Sugimoto Yoshihisa, Tanaka Masato, Nakanishi Kazuo, Misawa Haruo, Takigawa Tomoyuki, Ozaki Toshifumi
Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Spine (Phila Pa 1976). 2007 Dec 1;32(25):E761-3. doi: 10.1097/BRS.0b013e31815b7e87.
A retrospective study.
To predict intraoperative vertebral rotation in patients with scoliosis using posterior elements as anatomic landmarks.
In patients with scoliosis, accurate intraoperative vertebral rotation measurements are needed to avoid spinal cord injury caused by pedicle screw misplacement. Generally, we predict vertebral rotation by anatomic landmarks, that is, posterior elements that can be seen during surgery, such as spinous processes, transverse processes, or laminae. However, correlation between vertebral rotation and these anatomic landmarks is unclear.
Seventy-six vertebrae (T4-T12) of 17 patients with thoracic scoliosis were measured. Patients who had severe scoliosis (>90 degrees Cobb angle) were excluded from this study. We assessed apex and adjacent vertebrae using axial computed tomography scans taken with patients in a supine position. We measured the angle between the vertebral reference line (Ve), defined as the midline of the vertebral body, and various lines based on the following anatomic landmarks of posterior elements of the vertebrae: (a) The Spinous q process line (Sp), defined as the midline of the spinous process; (b) A bisector (Bi) of the bilateral lines that pass the depressions in the laminae to the medial apex of the transverse processes; (c) a line (Tr) perpendicular to a line which passes the bilateral transverse processes; and (d) a line (La) perpendicular to the line which passes the bilateral depressions in the laminae.
The average Cobb angle in A-P radiographs was 68 degrees. The average angles between Sp, Bi, Tr, and La and the vertebral reference line were 13.6 degrees (range 0 degrees -29.2 degrees), 3.0 degrees (range 0 degrees -9.0 degrees), 2.5 degrees (range 0 degrees -8.1 degrees), and 4.4 degrees (range 0 degrees -11.9 degrees), respectively.
The line Tr, (runs perpendicular to the line which passes the bilateral transverse processes) had the greatest correlation to the rotation of a vertebra. On the other hand, the line Sp (defined as the midline of the spinous process) was not sufficient for predicting rotation of a vertebra and can be disregarded during the intraoperative analysis and screw placement.
一项回顾性研究。
以脊柱后部结构作为解剖标志预测脊柱侧弯患者术中椎体旋转情况。
对于脊柱侧弯患者，需要准确的术中椎体旋转测量以避免椎弓根螺钉误置导致的脊髓损伤。一般来说，我们通过解剖标志来预测椎体旋转，即手术中可见的脊柱后部结构，如棘突、横突或椎板。然而，椎体旋转与这些解剖标志之间的相关性尚不清楚。
对17例胸椎侧弯患者的76个椎体（T4 - T12）进行测量。严重脊柱侧弯（Cobb角>90度）的患者被排除在本研究之外。我们使用患者仰卧位时的轴向计算机断层扫描评估顶椎和相邻椎体。我们测量了椎体参考线（Ve，定义为椎体中线）与基于椎体后部结构以下解剖标志的各种线之间的角度：（a）棘突线（Sp），定义为棘突中线；（b）穿过椎板凹陷至横突内侧顶点的双侧线的平分线（Bi）；（c）垂直于穿过双侧横突的线的线（Tr）；以及（d）垂直于穿过双侧椎板凹陷的线的线（La）。
前后位X线片上的平均Cobb角为68度。Sp、Bi、Tr和La与椎体参考线之间的平均角度分别为13.6度（范围0度 - 29.2度）、3.0度（范围0度 - 9.0度）、2.5度（范围0度 - 8.1度）和4.4度（范围0度 - 11.9度）。
线Tr（垂直于穿过双侧横突的线）与椎体旋转的相关性最大。另一方面，线Sp（定义为棘突中线）不足以预测椎体旋转，在术中分析和螺钉置入过程中可不予考虑。
