| 摘要: |
| 目的 探讨Chiari畸形合并脊柱侧凸患者胸椎后凸角（TK）与椎体旋转的相关性。方法 回顾性选择2017年7月至2019年7月于南京大学医学院附属鼓楼医院行EOS脊柱影像摄片的Chiari畸形伴脊柱侧凸患者30例和青少年特发性脊柱侧凸（AIS）患者34例。根据冠状面主胸弯Cobb角、顶椎节段等进行配对，AIS患者中TK ≤ 20°者入组，Chiari畸形伴脊柱侧凸患者中TK ≥ 30°者入组。选择入组患者的EOS脊柱影像并进行三维重建，利用三维重建图像测量患者的冠状面主胸弯Cobb角、顶椎节段、椎体旋转角度及TK，计算主胸弯平均椎体旋转角度（MTR）。采用Pearson相关分析研究AIS患者及Chiari畸形伴脊柱侧凸患者TK和主弯区MTR的相关性。结果 共24例（12对）患者入组，AIS组男4例、女8例，Chiari畸形伴脊柱侧凸组男5例、女7例，两组间性别构成差异无统计学意义（χ2=0.00，P>0.05）；两组患者年龄分别为12~18（15.25±2.00）岁、11~18（14.42±2.43）岁，冠状面主胸弯Cobb角分别为（58.13±11.45）°和（55.35±12.35）°，差异均无统计学意义（P均>0.05）。AIS组和Chiari畸形伴脊柱侧凸组患者的TK分别为（13.89±6.35）°、（37.11±9.40）°，MTR（绝对值）分别为（24.62±2.78）°和（21.53±1.66）°，差异均有统计学意义（t=-6.38、3.94，P<0.01、P=0.002）。Pearson相关分析显示，AIS组和Chiari畸形伴脊柱侧凸组患者TK均与MTR呈负相关（r=-0.667、-0.645，P=0.018、0.024）。结论 在冠状面形态相同的条件下，Chiari畸形伴脊柱侧凸患者较大的TK可能是由椎体旋转造成，提示脊柱外科医师在关注Chiari畸形伴脊柱侧凸患者冠状面矫形的同时须注意矢状面的旋转。 |
| 关键词: EOS影像系统 脊柱侧凸 Chiari畸形 脊柱后凸 椎体旋转 |
| DOI：10.16781/j.0258-879x.2020.11.1208 |
| 投稿时间：2019-12-18修订日期：2020-02-13 |
| 基金项目:江苏省自然科学基金（KB20180122）. |
|
| Thoracic kyphosis associated with vertebral rotation in patients with Chiari malformation and scoliosis |
| GU Qi△,SHU Shi-bin△,ZHANG Yuan-cheng,LIU Zhen,QIAN Bang-ping,QIU Yong,BAO Hong-da,ZHU Ze-zhang* |
(Department of Spinal Surgery, Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, Jiangsu, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To investigate the correlation between thoracic kyphosis (TK) and vertebral rotation in patients with Chiari malformation and scoliosis. Methods Thirty patients with Chiari malformation and scoliosis and 34 patients with adolescent idiopathic scoliosis (AIS) who underwent EOS imaging from Jul. 2017 to Jul. 2019 in Nanjing Drum Tower Hospital of Nanjing University Medical School were retrospectively selected. According to the Cobb angle and apical vertebral segment of the coronal main thoracic curve, patients with TK ≤ 20° in the AIS group and TK ≥ 30° in the Chiari group were enrolled. The EOS imaging of the patients was selected and three-dimensional reconstruction was performed. The Cobb angle, apical vertebral segment, vertebral rotation angle and TK of the coronal main thoracic curve were measured by the threedimensional reconstruction image, and the mean vertebral rotation (MTR) of the main thoracic curve was calculated. Pearson correlation analysis was used to study the correlation between TK and MTR in the main curvature region in the two groups. Results A total of 24 patients (12 pairs) were enrolled, including four males and eight females in the AIS group, and five males and seven females in the Chiari group. There was no differences in the gender composition between the two groups (χ2=0.00, P>0.05). The mean age of the two groups were 12-18 (15.25±2.00) years and 11-18 (14.42±2.43) years (P>0.05). The mean Cobb angle of the coronal main thoracic curve of the two groups were (58.13±11.45)° and (55.35±12.35)° (P> 0.05). The mean TK and MTR (absolute value) of the AIS group and the Chiari group were (13.89±6.35)° vs (37.11±9.40)° (t=-6.38, P<0.01) and (24.62±2.78)° vs (21.53±1.66)° (t=3.94, P=0.002), both with significant differences. Pearson correlation analysis showed that TK was associated with MTR in the both groups (r=-0.667 and -0.645, P=0.018 and 0.024). Conclusion Under the same coronal plane, the larger TK in patients with Chiari malformation and scoliosis may be caused by vertebral rotation, which suggests that spine surgeons should pay attention to sagittal rotation as well as coronal correction in Chiari malformation patients with scoliosis. |
| Key words: EOS imaging system scoliosis Chiari malformation kyphosis vertebral rotation |
