术前MRI和术中O型臂导航对脊柱侧凸椎体旋转的测量
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摘要
[目的]通过术前仰卧位MRI平扫和术中O型臂导航系统获得的俯卧位椎体旋转影像,探讨青少年特发性脊柱侧凸患者不同体位对椎体旋转的影响。[方法]回顾性分析2013年4月～2018年7月本医学中心骨科收治的21例青少年特发性脊柱侧凸(AIS)并接受后路切开内固定矫正术的患者,术前均行仰卧位全脊柱MRI平扫和术中俯卧位脊柱O型臂导航系统平扫及三维重建,上传临床图像显示系统Qreads5.10,采用G??en法分别测量同一患者同一椎体术前MRI和术中O型臂平扫的椎体旋转角,测量椎体的旋转包括主胸弯顶椎(AVR)、上端椎(UEVR)、下端椎(LEVR)、上端椎上位椎体(AVAUEVR)、下端椎下位椎体(AVBLEVR),使用配对t检验比较椎体不同体位下的旋转差异。[结果]患者在俯卧位(即常规后路手术体位)时主胸弯顶椎旋转度数(AVR)显著大于仰卧位时的度数,平均差值为3.14°,差异有统计学意义(P=0.015,<0.05)。俯卧位UEVR、AVAUEVR度数比仰卧位时均有所增加,平均差值分别为1.98°、0.83°,俯卧位LEVR、AVBLEVR度数较仰卧位时均有所减小,平均差值分别为1.07°、1.86°,但UEVR、LEVR、AVAUEVR、AVBLEVR在两种体位下的度数差异均无统计学意义(P>0.05)。[结论]与术前仰卧位MRI测量结果相比,术中俯卧位O型臂导航系统测量的AVR显著增大,而UEVR、AVAUEVR稍有增加,LEVR、AVBLEVR稍有减少。
[Objective] To compared the rotation of the vertebral body measured by preoperative MRI scans in supine position versus intraoperative O-arm navigation system in prone position in posterior surgery for adolescent idiopathic scoliosis(AIS). [Methods] A retrospective study was conducted on 21 AIS patients who underwent posterior correction and instrumentation from April 2013 to July 2018 in our orthopedic department. All patients underwent the preoperative full spine MRI scans in supine position and the O-arm navigation system scans in intraoperative prone position. As the images uploaded to the Qreads5.10 display system, the rotation angles of the vertebral body were determined by using the G??en method, including the apical vertebrae rotation(AVR) of the main thoracic curvature, the upper end vertebra rotation(UEVR), the lower end vertebra rotation(LEVR), adjacent vertebrae above UEVR(AVAUEVR) and adjacent vertebrae below LEVR(AVBLEVR). The results measured in supine position versus prone position were compared by the paired t-test. [Results] The AVR of the main thoracic curvature in the supine position was significantly greater than that in the prone position with a mean difference of 3.14°, which was statistically significant(P<0.05). However, the UEVR and AVAUEVR slightly increased in the prone position compared with those in supine position, associated with the differences of 1.98° and 0.83° respectively. The LEVR and AVBLEVR slightly decreased in prone position by comparing with those in supine position, with differences of 1.07° and 1.86° respectively.There were no significant differences in the UEVR, LEVR,AVAUEVR, and AVBLEVR between the two positions(P>0.05). [Conclusion] Compared with the consequences measured by MRI in supine position, the AVR significantly increases, the UEVR and AVAUEVR slightly increases, while the LEVR and AVBLEVR slightly decreases in prone position measured by the O-arm navigation system intraoperatively.
