中国脊柱脊髓杂志
中國脊柱脊髓雜誌
중국척주척수잡지
CHINESE JOURNAL OF SPINE AND SPINAL CORD
2014年
2期
97-102
,共6页
邱旭升%鲍虹达%刘臻%邱勇
邱旭升%鮑虹達%劉臻%邱勇
구욱승%포홍체%류진%구용
马凡综合征%脊柱畸形%矢状面%骨盆
馬凡綜閤徵%脊柱畸形%矢狀麵%骨盆
마범종합정%척주기형%시상면%골분
Marfan syndrome%Spinal deformity%Sagittal%Pelvis
目的:探索马凡综合征伴脊柱畸形患者脊柱-骨盆矢状面的形态特征。方法:收集以脊柱畸形来我院就诊的马凡综合征患者35例,男18例,女17例,年龄10~20岁,平均14.4±2.3岁。在站立位全脊柱侧位X线片上测量脊柱及骨盆矢状面参数,包括:(1)胸椎后凸角(thoracic kyphosis,TK),(2)胸腰段后凸角(thoracolumbar kyphosis,TL),(3)腰椎前凸角(lumbar lodorsis,LL),(4)骨盆入射角(pelvic incidence,PI),(5)骨盆倾斜角(pelvic tilt,PT),(6)骶骨倾斜角(sacral slope,SS),(7)矢状面平衡(sagittal vertical axis,SVA)。定义顶椎在T12、L1或者T12/L1椎间盘,后凸角度>10°的后凸为胸腰段后凸;顶椎在L1/2椎间盘或以下椎体、椎间盘,后凸角度>10°的后凸为腰椎后凸。采用Sponseller分型方法对患者脊柱矢状面形态进行分型,比较不同分型患者脊柱-骨盆矢状面形态。结果:本组患者在冠状面上以胸腰双弯(40.0%)、单胸弯(22.8%)以及三弯(20.0%)最常见,最大Cobb角43°~165°,平均75.2°±26.0°。在脊柱矢状面上,TK为-25°~73°(19.0°±24.1°),其中胸椎后凸正常者(20°≤TK≤50°)10例(28.6%);胸椎后凸增大患者(TK>50°)5例(14.3%);胸椎后凸减小者(0°≤TK<20°)13例(37.1%);另有7例(20.0%)患者表现为胸椎前凸。 TL 为-25°~73°(14.0°±19.0°);LL 为-17°~70°(37.1°±23.3°);SVA为-9.0~7.2cm(-2.0±4.3cm)。15例(42.9%)患者表现为胸腰段后凸或腰椎后凸(9例ⅡA型,6例ⅡB型),5例患者表现为后凸区明显的椎体楔形变。骨盆矢状面上,PI为25°~74°(40.1°±12.7°);PT为-12°~34°(6.9°±9.6°);SS为14°~68°(33.3°±12.6°)。 Sponseller分型Ⅰ型患者TK、LL、PI、SS明显大于Ⅱ型患者,而Ⅱ型患者TL明显大于Ⅰ型患者。未见腰椎滑脱现象。结论:马凡综合征伴脊柱畸形患者脊柱-骨盆矢状面形态差异较大,手术医生应该根据不同分型制定不同的手术策略。
目的:探索馬凡綜閤徵伴脊柱畸形患者脊柱-骨盆矢狀麵的形態特徵。方法:收集以脊柱畸形來我院就診的馬凡綜閤徵患者35例,男18例,女17例,年齡10~20歲,平均14.4±2.3歲。在站立位全脊柱側位X線片上測量脊柱及骨盆矢狀麵參數,包括:(1)胸椎後凸角(thoracic kyphosis,TK),(2)胸腰段後凸角(thoracolumbar kyphosis,TL),(3)腰椎前凸角(lumbar lodorsis,LL),(4)骨盆入射角(pelvic incidence,PI),(5)骨盆傾斜角(pelvic tilt,PT),(6)骶骨傾斜角(sacral slope,SS),(7)矢狀麵平衡(sagittal vertical axis,SVA)。定義頂椎在T12、L1或者T12/L1椎間盤,後凸角度>10°的後凸為胸腰段後凸;頂椎在L1/2椎間盤或以下椎體、椎間盤,後凸角度>10°的後凸為腰椎後凸。採用Sponseller分型方法對患者脊柱矢狀麵形態進行分型,比較不同分型患者脊柱-骨盆矢狀麵形態。結果:本組患者在冠狀麵上以胸腰雙彎(40.0%)、單胸彎(22.8%)以及三彎(20.0%)最常見,最大Cobb角43°~165°,平均75.2°±26.0°。在脊柱矢狀麵上,TK為-25°~73°(19.0°±24.1°),其中胸椎後凸正常者(20°≤TK≤50°)10例(28.6%);胸椎後凸增大患者(TK>50°)5例(14.3%);胸椎後凸減小者(0°≤TK<20°)13例(37.1%);另有7例(20.0%)患者錶現為胸椎前凸。 TL 為-25°~73°(14.0°±19.0°);LL 為-17°~70°(37.1°±23.3°);SVA為-9.0~7.2cm(-2.0±4.3cm)。15例(42.9%)患者錶現為胸腰段後凸或腰椎後凸(9例ⅡA型,6例ⅡB型),5例患者錶現為後凸區明顯的椎體楔形變。骨盆矢狀麵上,PI為25°~74°(40.1°±12.7°);PT為-12°~34°(6.9°±9.6°);SS為14°~68°(33.3°±12.6°)。 Sponseller分型Ⅰ型患者TK、LL、PI、SS明顯大于Ⅱ型患者,而Ⅱ型患者TL明顯大于Ⅰ型患者。未見腰椎滑脫現象。結論:馬凡綜閤徵伴脊柱畸形患者脊柱-骨盆矢狀麵形態差異較大,手術醫生應該根據不同分型製定不同的手術策略。
목적:탐색마범종합정반척주기형환자척주-골분시상면적형태특정。방법:수집이척주기형래아원취진적마범종합정환자35례,남18례,녀17례,년령10~20세,평균14.4±2.3세。재참립위전척주측위X선편상측량척주급골분시상면삼수,포괄:(1)흉추후철각(thoracic kyphosis,TK),(2)흉요단후철각(thoracolumbar kyphosis,TL),(3)요추전철각(lumbar lodorsis,LL),(4)골분입사각(pelvic incidence,PI),(5)골분경사각(pelvic tilt,PT),(6)저골경사각(sacral slope,SS),(7)시상면평형(sagittal vertical axis,SVA)。정의정추재T12、L1혹자T12/L1추간반,후철각도>10°적후철위흉요단후철;정추재L1/2추간반혹이하추체、추간반,후철각도>10°적후철위요추후철。