| 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 |
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投稿时间：2016-11-21
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| 作者 | Author | 单位 | Address | E-Mail |
| 冯宗贤 |
FENG Zong-xian |
南京医科大学鼓楼临床医学院脊柱外科, 江苏 南京 210008 |
Department of Spinal Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, Jiangsu, China |
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| 钱邦平 |
QIAN Bang-ping |
南京医科大学鼓楼临床医学院脊柱外科, 江苏 南京 210008 |
Department of Spinal Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, Jiangsu, China |
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| 毛赛虎 |
MAO Sai-hu |
南京医科大学鼓楼临床医学院脊柱外科, 江苏 南京 210008 |
Department of Spinal Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, Jiangsu, China |
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| 邱勇 |
QIU Yong |
南京医科大学鼓楼临床医学院脊柱外科, 江苏 南京 210008 |
Department of Spinal Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, Jiangsu, China |
scoliosis2002@sina.com |
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| 期刊信息：《中国骨伤》2017年，第30卷，第2期，第132-136页 |
| DOI：10.3969/j.issn.1003-0034.2017.02.008 |
| 基金项目:国家自然科学基金（编号:81372009） |
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中文摘要:
目的：通过对强直性脊柱炎（ankylosing spondylitis，AS）伴胸腰椎后凸畸形和椎间盘退变性疾病（disc degenerative disease，DDD）患者L1-S1椎弓根CT扫描相关参数的测量，研究两者椎弓根解剖参数差异，为临床手术中置钉提供参考依据。
方法：选取2012年3月至2014年11月行截骨矫形手术治疗并有完整术前临床及影像学资料的男性AS伴后凸畸形患者30例（AS组），年龄23~51岁，平均（35.7±9.5）岁，同时选取行手术治疗具有完整术前全腰椎及骶椎CT扫描全部附件结构影像清晰易辨的男性DDD患者30例（DDD组），年龄39~64岁，平均（52.4±8.9）岁。分别测量L1-S1节段椎弓根内聚角（pedicle transverse angle，EA），椎弓根矢状角（pedicle inclined angle，FA），椎弓根宽度（pedicle width，PW），椎弓根钉道长度（pedicle screw path length，PL），椎弓根高度（pedicle height，PH），统计比较是否存在差异。
结果：AS组和DDD组椎弓根宽度（PW）自L1-S1均是逐渐增大的，AS组PW在L5、S1均显著大于DDD组，分别为（16.47±2.66）mm vs.（14.51±2.11）mm和（21.76±2.97）mm vs.（18.87±2.14）mm（P<0.05）；椎弓根钉道长度（PL）自L1-S1在AS组均大于DDD组（P<0.05）；PL两组最大值均在L3节段；AS组椎弓根内聚角（EA）在L1-S1均较DDD组小；AS矢状角（FA）在L3-S1显著小于DDD组（P<0.05），分别为（-2.88±10.24）°，（-7.88±10.22）°，（-7.70±10.40）°，（-5.15±10.25）° vs.（4.05±2.21）°，（7.79±4.38）°，（7.07±3.21）°，（12.62±3.21）°。
结论：在AS伴后凸畸形患者腰椎及S1椎弓根置钉时可选用更粗更长螺钉来增加内固定强度，需注意适当减小内聚角，并根据矢状面形态调整头尾向。 |
| 【关键词】强直性脊柱炎 椎间盘退变性疾病 椎弓根解剖参数 |
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| Anatomical feature of lumbar and S1 pedicle in patients with thoracolumbar kyphosis secondary to ankylosing spondylitis |
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ABSTRACT
Objective: To measure the correlative parameters of vertebral pedicles from L1 to S1 by CT scan in the patients with thoracolumbar kyphosis secondary to ankylosing spondylitis(AS) and disc degenerative disease(DDD),and analyze their anatomical difference in order to provide the selection and placement of pedicle screw during operation.
Methods: The clinical data of 30 male AS patients (AS group) with the mean age of(35.7±9.5) years(ranged,23 to 51) and 30 male DDD patients (DDD group) with the mean age of(52.4±8.9) years(ranged,39 to 64) underwent surgery in our institution from March 2012 to November 2014 were analyzed. The CT scans of lumbar and sacrum were performed before surgery. The parameters of vertebral pedicle from L1 to S1 were measured and compared,including pedicle width (PW),pedicle screw path length (PL),pedicle height (PH),pedicle transverse angle (EA),and pedicle inclined angle (FA). Paired sample t-test was used to detect the divergence in the above-mentioned data between left and right sides. In addition,results between two groups were compared using independent sample t-test.
Results: The study showed that a gradual increase in the average pedicle width both AS group and DDD group from L1 to S1. The average PW of AS group was bigger than DDD group in L5 and S1(P<0.05),it was(16.47±2.66) mm and (21.76±2.97)mm vs. (14.51±2.11)mm and (18.87±2.14) mm respectively;the average PL of DDD group was smaller than AS group from L1 to S1(P<0.05);the both maximum of PL were in L3 segment;the average EA of AS group was smaller than DDD group from L1 to S1;the average FA of AS group was significantly smaller than DDD group from L3 to S1, (P<0.05),was(-2.88±10.24)°,(-7.88±10.22)°,(-7.70±10.40)°,(-5.15±10.25)° vs. (4.05±2.21)°,(7.79±4.38)°,(7.07±3.21)°,(12.62±3.21)°,respectively.
Conclusion: Increasing the strength of internal fixation is feasible to insert the larger and bigger pedicle screws in low lumbar and S1 among AS patients,while the EA should be decreased properly and the direction on the sagittal plane should be adjusted. |
| KEY WORDS Ankylosing spondylitis Disc degenerative disease Pedicle anatomy parameters |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 冯宗贤,钱邦平,毛赛虎,邱勇.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 |
| 英文格式: | FENG Zong-xian,QIAN Bang-ping,MAO Sai-hu,QIU Yong.Anatomical feature of lumbar and S1 pedicle in patients with thoracolumbar kyphosis secondary to ankylosing spondylitis[J].zhongguo gu shang / China J Orthop Trauma ,2017,30(2):132~136 |
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