[Objective] To compared the rotation of the vertebral body measured by preoperative MRI scans in supine position versus intraoperative O-arm navigation system in prone position in posterior surgery for adolescent idiopathic scoliosis(AIS). [Methods] A retrospective study was conducted on 21 AIS patients who underwent posterior correction and instrumentation from April 2013 to July 2018 in our orthopedic department. All patients underwent the preoperative full spine MRI scans in supine position and the O-arm navigation system scans in intraoperative prone position. As the images uploaded to the Qreads5.10 display system, the rotation angles of the vertebral body were determined by using the G??en method, including the apical vertebrae rotation(AVR) of the main thoracic curvature, the upper end vertebra rotation(UEVR), the lower end vertebra rotation(LEVR), adjacent vertebrae above UEVR(AVAUEVR) and adjacent vertebrae below LEVR(AVBLEVR). The results measured in supine position versus prone position were compared by the paired t-test. [Results] The AVR of the main thoracic curvature in the supine position was significantly greater than that in the prone position with a mean difference of 3.14°, which was statistically significant(P<0.05). However, the UEVR and AVAUEVR slightly increased in the prone position compared with those in supine position, associated with the differences of 1.98° and 0.83° respectively. The LEVR and AVBLEVR slightly decreased in prone position by comparing with those in supine position, with differences of 1.07° and 1.86° respectively.There were no significant differences in the UEVR, LEVR,AVAUEVR, and AVBLEVR between the two positions(P>0.05). [Conclusion] Compared with the consequences measured by MRI in supine position, the AVR significantly increases, the UEVR and AVAUEVR slightly increases, while the LEVR and AVBLEVR slightly decreases in prone position measured by the O-arm navigation system intraoperatively.
引文
[1]Horne JPM,Flannery RM,Usman SM.Adolescent idiopathic scoliosis:diagnosis and management[J].Am Family Physician,2014,89(3):193-198.
[2]Tambe AD.Current concepts in the surgical management of adolescent idiopathic scoliosis[J].Bone Joint J,2018,100-B(4):415-424.
[3]Romano M.Exercises for Adolescent idiopathic scoliosis[J].Spine,2013,38(14):E883-E893.
[4]黄紫房等.脊柱侧凸顶椎椎体及附件旋转角测量及其临床意义[J].中国矫形外科杂志,2012,20(7):632-635.
[5]Lykissas MG.Mid-to long-term outcomes in adolescent idiopathic scoliosis after instrumented posterior spinal fusion:a meta-analysis[J].Spine(Phila Pa 1976),2013,38(2):E113-119.
[6]Suk SI.Pedicle screw instrumentation for adolescent idiopathic scoliosis:the insertion technique,the fusion levels and direct vertebral rotation[J].ClinOrthopSurg,2011,3(2):89-100.
[7]Vallespir GP.Vertebral coplanar alignment:a standardized technique for three dimensional correction in scoliosis surgery:technical description and preliminary results in Lenke type 1 curves[J].Spine(Phila Pa 1976),2008,33(14):1588-1597.
[8]Gocen,S,Havitcioglu H,Alici E.A new method to measure vertebral rotation from CT scans[J].Eur Spine J,1999,8(4):261-265.
[9]Weinstein SL.Adolescent idiopathic scoliosis[J].Lancet,2008,371(9623):1527-1537.
[10]Ilharreborde B.Sagittal balance and idiopathic scoliosis:does final sagittal alignment influence outcomes,degeneration rate or failure rate[J].Eur Spine J,2018,27(Suppl 1):48-58.
[11]La Maida GA.Sagittal balance in adolescent idiopathic scoliosis:radiographic study of spino-pelvic compensation after surgery[J].Eur Spine J,2013,22(Suppl 6):S859-867.
[12]Morrison DG.Correlation between Cobb angle,spinous process angle(SPA)and apical vertebrae rotation(AVR)on posteroanterior radiographs in adolescent idiopathic scoliosis(AIS)[J].Eur Spine J,2015,24(2):306-312.
[13]Birchall D.Measurement of vertebral rotation in adolescent idiopathic scoliosis using three-dimensional magnetic resonance imaging[J].Spine(Phila Pa 1976),1997,22(20):2403-2407.
[14]Little JP.Evaluating the change in axial vertebral rotation following thoracoscopic anterior scoliosis surgery using low-dose computed tomography[J].Spine Deform,2017,5(3):172-180.
[15]Cecen GS.Computerized tomography imaging in adolescent idiopathic scoliosis:prone versus supine[J].Eur Spine J,2016,25(2):467-475.
[16]Nash CJ,Moe JH.A study of vertebral rotation[J].J Bone Joint Surg Am,1969,51(2):223-229.
[17]Richards BS.Measurement error in assessment of vertebral rotation using the Perdriolle torsionmeter[J].Spine(Phila Pa 1976),1992,17(5):513-517.
[18]Perdriolle R,Vidal J.Thoracic idiopathic scoliosis curve evolution and prognosis[J].Spine(Phila Pa 1976),1985,10(9):785-791.
[19]Larson AN.Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation[J].Spine(Phila Pa 1976),2012,37(3):E188-194.
