P<0.05);两组T5～T12的PH无统计学差异(P>0.05);两组PTA变化趋势一致,从T5～T12逐渐变为负数(T5～T10为正,T11～T12为负),AS患者在T5～T10较非AS组小,而在T11、T12较非AS组大,两组间比较均有统计学差异(P<0.05);两组PD和PL从T5～T12逐渐增大,AS患者大于非AS组患者,两组间比较有统计学差异(P<0.05)。结论:AS患者中下胸椎椎弓根较细长,行中下胸椎椎弓根螺钉内固定时可选用较长椎弓根螺钉以增加内固定强度,但不适宜增加椎弓根螺钉直径,置钉角度接近垂直,必要时可经椎弓根-肋骨途径置钉。
Objectives: To compare the T5-T12 pedicle parameters in ankylosing spondylitis(AS) with those in normal people on the CT scan, in order to provide reference for pedicle screw placement. Methods: A total of 40 males AS(AS group) with complete clinical data, CT scan and three-dimensional reconstruction of the middle and lower thoracic spine from January 2003 to June 2017 was enrolled with the age ranging from34 to 53 years old. And 40 males of thoracic vertebral fracture with complete clinical data, CT scan and three-dimensional reconstruction of middle and lower thoracic spine were selected(non-AS group), with the age ranging from 32 to 48 years old in the same period. The vertebral pedicle parameters from T5 to T12 were measured, including pedicle width(PW), pedicle height(PH), pedicle transverse angle(PTA) that between the pedicle axis and the median sagittal plane of the vertebral body, pedicles distance(PD), pedicle screw path length(PL). The measurements of two groups were compared. Results: The PW in AS and non-AS group increased gradually from T5 to T12. The PW in AS group was significantly smaller than that of non-AS group(P<0.05). There was no statistical difference of the PH between the two groups(P >0.05). The variation trend of PTA in the two groups was the same. The PTA gradually became negative(T5-T10 were positive,T11-T12 were negative) and the PTA in AS group was significantly smaller than that in non-AS group, but the results in T11 and T12 were opposite(P<0.05). The PD of the two groups gradually increased from T5 to T12, and it was significantly larger in AS group than that in non-AS group(P <0.05); the PL increased gradually from T5 to T12, and the PL in AS group was significantly larger than that in non-AS group(P<0.05). Conclusions: Long pedicle screw can be used to increase the strength of internal fixation in AS patients, but it is not suitable to increase the pedicle screw diameter. The pedicle screw angle is close to vertical. If necessary, it can be placed through pedicle-rib unit.
Objectives: To compare the T5-T12 pedicle parameters in ankylosing spondylitis(AS) with those in normal people on the CT scan, in order to provide reference for pedicle screw placement. Methods: A total of 40 males AS(AS group) with complete clinical data, CT scan and three-dimensional reconstruction of the middle and lower thoracic spine from January 2003 to June 2017 was enrolled with the age ranging from34 to 53 years old. And 40 males of thoracic vertebral fracture with complete clinical data, CT scan and three-dimensional reconstruction of middle and lower thoracic spine were selected(non-AS group), with the age ranging from 32 to 48 years old in the same period. The vertebral pedicle parameters from T5 to T12 were measured, including pedicle width(PW), pedicle height(PH), pedicle transverse angle(PTA) that between the pedicle axis and the median sagittal plane of the vertebral body, pedicles distance(PD), pedicle screw path length(PL). The measurements of two groups were compared. Results: The PW in AS and non-AS group increased gradually from T5 to T12. The PW in AS group was significantly smaller than that of non-AS group(P<0.05). There was no statistical difference of the PH between the two groups(P >0.05). The variation trend of PTA in the two groups was the same. The PTA gradually became negative(T5-T10 were positive,T11-T12 were negative) and the PTA in AS group was significantly smaller than that in non-AS group, but the results in T11 and T12 were opposite(P<0.05). The PD of the two groups gradually increased from T5 to T12, and it was significantly larger in AS group than that in non-AS group(P <0.05); the PL increased gradually from T5 to T12, and the PL in AS group was significantly larger than that in non-AS group(P<0.05). Conclusions: Long pedicle screw can be used to increase the strength of internal fixation in AS patients, but it is not suitable to increase the pedicle screw diameter. The pedicle screw angle is close to vertical. If necessary, it can be placed through pedicle-rib unit.
