先天性脊柱侧弯的形态学三维分析
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摘要
目的
运用三维CT重建影像学技术对先天性脊柱侧弯畸变脊椎进行三维分析,得出畸变椎体和相应椎板的对应关系,以便进一步明确诊断并制定合理的治疗方案。
方法
对40例先天性脊柱侧弯患者进行脊柱三维CT重建影像学检查,观察畸变脊椎的前、后方结构。将前方结构畸形分为形成障碍组(包括完全分节半椎体,半分节半椎体、楔形椎体和蝴蝶椎体)和分节障碍组(融合椎体和单侧不分节骨桥)。将后方结构分为完全分节单侧半椎板、完全分节双侧半椎板、半分节半椎板、错位椎板、融合椎板、椎板裂和正常椎板7种类型。
结果
40例先天性脊柱侧弯患者共有105个畸变椎体,其中33个完全分节半椎体对应6种后方结构,14个半分节半椎体对应5种后方结构,8个楔形椎体对应3种后方结构,18个蝴蝶椎对应3种后方结构,5组融合椎体对应2种后方结构,7组单侧不分节骨桥对应1种后方结构。
结论
先天性脊柱侧弯患者不仅存在不同类型椎体的畸形,同时伴有不同类型的椎板结构,并且两者之间存在对应关系。
Objective
The objective of this study were to conduct 3-dimensional analysis of the morphogy of malformed vertebrae and to elucidate the corresponding relationship between anterior component and posterior components.
Methods
40 patients were examined with spinal 3-dimensional CT reconstruction to observe the anterior and posterior components. We clarified the mophologic variation of anterior component in spinal malformation into formation failure (fully segmengted hemivertebrae, semi-segmented hemivertebrae, wedged-shaped vertebrae and butterfly vertebrae) and segmentation failure (block vertebrae and unilateral unsegmented bar), and we clarified the mophologic variation of posterior components in spinal malformation into fully segmented unilateral hemilamina, fully segmented hibateral hemilamina, hemi-segmented hemilamina, malposed lamina, fused lamina, cleft of lamina and normal lamina.
Results
40 patients exhibited 105 malformed bodys of vertebrae,in which there were 33 fully segmengted hemivertebraes showing 6 kinds,14 semi-segmented hemivertebraes showing 5 kinds,8 wedged-shaped vertebras showing 3 kinds,18 butterfly vertebraes showing 3 kinds,5 block vertebraes showing 2 kinds and 7 unilateral unsegmented bars showing 1 kind in posterior components of malformed vertebraes.
Conclusions
There were not only morphologic variations of the anterior component of malformed vertebra, but also morphologic variations of the posterior components of malformed vertebra, and there were corresponding relationship between them.
运用三维CT重建影像学技术对先天性脊柱侧弯畸变脊椎进行三维分析,得出畸变椎体和相应椎板的对应关系,以便进一步明确诊断并制定合理的治疗方案。
方法
对40例先天性脊柱侧弯患者进行脊柱三维CT重建影像学检查,观察畸变脊椎的前、后方结构。将前方结构畸形分为形成障碍组(包括完全分节半椎体,半分节半椎体、楔形椎体和蝴蝶椎体)和分节障碍组(融合椎体和单侧不分节骨桥)。将后方结构分为完全分节单侧半椎板、完全分节双侧半椎板、半分节半椎板、错位椎板、融合椎板、椎板裂和正常椎板7种类型。
结果
40例先天性脊柱侧弯患者共有105个畸变椎体,其中33个完全分节半椎体对应6种后方结构,14个半分节半椎体对应5种后方结构,8个楔形椎体对应3种后方结构,18个蝴蝶椎对应3种后方结构,5组融合椎体对应2种后方结构,7组单侧不分节骨桥对应1种后方结构。
结论
先天性脊柱侧弯患者不仅存在不同类型椎体的畸形,同时伴有不同类型的椎板结构,并且两者之间存在对应关系。
Objective
The objective of this study were to conduct 3-dimensional analysis of the morphogy of malformed vertebrae and to elucidate the corresponding relationship between anterior component and posterior components.
Methods
40 patients were examined with spinal 3-dimensional CT reconstruction to observe the anterior and posterior components. We clarified the mophologic variation of anterior component in spinal malformation into formation failure (fully segmengted hemivertebrae, semi-segmented hemivertebrae, wedged-shaped vertebrae and butterfly vertebrae) and segmentation failure (block vertebrae and unilateral unsegmented bar), and we clarified the mophologic variation of posterior components in spinal malformation into fully segmented unilateral hemilamina, fully segmented hibateral hemilamina, hemi-segmented hemilamina, malposed lamina, fused lamina, cleft of lamina and normal lamina.
