CAJ | 학술논문

目的研究3岁以下婴幼儿胸腰椎椎弓根的解剖学特点,探讨椎弓根螺钉固定的可行性、安全性.方法收集中南大学湘雅二医院CT资料室内52例3岁以下婴幼儿的相关影像学数据,通过薄层密扫和三维重建技术分别在横断面、矢状面和冠状面对T1～L5椎弓根内径、椎弓根外径、椎弓根长度、椎弓根内倾角和椎弓根高度进行测量,总结婴幼儿胸腰椎椎弓根的解剖学特点.结果婴幼儿椎弓根直径最小的节段为T5或T6椎体,平均直径在3.0 mm以下.椎弓根直径的整体变化趋势从T1至T5逐渐减小,T6至L5逐渐增大.年龄＜18个月儿童L4以上的平均椎弓根内径＜3.0 mm,T3至T9节段的平均椎弓根外径＜3.5 mm.年龄18～36个月儿童T5至T8节段的平均椎弓根内径＜3.0mm,T4至T7节段的平均椎弓根外径＜3.5 mm.椎弓根的直径、长度和高度与年龄呈明显正相关.结论 18个月以下婴幼儿T3至T9节段,18个月以上婴幼儿T4至T7节段的平椎弓根过于细小,置入椎弓根螺钉可行性低,风险较高.对3岁以下胸椎和腰椎疾患婴幼儿在T9节段以下进行椎弓根螺钉固定是可行、安全的.
목적 연구3세이하영유인흉요추추궁근적해부학특점,탐토추궁근라정고정적가행성、안전성.방법 수집중남대학상아이의원CT자료실내52례3세이하영유인적상관영상학수거,통과박층밀소화삼유중건기술분별재횡단면、시상면화관상면대T1～L5추궁근내경、추궁근외경、추궁근장도、추궁근내경각화추궁근고도진행측량,총결영유인흉요추추궁근적해부학특점.결과 영유인추궁근직경최소적절단위T5혹T6추체,평균직경재3.0 mm이하.추궁근직경적정체변화추세종T1지T5축점감소,T6지L5축점증대.년령＜18개월인동L4이상적평균추궁근내경＜3.0 mm,T3지T9절단적평균추궁근외경＜3.5 mm.년령18～36개월인동T5지T8절단적평균추궁근내경＜3.0mm,T4지T7절단적평균추궁근외경＜3.5 mm.추궁근적직경、장도화고도여년령정명현정상관.결론 18개월이하영유인T3지T9절단,18개월이상영유인T4지T7절단적평추궁근과우세소,치입추궁근라정가행성저,풍험교고.대3세이하흉추화요추질환영유인재T9절단이하진행추궁근라정고정시가행、안전적.
Objective To quantify the morphometric characteristics of the pedicles of the infantile thoracolumbar spine and to determine the feasibility and safety of pedicle screw fixation in very young children. Methods A total of 52 patients younger than three years of age underwent standard spiral computed tomography (CT) were enrolled in this study. The patients were grouped according to age, group 1 (0 ～ 18months of age) and group 2 (18 ～ 36 months of age). Images were reformatted, and multiplanar reconstructions were used to attain images of thoracic and lumbar pedicles on sagittal, coronal and transverse planes.The measurements included the inner and outer pedicle diameters on the transverse plane, pedicle sagittal diameter, pedicle length and the pedicle angle on the transverse. Characteristics of the pedicles of the immature thoracic and lumbar spine were studied. Results Pedicle diameters on the transverse plane decreased gradually from T1 to T5 and increased gradually from T6 to L5. The shortest transverse diameter of the thoracic pedicle was T5 or T6. The inner diameter of the segment of L4 in infant (younger than eighteen months) was less than 3.0 mm and the external diameter less than 3.5 mm from T3 to T9. The inner diameter of the segment from T5 to T8 in infant (more than eighteen months) was less than 3.0 mm and the external diameter from T4 to T7 was less than 3.5 mm. The sagittal diameter was significantly more than the transverse diameter. Pedicle diameters on the transverse plane, the sagittal diameter, and the length of the pedicle changed significantly with age, but the pedicle angle did not changed significantly with age. Conclusions The pedicles in the segment from T3 to T9 of less than eighteen months and from T4 to T7 of more than eighteen months were too small, there was no feasibility and safety of pedicle screw fixation. So pedicle screw fixation was feasible and safe for below T9 segment in the infants who are younger than three years old.