引文
1.Van DLS,Valkenburg HA,Cats A,et al.Evaluation of diagnostic criteria for ankylosing spondylitis:a proposal for modification of the New York criteria[J].Arthritis Rheum,1984,27(4):361-368.
2.叶文芳,刘健,曹云祥,等.强直性脊柱炎患者心功能、肺功能及骨代谢变化的研究进展[J].风湿病与关节炎,2014,3(8):46-48.
3.钱邦平,邱勇,王斌,等.强直性脊柱炎患者胸腰椎应力骨折的临床及影像学特点[J].中国脊柱脊髓杂志,2008,18(10):747-751.
4.Schwab F,Blondel B,Chay E,et al.The comprehensive anatomical spinal osteotomy classification[J].Neurosurgery,2014,74(1):112-120.
5.冯宗贤,钱邦平,毛赛虎,等.强直性脊柱炎伴胸腰椎后凸畸形腰椎及S1椎弓根的解剖特征及临床意义[J].中国骨伤,2017,30(2):132-136.
6.Fennell VS,Palejwala S,Skoch J,et al.Freehand thoracic pedicle screw technique using a uniform entry point and sagittal trajectory for all levels:preliminary clinical experience[J].J Neurosurg Spine,2014,21(5):778-784.
7.乔拴杰,韩西城.胸椎椎弓根的形态测量及其临床意义[J].中国临床解剖学杂志,1996,14(3):193-195.
8.史亚民,柴伟,侯树勋,等.胸椎椎弓根形态测量研究[J].中国脊柱脊髓杂志,2002,12(3):191-193.
9.钱邦平,邱勇,王斌,等.强直性脊柱炎脊柱骨折的临床特征及治疗策略[J].中华医学杂志,2007,87(41):2893-2898.
10.王高举,谢胜荣,杨进,等.老年骨质疏松性椎体压缩骨折和中青年胸腰椎骨折患者椎弓根宽度的CT观察[J].中国脊柱脊髓杂志,2016,26(12):1076-1081.
11.郭翔,罗锐,张伟,等.强直性脊柱炎X线表现分析[J].中华实用诊断与治疗杂志,2013,27(2):164-165.
12.Datir SP,Mitra SR.Morphometric study of the thoracic vertebral pedicle in an Indian population[J].Spine(Phila Pa1976),2004,29(11):1174-1181.
13.Lehman RA Jr,Kuklo TR.Use of the anatomic trajectory for thoracic pedicle screw salvage after failure/violation using the straight-forward technique:a biomechanical analysis[J].Spine,2003,28(18):2072-2077.
14.王岩,毛克亚,张永刚,等.对徒手置入胸椎椎弓根螺钉的安全性评价[J].中国脊柱脊髓杂志,2006,16(8):596-599.
15.马云兵,夏云祥,杨庆秋,等.经椎弓根-肋骨结构单元途径置入螺钉安全角度的应用解剖学测量[J].昆明医科大学学报,2013,34(1):11-14.
16.韦兴,侯树勋,史亚民,等.胸椎经"椎弓根-肋骨间"螺钉与椎弓根螺钉固定的抗拔出力比较[J].中国脊柱脊髓杂志,2006,16(8):623-625.
17.盛红枫,徐卫星,卢笛,等.上中胸椎经椎弓根-肋骨单元途径置钉的安全性及稳定性研究[J].中医正骨,2017,29(2):1-5.
