青少年特发性胸椎侧凸患者的脊髓偏移及临床意义.doc

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1、青少年特发性胸椎侧凸患者的脊髓偏移及临床意义【摘要】揭示青少年胸椎特发性侧凸患者椎管内脊髓的偏移，明确其变化趋势，并探讨其可能的发生机制和临床意义。［方法］本研究包括39名以右胸弯为主弯的青少年特发性脊柱侧凸（adolescentidiopathicscoliosis，AIS）患者。测量主胸弯节段内（T5~12）椎管内脊髓与凸凹侧椎弓根之间的距离，计算脊髓的偏移，揭示其变化趋势，并分析顶椎区脊髓偏移与主胸弯Cobbs角和顶椎相对偏移之间的相关性。［结果］在T5~12节段椎管内，脊髓与凸侧椎弓根之间的距离显著大于与凹侧椎弓根之间的距离（P＜0.05），即脊髓向凹侧椎弓根偏移，且以顶椎区最为

2、显著，而逐渐向两侧端椎区递减。顶椎区脊髓偏移与主胸弯Cobbs角和顶椎相对偏移存在显著的正相关（相关系数分别为0.631和0.546）。［结论］胸椎特发性脊柱侧凸患者存在侧凸节段椎管内脊髓偏移的现象，且以顶椎区最显著。研究结果提示脊髓偏移可能与脊椎偏移后凹侧脊神经的牵拉有关，而且凹侧置钉的风险高于凸侧。【关键词】脊髓偏移青少年特发性脊柱侧凸胸椎椎弓根螺钉Abstract：［Objective］Todemonstratetheshiftofthespinalcordtotheconcavesideofthespinalcanalinadolescentpatientswithidiopat

3、hicthoracicscoliosis,toinvestigatepossiblecauseoftheshiftofthespinalcordandtoexploreitsclinicalrelevance.［Method］Thirtynineadolescentswithidiopathicthoracicscoliosiswererecruitedinthisstudy.Cobbsangle,relativeapicaltranslationandrelativetrunkshiftofthemajorthoraciccurveswererecordedfromstandingp

4、osteroanteriorroentgenographyofthewholespine.Theshiftofthespinalcordwasdeterminedthroughthemeasurementsofdistancebetweenthespinalcordandthemedialwallsofthepediclesontheconvexandconcavesides,whichwereperformedintransversemagneticresonanceimagesofthespinalcanalinthemajorthoraciccurves（T5~12）.Thevari

5、ationsoftheshiftofthespinalcordweredetermined,andtherelationshipsbetweentheshiftofthespinalcordattheapicalregionandCobbsangle,andbetweenthatandtherelativeapicalvertebraltranslationwereanalyzed.［Result］Intheregionofthemajorthoraciccurves,thedistancefromthespinalcordtothepedicleontheconvexsidewassi

6、gnificantlylessthanthedistancetothepedicleontheconcaveside（P＜0.05）.Theshiftofthespinalcordtotheconcavitywasmuchmoreevidentattheapicalregion,andthenwasgraduallydecreasedtotheregionoftheendvertebrae.StrongcorrelationswerefoundbetweentheshiftofthespinalcordattheapicalregionandCobbsangle（r=0.631,P＜0.

7、001）,andbetweenthespinalcordshiftandtherelativeapicalvertebral7translation（r=0.546,P=0.003）.［Conclusion］Itisrevealedthatthespinalcordisshiftedtoconcavity,andthattheshiftismostsubstantialattheapicalregion.Theresul