[20]Luo TD.Accuracy of Pedicle screw placement in children 10 years or younger using navigation and intraoperative CT[J].Clin Spine Surg,2016,29(3):E135-138.
[21]Aaro S,Dahlborn M,Svensson L.Estimation of vertebral rotation in structural scoliosis by computer tomography[J].Acta Radiol Diagn(Stockh),1978,19(6):990-992.
[22]Cundy PJ.Cotrel-Dubousset instrumentation and vertebral rotation in adolescent idiopathic scoliosis[J].J Bone Joint Surg Br,1990,72(4):670-674.
[2]Tambe AD.Current concepts in the surgical management of adolescent idiopathic scoliosis[J].Bone Joint J,2018,100-B(4):415-424.
[3]Romano M.Exercises for Adolescent idiopathic scoliosis[J].Spine,2013,38(14):E883-E893.
[4]黄紫房等.脊柱侧凸顶椎椎体及附件旋转角测量及其临床意义[J].中国矫形外科杂志,2012,20(7):632-635.
[5]Lykissas MG.Mid-to long-term outcomes in adolescent idiopathic scoliosis after instrumented posterior spinal fusion:a meta-analysis[J].Spine(Phila Pa 1976),2013,38(2):E113-119.
[6]Suk SI.Pedicle screw instrumentation for adolescent idiopathic scoliosis:the insertion technique,the fusion levels and direct vertebral rotation[J].ClinOrthopSurg,2011,3(2):89-100.
[7]Vallespir GP.Vertebral coplanar alignment:a standardized technique for three dimensional correction in scoliosis surgery:technical description and preliminary results in Lenke type 1 curves[J].Spine(Phila Pa 1976),2008,33(14):1588-1597.
[8]Gocen,S,Havitcioglu H,Alici E.A new method to measure vertebral rotation from CT scans[J].Eur Spine J,1999,8(4):261-265.
[9]Weinstein SL.Adolescent idiopathic scoliosis[J].Lancet,2008,371(9623):1527-1537.
[10]Ilharreborde B.Sagittal balance and idiopathic scoliosis:does final sagittal alignment influence outcomes,degeneration rate or failure rate[J].Eur Spine J,2018,27(Suppl 1):48-58.
[11]La Maida GA.Sagittal balance in adolescent idiopathic scoliosis:radiographic study of spino-pelvic compensation after surgery[J].Eur Spine J,2013,22(Suppl 6):S859-867.
[12]Morrison DG.Correlation between Cobb angle,spinous process angle(SPA)and apical vertebrae rotation(AVR)on posteroanterior radiographs in adolescent idiopathic scoliosis(AIS)[J].Eur Spine J,2015,24(2):306-312.
[13]Birchall D.Measurement of vertebral rotation in adolescent idiopathic scoliosis using three-dimensional magnetic resonance imaging[J].Spine(Phila Pa 1976),1997,22(20):2403-2407.
[14]Little JP.Evaluating the change in axial vertebral rotation following thoracoscopic anterior scoliosis surgery using low-dose computed tomography[J].Spine Deform,2017,5(3):172-180.
[15]Cecen GS.Computerized tomography imaging in adolescent idiopathic scoliosis:prone versus supine[J].Eur Spine J,2016,25(2):467-475.
[16]Nash CJ,Moe JH.A study of vertebral rotation[J].J Bone Joint Surg Am,1969,51(2):223-229.
[17]Richards BS.Measurement error in assessment of vertebral rotation using the Perdriolle torsionmeter[J].Spine(Phila Pa 1976),1992,17(5):513-517.
[18]Perdriolle R,Vidal J.Thoracic idiopathic scoliosis curve evolution and prognosis[J].Spine(Phila Pa 1976),1985,10(9):785-791.
[19]Larson AN.Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation[J].Spine(Phila Pa 1976),2012,37(3):E188-194.
[20]Luo TD.Accuracy of Pedicle screw placement in children 10 years or younger using navigation and intraoperative CT[J].Clin Spine Surg,2016,29(3):E135-138.
[21]Aaro S,Dahlborn M,Svensson L.Estimation of vertebral rotation in structural scoliosis by computer tomography[J].Acta Radiol Diagn(Stockh),1978,19(6):990-992.
[22]Cundy PJ.Cotrel-Dubousset instrumentation and vertebral rotation in adolescent idiopathic scoliosis[J].J Bone Joint Surg Br,1990,72(4):670-674.