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目的:测量1～6岁小儿胸椎椎弓根的形态学参数,为小儿胸椎椎弓根螺钉固定提供解剖学依据。方法:收集2009年7月~2010年1月在北京儿童医院行胸部CT检查的1～6岁非脊柱疾患小儿胸椎螺旋CT影像资料。根据年龄将入组儿童分为1～岁组(1组),2～岁组(2组),4～6岁组(3组),每组20例。每例均测量T1～T12左右两侧椎弓根参数共24组数值。将64排螺旋CT平扫胸椎的三维重建数据传至工作站,在多平面重建技术下获得每个椎弓根的矢状面及横断面成像,测量胸椎椎弓根横径(内外径)、纵径(内外径)、骨-螺钉通道长度、椎弓根横断面夹角、椎弓根矢状面夹角,并将上述各参数与年龄进行相关性分析,椎弓根横断面夹角和椎弓根矢状面夹角年龄组间采用多重T检验。结果:(1)椎弓根的横径(内外径)T1～T4逐渐减小,T5～T12逐渐增大;横内径值(除T1、T6、T11、T12外)与年龄无显著相关性(rs:0.011～0.363,除T1、T6、T11、T12外,P>0.05),其随年龄增长变化不明显;横外径值(除T4外)与年龄均存在显著正相关性(rs:0.151～0.539,除T4外,P<0.05),其随年龄增长而增长。(2)椎弓根纵径(内外径)T1～T12逐渐增大,除T1外纵径均大于横径;各节段参数与年龄均存在显著正相关性(纵内径rs:0.526～0.786,纵外径rs:0.692～0.864,P<0.05)。(3)骨-螺钉通道长度各年龄组中最短为T1或T2,最长为T9或T10,T1～T9有逐渐增加的趋势,T10～T12有逐渐减小的趋势;各节段参数与年龄均存在显著正相关性(rs:0.299～0.676,P<0.05)。(4)椎弓根横断面夹角最大为T1,T1～T12逐渐减小,部分小儿T11及T12的椎弓根横断面夹角可达0°甚至负角,除T1外,其余各节段参数与年龄均存在显著负相关性(rs:-0.432～-0.107,除T1 P>0.05外,余P<0.05),1组与2、3组间存在显著性差异(P<0.05),2组与3组间无显著性差异(P>0.05)。(5)椎弓根矢状面夹角T1~T12呈下降趋势,各节段参数与年龄无显著相关性(rs:-0.125～0.127,P>0.05),1、2、3三组间无显著性差异(P>0.05)。结论:1～6岁小儿胸椎椎弓根横外径、纵经、骨-螺钉通道长度与年龄的相关性较大,而椎弓根横内径的生长速度较慢,与年龄的相关性较小;横断面及矢状面夹角与年龄的相关性较小,除1~岁年龄组外,其余年龄段的参数值随年龄增长无明显变化。因此行1～6岁小儿胸椎椎弓根螺钉内固定手术时,应根据患儿年龄及术中情况妥善选择螺钉型号及进钉方式,以避免手术风险。
Objective: To measure the morphological parameters of thoracic pedicle of 1 ~ 6 years old pediatric pediatric thoracic pedicle screw fixation to provide anatomical basis. Methods: Thoracic spiral CT images of children aged 1 ~ 6 years old with non-spinal diseases underwent chest CT examination in Children’s Hospital of Beijing from July 2009 to January 2010 were collected. The children were divided into 1 ~ group (group 1), 2 ~ group (group 2), 4 ~ 6 group (group 3) according to age, 20 in each group. Each case were measured on both sides of T1 ~ T12 pedicle parameters a total of 24 values. Three-dimensional reconstruction data of 64-slice spiral CT plain thoracic vertebrae were transmitted to the workstation. The sagittal plane and cross-sectional images of each pedicle were obtained under the multiplanar reconstruction technique. The thoracic pedicle transverse diameter (inner diameter and outer diameter) (Diameter), the length of bone-screw channel, the angle of pedicle cross-section and the angle of pedicle sagittal plane. Correlation analysis was made between the above parameters and age. The cross-sectional angle of pedicle and vertebral The sagittal angle between the sagittal planes was tested by multiple T test. Results: (1) T1 ~ T4 of pedicle diameter and diameter of T5 ~ T12 gradually increased, while there was no significant correlation between T1 and T12 (except T1, T6, T11 and T12) rs: 0.011 ~ 0.363, P> 0.05 except T1, T6, T11, T12), which showed no obvious change with age. There was a significant positive correlation ~ 0.539, except T4, P <0.05), which increased with age. (2) T1 ~ T12 of pedicle longitudinal diameter (internal diameter and external diameter) gradually increased, except T1 longitudinal diameter were greater than the transverse diameter; each segment parameters and age there is a significant positive correlation (longitudinal diameter rs: 0.526 ~ 0.786, Vertical diameter rs: 0.692 ~ 0.864, P <0.05). (3) The length of bone-screw channel in each age group was the shortest for T1 or T2, the longest for T9 or T10, T1 ~ T9 increased gradually and T10 ~ T12 decreased gradually. The parameters of each segment There was a significant positive correlation (rs: 0.299 ~ 0.676, P <0.05). (4) The maximum included angle of pedicle transverse section is T1, T1 ~ T12 is gradually reduced, some children pedicle T11 and T12 pedicle cross-sectional angle up to 0 ° or even negative angle, in addition to T1, the rest of the segments There was a significant negative correlation between parameters and age (rs: -0.432 ~ -0.107, except P <0.05, P <0.05). There was a significant difference between group 1 and group 2 (P <0.05) There was no significant difference between the three groups (P> 0.05). (5) The angle of T1 ~ T12 in pedicle sagittal plane descended. The parameters of each segment had no significant correlation with age (rs: -0.125 ~ 0.127, P> 0.05) Significant difference (P> 0.05). CONCLUSION: The pedicle diameter, longitudinal and bone-screw length of pediatric thoracic peduncles in 1 ~ 6 years old are related to age, while the transverse diameter of pedicles is slower and less related to age The correlation between the included angle of transverse section and sagittal plane was smaller than that of age. The parameters of other age groups had no significant change with age except 1 ~ age group. Therefore, 1 to 6-year-old pediatric thoracic pedicle screw fixation should be based on the child’s age and intraoperative conditions to properly select the screw type and nail approach to avoid the risk of surgery.