CT三维重建在检测儿童脊柱侧弯生长棒矫治调控现象中的影像学价值研究

摘要

目的 通过脊柱CT三维重建方法 对脊柱侧弯顶锥区域椎间隙进行观察,摸索建立一个客观、无创的观测脊柱侧弯患者行板-棍系统(plate-rod system for scoliosis,PRSS)植入术后对于脊柱生长调控现象的指征.方法 对2000年2月-2012年4月在北京协和医学院及中国人民武装警察部队总医院植入脊柱侧弯PRSS系统超过5年且现年龄≥10岁的儿童脊柱侧弯患者进行全脊柱CT扫描,对扫描结果 进行三维重建,通过旋转图像观察顶锥区域终板软骨成熟、钙化、融合情况,评价PRSS的调控效果.同时计算有效辐射剂量(effective dose, ED).结果 15例PRSS术后的脊柱侧弯患者,平均年龄16.75岁,手术时平均年龄8.17岁,检查时间平均为术后8.58年.全脊柱CT扫描平均ED为(6.97±2.31)mSv,为安全范围.经三维重建后,观察顶锥区域融合情况,观察到10例患者脊柱侧弯凸侧终板软骨提前成熟、钙化,凸侧椎间隙较早出现融合,且随年龄增加逐渐明显,其中凹侧未融合者8例,凹侧融合者2例;无单纯凹侧融合者.结论 运用CT扫描后三维重建方法 ,能够直观地观察到生长中的脊柱侧弯受调控后的生长成熟情况,是检测儿童脊柱侧弯生长棒矫治调控现象的可靠检测方法 ,且对于生长棒的手术取棒时机选择有一定的指导意义.%Objective To observe the intervertebral space atcurve apex by CT three-dimensional reconstruction of spine and explore an objective and non-invasive observation of plate-rod system for scoliosis (PRSS) implantation in patients with scoliosis Postoperative spine growth and regulation of the phenomenon. Methods Total spine CT scans were performed in children with scoliosis who were implanted in the PRSS system of scoliosis for more than 5 years and were now over 10 years old. The scan results were reconstructed in three dimensions. The end-plate cartilage in the vertex cones was observed by rotating the image , Calcification, fusion, evaluation of PRSS regulatory effect; at the same time calculate the effective dose (effective dose, ED). Results The average age of 15 patients with scoliosis after PRSS was 16.75 years old. The average age of the patients was 8.17 years old. The average examination time was 8.58 years. The mean effective radiation dose (ED) of whole-spine CT scanning was 6.97 ± 2.31mSv, which was the safe range. After three-dimensional reconstruction, the top cone area fusion was observed. Ten cases of sciatic calcification showed that the cartilage in the scoliosis flexed earlier, the calcification and the convex intervertebral space merged earlier, and gradually increased with age, in which concave side Fusion in 8 cases, concave side of the fusion in 2 cases; no simple concave side fusion. Conclusion Three-dimensional CT reconstruction method can intuitively observe the growth and maturation of scoliosis in growth. It is a reliable method to detect the regulation of scoliosis growth rod in children. The timing of surgery to take the stick have a certain guiding significance.