CAJ | 학술논문

目的：探讨I型神经纤维瘤病( neurofibromatosis type 1，NF1)伴脊柱侧凸患者胸椎椎弓根分型的特点。方法2005年7月至2012年3月，我院收治的100例NF1伴脊柱侧凸者采用螺旋CT行胸椎连续扫描。在Lenke分型基础上对其进一步细化，将椎弓根形态分型为：A型(正常型)；B型(狭窄型)；C型(峡部硬化型)；D型(完全硬化型)；E型(椎弓根缺如型)。A、B、C、D、E型胸椎椎弓根分别为911个、561个、334个、422个和172个，共2400个。按照上述分型标准，在图像编档和通信系统( PACS )上逐层阅片，选择胸椎椎弓根显示最清楚的层面对椎弓根横径进行测量并分型，分别统计不同组别的 NF1伴脊柱侧凸( scoliosis secondary to neurofibromatosis type 1，NF1-S )患者胸椎椎弓根类型发生率，并对其畸形率进行统计学分析。结果100例 NF1-S 中，畸形率( B～E )为62%；其中非萎缩性脊柱侧凸15例，胸椎椎弓根畸形率为41.1%；萎缩性脊柱侧凸85例，胸椎椎弓根畸形率为65.7%，萎缩性脊柱侧凸的胸椎椎弓根畸形率明显高于非萎缩性脊柱侧凸(χ2＝78.8，P＜0.001)。凹侧、中立椎和凸侧椎体的胸椎椎弓根畸形率依次下降(80.8%＞66.8%＞47.9%，P＜0.001)。(40°～59°)组、(60°～79°)组与≥80°组间胸椎椎弓根畸形率依次上升(50.7%＜59.6%＜69.2%，P＜0.001)。≥18岁组的胸椎椎弓根畸形率(55.3%)明显低于＜18岁组(63.5%， P＝0.001)；此外，不同性别间胸椎椎弓根畸形率差异无统计学意义(男63.4%，女60.4%，P＝0.13)。结论在NF1-S患者中，胸椎椎弓根畸形率为62%。其中萎缩性脊柱侧凸中胸椎椎弓根畸形率明显高于非萎缩性脊柱侧凸；凸侧胸椎椎弓根畸形率明显低于凹侧；随着Cobb’s角的增大，胸椎椎弓根畸形率明显增加；在成人NF1-S患者中胸椎椎弓根畸形率明显低于未成年患者；不同性别NF1-S患者胸椎椎弓根的畸形率相似。目的：探討I型神經纖維瘤病( neurofibromatosis type 1，NF1)伴脊柱側凸患者胸椎椎弓根分型的特點。方法2005年7月至2012年3月，我院收治的100例NF1伴脊柱側凸者採用螺鏇CT行胸椎連續掃描。在Lenke分型基礎上對其進一步細化，將椎弓根形態分型為：A型(正常型)；B型(狹窄型)；C型(峽部硬化型)；D型(完全硬化型)；E型(椎弓根缺如型)。A、B、C、D、E型胸椎椎弓根分彆為911箇、561箇、334箇、422箇和172箇，共2400箇。按照上述分型標準，在圖像編檔和通信繫統( PACS )上逐層閱片，選擇胸椎椎弓根顯示最清楚的層麵對椎弓根橫徑進行測量併分型，分彆統計不同組彆的 NF1伴脊柱側凸( scoliosis secondary to neurofibromatosis type 1，NF1-S )患者胸椎椎弓根類型髮生率，併對其畸形率進行統計學分析。結果100例 NF1-S 中，畸形率( B～E )為62%；其中非萎縮性脊柱側凸15例，胸椎椎弓根畸形率為41.1%；萎縮性脊柱側凸85例，胸椎椎弓根畸形率為65.7%，萎縮性脊柱側凸的胸椎椎弓根畸形率明顯高于非萎縮性脊柱側凸(χ2＝78.8，P＜0.001)。凹側、中立椎和凸側椎體的胸椎椎弓根畸形率依次下降(80.8%＞66.8%＞47.9%，P＜0.001)。(40°～59°)組、(60°～79°)組與≥80°組間胸椎椎弓根畸形率依次上升(50.7%＜59.6%＜69.2%，P＜0.001)。≥18歲組的胸椎椎弓根畸形率(55.3%)明顯低于＜18歲組(63.5%， P＝0.001)；此外，不同性彆間胸椎椎弓根畸形率差異無統計學意義(男63.4%，女60.4%，P＝0.13)。結論在NF1-S患者中，胸椎椎弓根畸形率為62%。其中萎縮性脊柱側凸中胸椎椎弓根畸形率明顯高于非萎縮性脊柱側凸；凸側胸椎椎弓根畸形率明顯低于凹側；隨著Cobb’s角的增大，胸椎椎弓根畸形率明顯增加；在成人NF1-S患者中胸椎椎弓根畸形率明顯低于未成年患者；不同性彆NF1-S患者胸椎椎弓根的畸形率相似。
목적：탐토I형신경섬유류병( neurofibromatosis type 1，NF1)반척주측철환자흉추추궁근분형적특점。방법2005년7월지2012년3월，아원수치적100례NF1반척주측철자채용라선CT행흉추련속소묘。재Lenke분형기출상대기진일보세화，장추궁근형태분형위：A형(정상형)；B형(협착형)；C형(협부경화형)；D형(완전경화형)；E형(추궁근결여형)。A、B、C、D、E형흉추추궁근분별위911개、561개、334개、422개화172개，공2400개。안조상술분형표준，재도상편당화통신계통( PACS )상축층열편，선택흉추추궁근현시최청초적층면대추궁근횡경진행측량병분형，분별통계불동조별적 NF1반척주측철( scoliosis secondary to neurofibromatosis type 1，NF1-S )환자흉추추궁근류형발생솔，병대기기형솔진행통계학분석。결과100례 NF1-S 중，기형솔( B～E )위62%；기중비위축성척주측철15례，흉추추궁근기형솔위41.1%；위축성척주측철85례，흉추추궁근기형솔위65.7%，위축성척주측철적흉추추궁근기형솔명현고우비위축성척주측철(χ2＝78.8，P＜0.001)。요측、중립추화철측추체적흉추추궁근기형솔의차하강(80.8%＞66.8%＞47.9%，P＜0.001)。(40°～59°)조、(60°～79°)조여≥80°조간흉추추궁근기형솔의차상승(50.7%＜59.6%＜69.2%，P＜0.001)。≥18세조적흉추추궁근기형솔(55.3%)명현저우＜18세조(63.5%， P＝0.001)；차외，불동성별간흉추추궁근기형솔차이무통계학의의(남63.4%，녀60.4%，P＝0.13)。결론재NF1-S환자중，흉추추궁근기형솔위62%。기중위축성척주측철중흉추추궁근기형솔명현고우비위축성척주측철；철측흉추추궁근기형솔명현저우요측；수착Cobb’s각적증대，흉추추궁근기형솔명현증가；재성인NF1-S환자중흉추추궁근기형솔명현저우미성년환자；불동성별NF1-S환자흉추추궁근적기형솔상사。
