Sucato Daniel J, Duchene Clark
Department of Orthopaedic Surgery, University of Texas at Southwestern Medical Center, Texas Scottish Rite Hospital, Dallas 75219, USA.
J Bone Joint Surg Am. 2003 Aug;85(8):1461-9.
There is little information documenting the relationship of the aorta to the thoracic scoliotic spine. Recent studies have suggested that the ends of screws placed during an anterior spinal arthrodesis, and pedicle screws used for the treatment of right thoracic scoliosis, may be in proximity to the aorta. The purpose of this study was to analyze the anatomical relationship between the aorta and the spine in a comparison of patients with idiopathic right thoracic scoliosis and patients with a normal spine.
Thirty-six patients with adolescent idiopathic scoliosis with a right thoracic curve and forty-three with a normal straight spine were studied. Radiographs were analyzed to determine the Cobb angle, the apex of the curve, and the apical vertebral rotation for the patients with scoliosis. Axial magnetic resonance images from the fourth thoracic vertebra to the third lumbar vertebra at the midvertebral body level were used to measure the distance from the aorta to the closest point of the vertebral body cortex, the distance from the posterior edge of the aorta to the spinal canal, and the aorta-vertebral angle.
No differences were found between the groups with respect to age or sex distribution. For the scoliosis and normal groups, boys had greater average vertebral body width and depth for all levels than did girls (p < 0.05). For the scoliosis group, the most common apical vertebra was the eighth thoracic vertebra, the average coronal curve measurement was 55.2 degrees, and the average apical rotation was 17.3 degrees. The average distance from the aortic wall to the vertebral body cortex at the apex of the curve was greater in the patients with scoliosis (4.0 mm) than at similar levels in the normal group (2.5 mm) (p < 0.05). The distance from the posterior aspect of the aorta to the anterior aspect of the spinal canal was less in the scoliosis group (11.1 mm) than in the normal group (19.2 mm) for the fifth to the twelfth thoracic level (p < 0.05). The aorta was positioned more laterally and posteriorly adjacent to the vertebral body at the fifth to the twelfth thoracic level in patients with scoliosis compared with that in normal patients as reflected in a smaller aorta-vertebral angle (p < 0.05). With an increasing coronal Cobb angle in the thoracic curve and apical vertebral rotation, the aorta was positioned more laterally and posteriorly (p < 0.05).
In patients with right thoracic idiopathic scoliosis, the aorta is positioned more laterally and posteriorly relative to the vertebral body compared with that in patients without spinal deformity.
关于主动脉与胸椎侧弯脊柱之间关系的文献资料较少。近期研究表明，前路脊柱融合术中所置入螺钉的末端以及用于治疗右胸段脊柱侧弯的椎弓根螺钉，可能靠近主动脉。本研究的目的是在特发性右胸段脊柱侧弯患者与脊柱正常患者的对比中，分析主动脉与脊柱之间的解剖关系。
对36例患有青少年特发性脊柱侧弯且为右胸弯的患者以及43例脊柱正常且笔直的患者进行研究。对脊柱侧弯患者的X线片进行分析，以确定Cobb角、侧弯顶点以及顶点椎体的旋转情况。使用从第四胸椎至第三腰椎椎体中部水平的轴向磁共振成像，来测量主动脉至椎体皮质最近点的距离、主动脉后缘至椎管的距离以及主动脉 - 椎体角。
两组在年龄或性别分布方面未发现差异。对于脊柱侧弯组和正常组，男孩在所有节段的椎体平均宽度和深度均大于女孩（p < 0.05）。对于脊柱侧弯组，最常见的顶点椎体为第八胸椎，平均冠状面弯曲度为55.2度，平均顶点旋转度为17.3度。脊柱侧弯患者在侧弯顶点处主动脉壁至椎体皮质的平均距离（4.0毫米）大于正常组相似节段的距离（2.5毫米）（p < 0.05）。在第五至第十二胸椎节段，脊柱侧弯组中主动脉后缘至椎管前缘的距离（11.1毫米）小于正常组（19.2毫米）（p < 0.05）。与正常患者相比，脊柱侧弯患者在第五至第十二胸椎节段主动脉更偏向外侧和后方与椎体相邻，这表现为较小的主动脉 - 椎体角（p < 0.05）。随着胸段弯曲的冠状面Cobb角和顶点椎体旋转增加，主动脉的位置更偏向外侧和后方（p < 0.05）。
与无脊柱畸形的患者相比，特发性右胸段脊柱侧弯患者的主动脉相对于椎体的位置更偏向外侧和后方。
