What is the Difference in Morphologic Features of the Thoracic Pedicle Between Patients With Adolescent Idiopathic Scoliosis and Healthy Subjects? A CT-based Case-control Study
What is the Difference in Morphologic Features of the Thoracic Pedicle Between Patients With Adolescent Idiopathic Scoliosis and Healthy Subjects? A CT-based Case-control Study
复制标题
青少年特发性脊柱侧凸患者与健康受试者胸椎椎弓根形态特征有何差异？
DOI：
10.1007/s11999-017-5448-9
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发表时间：
2017-11-01
影响因子：
4.2
通讯作者：
Su, Peiqiang
中科院分区：
文献类型：
--
作者：
Gao, Bo;Gao, Wenjie;Su, Peiqiang
背景描述青少年特发性脊柱侧凸患者胸椎椎弓根的形态特征对于椎弓根螺钉的置入是必要的。先前的研究由于样本量小和受调查患者的异质性而显示可靠性不足。 问题/目的 使用 CT 扫描 (1) 描述 60 名 Lenke 1 型青少年特发性脊柱侧凸女性患者和 60 名年龄、性别和身高匹配的对照者的 2718 个胸椎椎弓根的形态学特征； (2)根据椎弓根宽度将椎弓根分为三类，并分析各类型的分布。方法对60例Lenke 1型青少年特发性脊柱侧凸女性患者和60名匹配女性对照的2718个椎弓根进行CT分析。所有患者均于2008年1月至2013年12月在中山大学附属第一医院诊断为青少年特发性脊柱侧凸Lenke 1型，均接受椎弓根螺钉内固定术，并存档术前X线片和CT图像。在这些手术之前，我们会定期进行 CT 扫描；在此期间接受手术的所有患者都进行了 CT 扫描，所有内容均可在此处进行分析。对照受试者进行了其他临床指征的 CT 扫描，未发现脊柱异常。选择与患者年龄（15±2.6 岁与 15±2.6 岁）和性别相匹配的对照受试者。两组的身高也匹配（154±9 cm 与 155±10 cm；平均差，− 1.06 cm；95% CI，− 1.24 至− 0.81 cm；p < 0.001）。从 T1 到 T12 测量椎弓根宽度和长度。胸椎分为四个区域：结构曲线中的顶椎（AV-SC）、结构曲线中的非顶椎（NAV-SC）、非结构曲线中的顶椎（AV-NSC）和非结构曲线中的非顶椎（NAV-NSC）。椎弓根分为三型：椎弓根宽度小于2mm为I型，2mm～4mm为II型，大于4mm为III型。 I型和II型被定义为发育不良的蒂。酌情采用配对t检验、独立样本t检验、单因素方差分析、Bonferroni事后检验、卡方检验或Fisher精确检验对患者和对照组进行统计比较。结果凸侧椎弓根宽度(PWv)与对照组(PWn)无差异，但凹侧椎弓根宽度(PWc)(4.99±1.87 mm)为比 PWv (6±1.66 mm) 和 PWn (6±1.45 mm) 窄。与AV-NSC (20%±25%)相比，AV-SC区域的椎弓根宽度(VDPW)变化程度最大(34%±37%)(平均差，14%；95%CI，1.15%-27%；p=0.025)，NAV-SC(17%±30%)(平均差，17%；95%CI， 7%-27%；p< 0.001)，NAV-NSC (11%±24%)（平均差，24%；95% CI，13%-34%；p< 0.001）。与对照组（13%；1396 人中的 178 人）相比，青少年特发性脊柱侧凸患者（22%；1322 人中的 293 人）发育不良的椎弓根出现更多（比值比 [OR]= 0.51；95% CI，0.42-0.63；p < 0.001）。在青少年特发性脊柱侧弯患者中，常见于凹侧（34%，661 例中的 228 例）和 AV-SC 区域（32%；136 例中的 43 例）。 结论 凹侧椎弓根宽度比凸侧椎弓根宽度和健康对照者的椎弓根宽度窄。结构曲线中的顶椎是曲线上最多样化的区域，发育不良的椎弓根发生率最高。
Background Describing the morphologic features of the thoracic pedicle in patients with adolescent idiopathic scoliosis is necessary for placement of pedicle screws. Previous studies showed inadequate reliability owing to small sample size and heterogeneity of the patients surveyed.Questions/Purposes To use CT scans (1) to describe the morphologic features of 2718 thoracic pedicles from 60 female patients with Lenke Type 1 adolescent idiopathic scoliosis and 60 age-, sex-, and height-matched controls; and (2) to classify the pedicles in three types based on pedicle width and analyze the distribution of each type.Methods A total of 2718 pedicles from 60 female patients with Lenke Type 1 adolescent idiopathic scoliosis and 60 matched female controls were analyzed via CT. All patients surveyed were diagnosed with adolescent idiopathic scoliosis, Lenke Type 1, at the First Affiliated Hospital of Sun Yat-sen University, and all underwent pedicle screw fixation between January 2008 and December 2013 with preoperative radiographs and CT images on file. We routinely obtained CT scans before these procedures; all patients who underwent surgery during that period had CT scans, and all were available for analysis here. Control subjects had CT scans for other clinical indications and had no abnormal findings of the spine. The control subjects were chosen to match patients in terms of age (15±2.6 years versus 15±2.6 years) and sex. Height of the two groups also was matched (154±9 cm versus 155±10 cm; mean difference,− 1.06 cm; 95% CI,− 1.24 to− 0.81 cm; p< 0.001). Pedicle width and length were measured from T1 to T12. The thoracic spine was classified in four regions: apical vertebra in the structural curve (AV-SC), nonapical vertebra in the structural curve (NAV-SC), apical vertebra in the nonstructural curve (AV-NSC), and nonapical vertebra in the nonstructural curve (NAV-NSC). Pedicles were classified in three types: pedicle width less than 2 mm as Type I, 2 mm to 4 mm as Type II, and greater than 4 mm as Type III. Types I and II were defined as dysplastic pedicles. Paired t test, independent samples t test, one-way ANOVA, followed by Bonferroni's post hoc test and chi-square or Fisher's exact tests were used for statistical comparisons between patients and controls, as appropriate.Results No difference was found between pedicle width on the convex side (PWv) and in controls (PWn), but pedicle width on the concave side (PWc)(4.99±1.87 mm) was found to be narrower than PWv (6±1.66 mm) and PWn (6±1.45 mm). The variation degree of pedicle width (VDPW) was greatest in the AV-SC region (34%±37%), in comparison to AV-NSC (20%±25%)(mean difference, 14%; 95% CI, 1.15%-27%; p= 0.025), NAV-SC (17%±30%)(mean difference, 17%; 95% CI, 7%-27%; p< 0.001), and NAV-NSC (11%±24%)(mean difference, 24%; 95% CI, 13%-34%; p< 0.001). Dysplastic pedicles appeared more in patients with adolescent idiopathic scoliosis (22%; 293 of 1322) compared with controls (13%; 178 of 1396)(odds ratio [OR]= 0.51; 95% CI, 0.42-0.63; p< 0.001). In patients with adolescent idiopathic scoliosis, they commonly occurred on the concave side 34%(228 of 661) and on the AV-SC region (32%; 43 of 136).Conclusions Pedicle width on the concave side was narrower than pedicle width on the convex side and pedicle width in healthy control subjects. The apical vertebra in the structural curve was the most variegated region of the curve with the highest prevalence of dysplastic pedicles.