青少年特发性脊柱侧凸胸椎形态学的MRI测量及临床意义

摘要

目的 通过磁共振成像(MRI)观察青少年特发性脊柱侧凸(AIS)和正常同年龄组青少年胸椎的形态学差异,探讨其临床意义.方法 胸椎轻度侧凸(MS)组患者10例(Cobb角15°～39°),胸椎中度侧凸(SS)组患者10例(Cobb角40°～75°).另选健康青少年10名作为对照(非侧凸组).所有研究对象均为女性,年龄13～14岁.用1.5 T磁共振扫描仪(Sonata,Siemens,Erlanger,德国)对所有研究对象进行全脊柱矢状面扫描,在图像工作站(Easy Vision,Philips Medical Systems,Best,荷兰)上重建脊柱矢状面图像,测量每个胸椎椎体前壁高度,后壁高度,棘突间高度,在横截面测量椎体横径长度,并进行对比分析.结果 椎体前后高度、宽度从T1到T12逐渐增加,并呈线性分布,脊柱侧凸组椎体高度普遍>正常同年龄非侧凸组患者.脊柱侧凸组患者椎体高度横径比值以及脊椎前后高度比值均>无侧凸组.胸椎侧凸顶椎区T6～T9椎体前方高度、椎体高度横径比值以及脊椎前后高度比值,脊柱侧凸组明显>非侧凸组,差异均有统计学意义(P<0.05).结论 AIS胸椎侧凸女性患者胸椎顶椎区存在显著的脊柱生长模式异常,与正常胸椎相比AIS的胸椎更高、并显得更为瘦长.%Objectives To evaluate and compare thoracic vertebrae morphology between patients with idiopathic and normal adolescents throngh MRI.Methods Two-dimensional sagittal MRI of the spine was performed in 10 normal adolescent,10 patients with mild idiopathic thoracic scoliosis(Cobb angle 15°-39°)and 10 patients with moderate thoracic scoliosis(Cobb angle 40°-75°),all of them were female and between 13-14 years old.Sagittal imaging was reconstructed on image working station (Easy Vision,Philips Medical Systems,Best,Netherland).Anterior height,posterior height and width of vertebral body as well as length between spinous process were measured on each thoracic spine.Results Anterior height,posterior height and width of vertebral body increased from T1 to T12 with the values from scoliotic groups larger than normal group.The anterior height/width ratio and anterior/posterior column ratio were also larger in scoliotic group especially at apical area.Conclusion The thoracic vertebrae are higher and slimmer in scoliotic patient than in normal age-matched girls which implied that there is abnormal endochondral ossification on spine during adolescent growth spurt.