The Position of the Aorta Relative to the Vertebrae in Patients With Lenke Type 1 Adolescent Idiopathic Scoliosis.
The Position of the Aorta Relative to the Vertebrae in Patients With Lenke Type 1 Adolescent Idiopathic Scoliosis.
复制标题
Lenke 1 型青少年特发性脊柱侧凸患者主动脉相对于椎骨的位置。
DOI：
10.1097/brs.0000000000001257
复制
发表时间：
2016
期刊：
影响因子：
3
通讯作者：
Iwamoto Y.
中科院分区：
文献类型：
--
作者：
Bekki H;Harimaya K;Matsumoto Y;Hayashida M;Okada S;Doi T;Iwamoto Y.
研究设计。目的：本研究的目的是明确Lenke 1型青少年特发性脊柱侧凸患者主动脉相对脊柱的位置。背景资料摘要。几位作者研究了脊柱侧凸患者的主动脉位置；然而，他们的分析包括几种类型的曲线。根据脊柱侧凸曲线类型，主动脉的位置可能不同。对38例Lenke 1型患者进行分析。从T4到L2测量左椎弓根螺钉插入点到主动脉的角度（左椎弓根主动脉[LtP-Ao]角度）和距离（LtP-Ao距离）。测量数据从顶椎上方4个节段到顶椎下方4个节段进行评估。检查腰椎调节剂A和C的差异。根据螺钉的方向误差和长度，将主动脉进入预期区域的蒂定义为危险蒂，从T10到l2进行计数。主动脉位于椎体后外侧，在胸椎中段与椎体相邻，在胸腰椎前方与椎体相距较远。LtP-Ao角度在根尖以上1节段最大，LtP-Ao距离在根尖以上2节段最短。从T11到L2， Lenke 1A的LtP-Ao角度显著大于1C，从T11到L1, 1A的LtP-Ao距离显著小于1C。当螺钉长度为40 mm，方向误差在10以内时，无论采用何种腰椎调节器，T11处均存在大量危险椎弓根。结论：方向误差有损伤椎尖周围主动脉的潜在危险。选择合适长度的螺钉是必要的，以避免胸腰椎水平的前椎壁破裂，特别是在T11。证据水平：3脊柱内固定已经从原位融合发展到节段性钢丝固定、节段性钩固定和节段性螺钉固定。在这些技术中，椎弓根螺钉在脊柱矫正手术中的应用有越来越多的趋势。节段性椎弓根螺钉内固定提供更大的矫正、椎体旋转和通过单一后路维持矫正2；然而，有一些关于椎弓根螺钉在胸/胸腰椎中的安全性的担忧。青少年特发性脊柱侧凸（AIS）后路脊柱重建手术中最危险的并发症之一是椎弓根螺钉损伤主动脉。3
Study Design.A computed tomography study.Objective.The aim of the study was to clarify the position of the aorta relative to the spine in patients with Lenke type 1 adolescent idiopathic scoliosis.Summary of Background Data.Several authors have examined the position of the aorta in patients with scoliosis; however, their analysis included several types of curve. There is a possibility that the position of the aorta differs according to the scoliosis curve type.Methods.Thirty-eight patients with Lenke type 1 were analyzed. The angle (left pedicle aorta [LtP-Ao] angle) and distance (LtP-Ao distance) from the insertion point of the left pedicle screw to the aorta were measured from T4 through L2. The measured data were evaluated from 4 levels above to 4 levels below the apical vertebra. The difference between lumbar modifiers A and C was examined. Dangerous pedicles, which were defined as those in which the aorta entered the expected area based on the screw direction error and length, were counted from T10 to L2.Results.The aorta was located posterolaterally and adjacent to the vertebra at the middle thoracic level, and anteromedially and distant at the thoracolumbar level. LtP-Ao angle was largest at 1 level above the apical vertebra, and LtP-Ao distance was shortest at 2 levels above. LtP-Ao angle of Lenke 1A was significantly larger than 1C from T11 to L2, and LtP-Ao distance of 1A was significantly shorter than 1C from T11 to L1. When the screw length was 40 mm and the direction error was within 10, there were a large number of dangerous pedicles at T11, regardless of the lumbar modifier.Conclusion.The direction error has a potential risk of injuring the aorta around the apical vertebra. The selection of screws of the proper length is necessary to avoid a breach of the anterior vertebral wall at thoracolumbar level, especially at T11.Level of Evidence: 3Spinal instrumentation has evolved from in situ fusion to segmental wire fixation, segmental hook fixation, and segmental screw fixation. 1 Among these techniques, there is an increasing trend of using pedicle screws in spinal corrective surgery. Segmental pedicle screw instrumentation provides greater correction, vertebral derotation, and maintenance of correction through a single posterior approach 2; however, there are some concerns about pedicle screw safety in the thoracic/thoracolumbar spine. One of the most threatening complications in posterior spinal reconstruction surgery of adolescent idiopathic scoliosis (AIS) is aortic injury by a pedicle screw. 3