Results
40 patients exhibited 105 malformed bodys of vertebrae,in which there were 33 fully segmengted hemivertebraes showing 6 kinds,14 semi-segmented hemivertebraes showing 5 kinds,8 wedged-shaped vertebras showing 3 kinds,18 butterfly vertebraes showing 3 kinds,5 block vertebraes showing 2 kinds and 7 unilateral unsegmented bars showing 1 kind in posterior components of malformed vertebraes.
Conclusions
There were not only morphologic variations of the anterior component of malformed vertebra, but also morphologic variations of the posterior components of malformed vertebra, and there were corresponding relationship between them.
引文
1 Giampietro PF, Blank RD, Raggio CL, et al. Congenital and idiopathic scoliosis:clinical and genetic aspects. Clin Med Res,2003,1:125-136.
2 Shands AR Jr, Bundens WD. Congenital deformities of the spine:an analysis of the roentgenograms of 700 children. Bull Hosp Jt Dis,1956,17:110-133.
3 叶启彬,主编.脊柱侧弯的预防与治疗[M].北京：北京医科大学中国协和医科大学联合出版社,1993,180-183.
4 Erol B, Tracy MR, Dormans JP, et al. Congenital scoliosis and vertebral malformations: characterization of segmental defects for genetic analysis. J Pediatr Orthop,2004,24:674-682.
5 Maisenbacher MK, Han JS, O'Brien ML, et al. Molecular analysis of congenital scoliosis:a candidate gene approach. Hum Genet,2005,116:416-419.
6 McMaster MJ, Ohtsuka K. The natural history of congenital scoliosis:a study of two hundred and fifty-one patients. J Bone Joint Surg Am,1982,64:1128-47.
7 McMaster MJ, David CV. Hemivertebra as a cause of scol iosis:a study of 104 patients. J Bone Joint Surg Br,1986,68:588-95.
8 Moe JH, Winter RB, Bradford DS, et al. Scoliosis and Other Spinal Deformities.Philadelphia: Saunders,1978:131-202.
9 Winter RB, Moe JH, Eilers VE. Congenital scoliosis:a study of 234 patientstreated and untreated. J Bone Joint Surg Am,1968,50:1-47.
10 Winter RB, Lonstein LE, Leonard AS, et al. Congenital Deformities of the Spine. Thieme-Stratton,1983:1-17.
11 Hedequist DJ,Emans JB.The correction of preoperation three-dimensional computed tomography reconstructions with operative findings in congenital scoliosis.Spine,2003,28 (22):2531-2534.
12 Newton PO, Hahn GW, Ficka KB, et al. Utility of three dimensional and multiplanar reformatted computed tomography for evaluation of pediatric congenital spine abnormalities. Spine,2002,27:844-50.
13 Nakamura H, Matsuda H, Konishi S, et al. Single-stage excision of hemivertebra via the posterior approach alone for congenital spine deformity. Spine,2002,27:110-5.
14 Ruf M, Harms J. Hemivertebra resection by posterior approach. Spine,2002,27:1116-23.
15 Bush CH, Kalen V. Three dimensional computed tomography in the assessment of congenital scoliosis. Skeletal Radiol,1999;28:632-7.
16 Newton PO, White KK, Faro F, et al.The success of thoracoscopic anterior fusion in a consecutive series of 112 pediatric spinal deformity cases.Spine,2005,30(4):392-398.
17马梦昆,李伟强,劳汉昌,杨震龙.三维CT成像在先天性半椎体手术中的指导意义.中国脊柱脊髓杂志,2002,2(12)：104.
18王亭,邱贵兴,李其一.CT三维重建在先天性脊柱侧凸诊疗中的价值.中华骨科杂志,2005,25(8)：449-452.
19 Nakajima A,Kawakami N,Imagama S,et al.Three-dimensional analysis of formation failure in congenital scoliosis.Spine,2007,32(5):562-567.
20毛克亚,王岩,张永刚.先天性脊柱形成障碍椎体后部形态结构分析.实用骨科杂志,2009,15(10)：721-723.
21 Li X, Luo Z, Li X, et al. Hemivertebra resection for the treatment of congenital lumbarspinal scoliosis with lateral-posterior app roach [J]. Sp ine,2008,33(18):2001-2006.
