摘要
目的:应用数字化三维重建技术,对青少年特发性脊柱侧弯患者胸椎椎弓根的形态变化进行观察,分析其形态变化的规律。方法:随机选取2000-10/2004-10解放军总医院骨科需要手术矫正的青少年特发性脊柱侧弯患者18例,男4例,女14例,年龄14～19岁。18例患者均经过手术矫正内固定治疗,术后未出现严重并发症。①患者拍摄脊柱正侧位X线片,测量脊柱侧弯的Cobb角。②根据18例青少年特发性脊柱侧弯患者CT断层扫描DICOM数据,采用Mimics和3DView软件进行脊柱数字化三维重建和显示,直接在计算机上观察胸椎椎弓根的形态,测量胸椎椎弓根的横径、椎弓根-肋骨头结合体横径、椎弓根矢状径。结果:按意向处理分析,18例患者全部纳入实验。①脊柱侧弯度数测量结果:18例患者主胸弯凸向右侧,X线和CT均未发现椎体和肋骨畸形。Cobb角45°～125°,平均68.3°。②椎体形态观察:随着脊柱侧弯和椎体旋转的变化,上下关节突、横突、椎板及椎体都出现不对称变化,一般凹侧关节突和横突小于凸侧。从冠状面断层可观察到椎弓根内侧壁皮质骨厚度明显比外侧壁皮质骨厚。③胸椎椎弓根的横径、椎弓根-肋骨头结合体横径、椎弓根矢状径测量结果:椎弓根横径为3.27～7.94mm,T4左侧最小,凹侧椎弓根横径小于凸侧;胸椎椎弓根-肋骨联合体横径为11.32～15.91mm,T5右侧椎弓根-肋骨联合体横径最小;双侧椎弓根矢状径自T1～12逐渐增大,双侧无明显差异。T1右侧矢状径最小,为7.97mm,而T12左侧矢状径最大,为12.92mm。结论:数字化三维重建技术可精确测量青少年特发性脊柱患者椎弓根的各项径线。一般情况下凹侧关节突和横突小于凸侧,凸、凹侧椎弓根各个节段的形态变化存在一定规律。
AIM: To observe the form change of the thoracic pedicles in adolescent idiopathic scoliosis with digital three-dimensional reconstruction and analyze its regularity of form change. METHODS: Totally 18 patients with adolescent idiopathic scoliosis who need to correct,hospitalized from October 2000 to October 2004 in the Department of Orthopaedics,General Hospital of Chinese PLA, were selected.The patients were 4 males and 14 females at the age of 14 to 19 years.All the 18 patients received the therapy of internal fixation for correction,serious complications were not found after operation.①Direct and lateral side X-ray photograph of the patients were taken and Cobb angle of the scoliosis was measured.②The CT scanned DICOM data of 18 cases of adolescent idiopathic scoliosis were collected for digital three-dimensional reconstruction with Minics and 3D View software to observe the form of thoracic pedicle, and measure transverse diameter of thoracic pedicle, transverse diameter of pedicle-rib unit and sagittal diameter of pedicle. RESULTS: According to intention-to-treat analysis,all 18 patients were involved the experiment. ①The measuring results of scoliosis: 18 patients had the right tendency of thoracic spine. Malformed vertebral body and rib were not found through X-ray and CT.Angle of Cobb was 45°-125°with the average angle of 68.3°.②Form observation of vertebral body: with the change of scoliosis and vertebral body rotation,dissymmetrical change appeared in upper and down articular process,transverse process, lamina of vertebra and vertebral body.The articular process and transverse process in the concave side was smaller commonly than those in the convex side.It was found from the fault of the coronal face that cortex thickness of the medial wall in the pedicle was obviously thicker than that of the lateral wall.③The measuring result of transverse diameter of thoracic pedicle, transverse diameter of pedicle-rib unit and sagittal diameter of pedicle: transverse diameter of thoracic pedicle was 3.27-7.94 mm and that of T4 left side was the smallest. The transverse pedicle diameter on the concave side was significantly smaller than that of the convex side;Transverse diameter of pedicle-rib unit was 11.32-15.91 mm and that of T5 right side was the smallest; Sagittal diameter of both side increased gradually from T1 through T12.No significant difference existed on the both sides.Sagittal diameter of T1 right side was the smallest (7.97 mm),while sagittal diameter of T12 right side was the biggest(12.92 mm). CONCLUSION:Digital three-dimensional reconstruction can measure exactly the thoracic pedicle transverse diameters of both convex and concave side in adolescent idiopathic scoliosis patients.At general condition,the articular process and transverse process on the concave side was smaller than those on the convex side.Regularity exists in form change of each segment on convex and concave side of the pedicles.
出处
《中国临床康复》
CSCD
北大核心
2005年第22期13-15,i001,共4页
Chinese Journal of Clinical Rehabilitation