Objective To investigate the features of morphologic classiifcation of thoracic pedicles in the patients with scoliosis secondary to neurofibromatosis type 1 ( NF1-S ). Methods Successive spiral CT thoracic vertebrae scans of 100 patients with NF1-S who were adopted from July 2005 to March 2012 were obtained. The morphology of thoracic pedicles was classiifed based on the Lenke classiifcation system. There were type A ( normal type ), type B ( stenotic type ), type C ( isthmic type ), type D ( complete sclerosis type ) and type E ( pedicle absent type ). The numbers of thoracic pedicles of type A, B, C, D and E among the 100 patients with NF1-S were 911, 561, 334, 422 and 172 respectively, and 2400 in all. According to the above classiifcation standard, all the patients’ transverse pedicle diameters of the thoracic vertebrae were measured and classiifed based on the clearest images with the software of picture archiving and communication system ( PACS ). The incidence of different types of thoracic pedicles in the patients with NF1-S was recorded respectively, and the malformation rate was analyzed statistically. Results The malformation rate ( type B-E ) was 62%in the 100 patients with NF1-S. Nondystrophic scoliosis was found in 15 patients whose malformation rate of thoracic pedicles ( MRTP ) was 41.1%and dystrophic scoliosis was found in 85 patients whose MRTP was 65.7%. The MRTP in the dystrophic group was obviously higher than that in the nondystrophic group (χ2=78.8, P<0.001 ). The MRTP was decreased in turn in the concavity group, the neutral vertebrae group and the convexity group ( 80.8%>66.8%>47.9%, P<0.001 ). The MRTP was increased in turn in the ( 40°-59° ) group, ( 60°-79° ) group and≥80° group (50.7%<59.6%<69.2%, P<0.001 ). The MRTP of the patients equal to or more than 18 years old ( 55.3% ) was lower than that of the patients less than 18 years old ( 63.5% ) ( P=0.001 ). In addition, there were no signiifcant differences between males ( 63.4%) and females ( 60.4%) in terms of the MRTP ( P=0.13 ). Conclusions The MRTP in the patients with NF1-S is 62%. The MRTP is obviously higher in the dystrophic scoliosis group than in the nondystrophic scoliosis group. The MRTP is obviously lower in the convexity group than in the concavity group. The MRTP is signiifcantly increased as the Cobb’s angle is increased. The MRTP is obviously lower in adults than in adolescents. The MRTP is not affected by the sex.