22 Bollini G, Docquier PL, Viehweger E, et al. Thoracolumbar hemivertebrae resection by double approach in a single procedure: long-term follow-up[J]. Spine,2006,31 (15):1745-1757.
1 李正,王慧贞,吉十俊.实用小儿外科学,2001：1433-1435.
2 张永刚,王岩等.先大性脊柱侧弯术前影像学评估与术中观察结果的比较.中国临床康复,2005,9(18)：22-23.
3 Daniel J, Hedequist et al。The correlation of preoperative three-dimensional computed tomography reconstructions with operative findings in congenital scoliosis.Spine,2003, 28(22):2531-2534.
4 王亭,邱贵兴,李其一.CT三维重建在先天性脊柱侧凸诊疗中的价值.中华骨科杂志,2005,8(25)：449-452.
5 Newton PO,Hahn GW,Frica KB,et al.Utility of three-dimensional and multiplanar reformatted computed tomography for evaluation of pediatric congenital spine abnormalities.Spine,2002,27(8):844-850.
6 Stefan Parent,Hubert Labelle,Wafa Skalli et al.Vertebral wedging characteristic changes in scoliotic spine.Spine,2004,29(20):E455-E462.
7 王宗烨,张朝利,费军等.螺旋CT多平面三维重建技术在脊柱侧弯术前扫描的应用.医学临床研究,2004,6(21)：625-627.
8 张永刚,王岩等.数字化重建技术定量评估青少年特发性脊柱侧弯胸椎椎弓根的形态变化.中国临床康复,2005,9(22)：13-15.
9 Reichle E,Morlock M, Sellenschloh K et al.Definition of pedicle malposition.Primary stability and loosening characteristics of pedicle screws in relation position:spongious anchoring,cortical anchoring,perforation and malposition.Orthpade,2002,31:402-405.
10 Polly DW Jr,Potter BK,Kuklo T et al.Vlumetric spinal canal intrusion:a comparision between thoracic pedicle screws and thoracid hook.Spine,2004,29:63-69.
11 张劲松,葛雅丽,宦怡等.曲面重建在旋转型脊柱侧弯中的应用.中国医学影像学杂志,2001，2(9)：141-142.
12彭云,张宁宁张学军等.16层螺旋CT和多平面重加对儿童先天性脊柱侧弯的评价.中华放射杂志,2006,3(40)：297-300.
13 Nakajima A,Kawakami N,Imagama S,et al.Three-dimensional analysis of formation failure in congenital scoliosis.Spine,2007,32(5):562-567.
14毛克亚,王岩,张永刚.先天性脊柱形成障碍椎体后部形态结构分析.实用骨科杂志,2009,15(10)：721-723.
15 Yousset M,Smadar Peleg,Hanne B et al.Facet asymmetry in normal vertebral growth.Spine,2008,33:898-902.
2 Shands AR Jr, Bundens WD. Congenital deformities of the spine:an analysis of the roentgenograms of 700 children. Bull Hosp Jt Dis,1956,17:110-133.
3 叶启彬,主编.脊柱侧弯的预防与治疗[M].北京：北京医科大学中国协和医科大学联合出版社,1993,180-183.
4 Erol B, Tracy MR, Dormans JP, et al. Congenital scoliosis and vertebral malformations: characterization of segmental defects for genetic analysis. J Pediatr Orthop,2004,24:674-682.
5 Maisenbacher MK, Han JS, O'Brien ML, et al. Molecular analysis of congenital scoliosis:a candidate gene approach. Hum Genet,2005,116:416-419.
6 McMaster MJ, Ohtsuka K. The natural history of congenital scoliosis:a study of two hundred and fifty-one patients. J Bone Joint Surg Am,1982,64:1128-47.
7 McMaster MJ, David CV. Hemivertebra as a cause of scol iosis:a study of 104 patients. J Bone Joint Surg Br,1986,68:588-95.
8 Moe JH, Winter RB, Bradford DS, et al. Scoliosis and Other Spinal Deformities.Philadelphia: Saunders,1978:131-202.
9 Winter RB, Moe JH, Eilers VE. Congenital scoliosis:a study of 234 patientstreated and untreated. J Bone Joint Surg Am,1968,50:1-47.
10 Winter RB, Lonstein LE, Leonard AS, et al. Congenital Deformities of the Spine. Thieme-Stratton,1983:1-17.
11 Hedequist DJ,Emans JB.The correction of preoperation three-dimensional computed tomography reconstructions with operative findings in congenital scoliosis.Spine,2003,28 (22):2531-2534.