채용Sponseller분형방법대환자척주시상면형태진행분형,비교불동분형환자척주-골분시상면형태。결과:본조환자재관상면상이흉요쌍만(40.0%)、단흉만(22.8%)이급삼만(20.0%)최상견,최대Cobb각43°~165°,평균75.2°±26.0°。재척주시상면상,TK위-25°~73°(19.0°±24.1°),기중흉추후철정상자(20°≤TK≤50°)10례(28.6%);흉추후철증대환자(TK>50°)5례(14.3%);흉추후철감소자(0°≤TK<20°)13례(37.1%);령유7례(20.0%)환자표현위흉추전철。 TL 위-25°~73°(14.0°±19.0°);LL 위-17°~70°(37.1°±23.3°);SVA위-9.0~7.2cm(-2.0±4.3cm)。15례(42.9%)환자표현위흉요단후철혹요추후철(9례ⅡA형,6례ⅡB형),5례환자표현위후철구명현적추체설형변。골분시상면상,PI위25°~74°(40.1°±12.7°);PT위-12°~34°(6.9°±9.6°);SS위14°~68°(33.3°±12.6°)。 Sponseller분형Ⅰ형환자TK、LL、PI、SS명현대우Ⅱ형환자,이Ⅱ형환자TL명현대우Ⅰ형환자。미견요추활탈현상。결론:마범종합정반척주기형환자척주-골분시상면형태차이교대,수술의생응해근거불동분형제정불동적수술책략。
Objectives: To investigate the spino-pelvic alignment in Marfan syndrome patients. Methods: A retrospective study was performed on 35 patients with spinal deformity secondary to Marfan syndrome(18 males and 17 females), the average age was 14.4±2.3 years(10-20). The following spinal and pelvic parameters were measured on the standing lateral radiographs of the whole spine: (1)thoracic kyphosis (TK), (2)thoracolumbar kyphosis (TL), (3)lumbar lodorsis (LL), (4)pelvic incidence (PI), (5)pelvic tilt (PT), (6)sacral slope (SS), (7)sagittal vertical axis (SVA). The thoracolumbar kyphosis was defined as the kyphosis Cobb angle larger than 10 ° and the apex sitting at T12, L1 or T12/L1 disc; the lumbar kyphosis was defined as the kyphosis Cobb angle larger than 10° and the apex below L1/2 disc. The patients were divided into two groups according to Spon-seller′s classification, and the spino-pelvic parameters were compared between two groups. Results: In the frontal plane, the most common curve types were double major(40.0%), thoracic(22.8%) and triple(20.0%), and the mean maximum Cobb angle was 75.2°±26.0°(43°-165°). In the sagittal plane of the spine, the TK was 19.0°±24.1°(-25°-73°), 28.6%(10/35) for normal thoracic kyphosis(20°≤TK≤50°), 14.3%(5/35) for hyperkypho-sis(TK>50°), 37.1%(13/35) for hypokyphosis(0°≤TK<20°), and 20.0%(7/35) for thoracic lordosis. TL was 14.0°±19.0°(-25°-73°); LL was 37.1°±23.3°(-17°-70°); SVA was -9.0-7.2cm(-2.0±4.3cm). According to our defini tion, 42.9%(15/35, 9 type ⅡA, 6 type ⅡB) of cases had thoracolumbar kyphosis or lumbar kyphosis, and 5 presented with vertebral wedging. In the sagittal plane of the pelvis, PI was 40.1°±12.7°(25°-74°); PT was 6.9°±9.6°(-12°-34°); SS was 33.3°±12.6°(14°-68°). Type Ⅰ had larger TK, LL, PI, SS than type Ⅱ, while type Ⅱ had larger TL and PT than type Ⅰ. Furthermore, there was no spondylolisthesis occurred in this se-ries. Conclusions: The patients with Marfan syndrome differ greatly in the spino-pelvic alignments, which indicate different surgical strategies according to different spino-pelvic alignments.