18.Kim YJ,Lenke LG,Bridwell KH,et al.Free hand pedicle screw placement in the thoracic spine:is it safe[J].Spine(Phila Pa 1976),2004,29(3):333-342.
19.Li J,Zhao H,Xie H,et al.A new free-hand pedicle screw placement technique with reference to the supraspinal ligament[J].J Biomed Res,2014,28(1):64-70.
2.叶文芳,刘健,曹云祥,等.强直性脊柱炎患者心功能、肺功能及骨代谢变化的研究进展[J].风湿病与关节炎,2014,3(8):46-48.
3.钱邦平,邱勇,王斌,等.强直性脊柱炎患者胸腰椎应力骨折的临床及影像学特点[J].中国脊柱脊髓杂志,2008,18(10):747-751.
4.Schwab F,Blondel B,Chay E,et al.The comprehensive anatomical spinal osteotomy classification[J].Neurosurgery,2014,74(1):112-120.
5.冯宗贤,钱邦平,毛赛虎,等.强直性脊柱炎伴胸腰椎后凸畸形腰椎及S1椎弓根的解剖特征及临床意义[J].中国骨伤,2017,30(2):132-136.
6.Fennell VS,Palejwala S,Skoch J,et al.Freehand thoracic pedicle screw technique using a uniform entry point and sagittal trajectory for all levels:preliminary clinical experience[J].J Neurosurg Spine,2014,21(5):778-784.
7.乔拴杰,韩西城.胸椎椎弓根的形态测量及其临床意义[J].中国临床解剖学杂志,1996,14(3):193-195.
8.史亚民,柴伟,侯树勋,等.胸椎椎弓根形态测量研究[J].中国脊柱脊髓杂志,2002,12(3):191-193.
9.钱邦平,邱勇,王斌,等.强直性脊柱炎脊柱骨折的临床特征及治疗策略[J].中华医学杂志,2007,87(41):2893-2898.
10.王高举,谢胜荣,杨进,等.老年骨质疏松性椎体压缩骨折和中青年胸腰椎骨折患者椎弓根宽度的CT观察[J].中国脊柱脊髓杂志,2016,26(12):1076-1081.
11.郭翔,罗锐,张伟,等.强直性脊柱炎X线表现分析[J].中华实用诊断与治疗杂志,2013,27(2):164-165.
12.Datir SP,Mitra SR.Morphometric study of the thoracic vertebral pedicle in an Indian population[J].Spine(Phila Pa1976),2004,29(11):1174-1181.
13.Lehman RA Jr,Kuklo TR.Use of the anatomic trajectory for thoracic pedicle screw salvage after failure/violation using the straight-forward technique:a biomechanical analysis[J].Spine,2003,28(18):2072-2077.
14.王岩,毛克亚,张永刚,等.对徒手置入胸椎椎弓根螺钉的安全性评价[J].中国脊柱脊髓杂志,2006,16(8):596-599.
15.马云兵,夏云祥,杨庆秋,等.经椎弓根-肋骨结构单元途径置入螺钉安全角度的应用解剖学测量[J].昆明医科大学学报,2013,34(1):11-14.
16.韦兴,侯树勋,史亚民,等.胸椎经"椎弓根-肋骨间"螺钉与椎弓根螺钉固定的抗拔出力比较[J].中国脊柱脊髓杂志,2006,16(8):623-625.
17.盛红枫,徐卫星,卢笛,等.上中胸椎经椎弓根-肋骨单元途径置钉的安全性及稳定性研究[J].中医正骨,2017,29(2):1-5.
18.Kim YJ,Lenke LG,Bridwell KH,et al.Free hand pedicle screw placement in the thoracic spine:is it safe[J].Spine(Phila Pa 1976),2004,29(3):333-342.
19.Li J,Zhao H,Xie H,et al.A new free-hand pedicle screw placement technique with reference to the supraspinal ligament[J].J Biomed Res,2014,28(1):64-70.
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