12 Newton PO, Hahn GW, Ficka KB, et al. Utility of three dimensional and multiplanar reformatted computed tomography for evaluation of pediatric congenital spine abnormalities. Spine,2002,27:844-50.
13 Nakamura H, Matsuda H, Konishi S, et al. Single-stage excision of hemivertebra via the posterior approach alone for congenital spine deformity. Spine,2002,27:110-5.
14 Ruf M, Harms J. Hemivertebra resection by posterior approach. Spine,2002,27:1116-23.
15 Bush CH, Kalen V. Three dimensional computed tomography in the assessment of congenital scoliosis. Skeletal Radiol,1999;28:632-7.
16 Newton PO, White KK, Faro F, et al.The success of thoracoscopic anterior fusion in a consecutive series of 112 pediatric spinal deformity cases.Spine,2005,30(4):392-398.
17马梦昆,李伟强,劳汉昌,杨震龙.三维CT成像在先天性半椎体手术中的指导意义.中国脊柱脊髓杂志,2002,2(12)：104.
18王亭,邱贵兴,李其一.CT三维重建在先天性脊柱侧凸诊疗中的价值.中华骨科杂志,2005,25(8)：449-452.
19 Nakajima A,Kawakami N,Imagama S,et al.Three-dimensional analysis of formation failure in congenital scoliosis.Spine,2007,32(5):562-567.
20毛克亚,王岩,张永刚.先天性脊柱形成障碍椎体后部形态结构分析.实用骨科杂志,2009,15(10)：721-723.
21 Li X, Luo Z, Li X, et al. Hemivertebra resection for the treatment of congenital lumbarspinal scoliosis with lateral-posterior app roach [J]. Sp ine,2008,33(18):2001-2006.
22 Bollini G, Docquier PL, Viehweger E, et al. Thoracolumbar hemivertebrae resection by double approach in a single procedure: long-term follow-up[J]. Spine,2006,31 (15):1745-1757.
1 李正,王慧贞,吉十俊.实用小儿外科学,2001：1433-1435.
2 张永刚,王岩等.先大性脊柱侧弯术前影像学评估与术中观察结果的比较.中国临床康复,2005,9(18)：22-23.
3 Daniel J, Hedequist et al。The correlation of preoperative three-dimensional computed tomography reconstructions with operative findings in congenital scoliosis.Spine,2003, 28(22):2531-2534.
4 王亭,邱贵兴,李其一.CT三维重建在先天性脊柱侧凸诊疗中的价值.中华骨科杂志,2005,8(25)：449-452.
5 Newton PO,Hahn GW,Frica KB,et al.Utility of three-dimensional and multiplanar reformatted computed tomography for evaluation of pediatric congenital spine abnormalities.Spine,2002,27(8):844-850.
6 Stefan Parent,Hubert Labelle,Wafa Skalli et al.Vertebral wedging characteristic changes in scoliotic spine.Spine,2004,29(20):E455-E462.
7 王宗烨,张朝利,费军等.螺旋CT多平面三维重建技术在脊柱侧弯术前扫描的应用.医学临床研究,2004,6(21)：625-627.
8 张永刚,王岩等.数字化重建技术定量评估青少年特发性脊柱侧弯胸椎椎弓根的形态变化.中国临床康复,2005,9(22)：13-15.
9 Reichle E,Morlock M, Sellenschloh K et al.Definition of pedicle malposition.Primary stability and loosening characteristics of pedicle screws in relation position:spongious anchoring,cortical anchoring,perforation and malposition.Orthpade,2002,31:402-405.
10 Polly DW Jr,Potter BK,Kuklo T et al.Vlumetric spinal canal intrusion:a comparision between thoracic pedicle screws and thoracid hook.Spine,2004,29:63-69.
11 张劲松,葛雅丽,宦怡等.曲面重建在旋转型脊柱侧弯中的应用.中国医学影像学杂志,2001，2(9)：141-142.
12彭云,张宁宁张学军等.16层螺旋CT和多平面重加对儿童先天性脊柱侧弯的评价.中华放射杂志,2006,3(40)：297-300.
13 Nakajima A,Kawakami N,Imagama S,et al.Three-dimensional analysis of formation failure in congenital scoliosis.Spine,2007,32(5):562-567.
14毛克亚,王岩,张永刚.先天性脊柱形成障碍椎体后部形态结构分析.实用骨科杂志,2009,15(10)：721-723.
15 Yousset M,Smadar Peleg,Hanne B et al.Facet asymmetry in normal vertebral growth.Spine,2008,33:898-902.
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