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南阳月季苗 www.jxrose.cn
【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(adolescent idiopathic scoliosis，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Cobbs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，且以顶椎区最为显著，而逐渐向两侧端椎区递减。顶椎区脊髓偏移与主胸弯Cobbs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,To demonstrate the shift of the spinal cord to the concave side of the spinal canal in adolescent patients with idiopathic thoracic scoliosis,to investigate possible cause of the shift of the spinal cord and to explore its clinical relevance.,Method,Thirtynine adolescents with idiopathic thoracic scoliosis were recruited in this study.Cobbs angle,relative apical translation and relative trunk shift of the major thoracic curves were recorded from standing posteroanterior roentgenography of the whole spine.The shift of the spinal cord was determined through the measurements of distance between the spinal cord and the medial walls of the pedicles on the convex and concave sides,which were performed in transverse magnetic resonance images of the spinal canal in the major thoracic curves(T5~12).The variations of the shift of the spinal cord were determined,and the relationships between the shift of the spinal cord at the apical region and Cobbs angle,and between that and the relative apical vertebral translation were analyzed.,Result,In the region of the major thoracic curves,the distance from the spinal cord to the pedicle on the convex side was significantly less than the distance to the pedicle on the concave side(P,0.05).The shift of the spinal cord to the concavity was much more evident at the apical region,and then was gradually decreased to the region of the end vertebrae.Strong correlations were found between the shift of the spinal cord at the apical region and Cobbs angle(r= 0.631,P,0.001),and between the spinal cord shift and the relative apical vertebral translation(r=0.546,P=0.003).,Conclusion, It is revealed that the spinal cord is shifted to concavity,and that the shift is most substantial at the apical region.The result of this study suggests that the dural shift might be related with the involvement of the tension of nerves on the concave side,and that screw placement might be at a much higher risk of spinal cord injury on the concavity than that on the convexity.
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