Qiu Yong, Wang Wei-Jun, Wang Bin, Zhu Ze-Zhang, Zhu Feng, Yu Yang, Qian Bang-Ping, Ma Wei-Wei
Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing 210089, China.
Zhonghua Wai Ke Za Zhi. 2007 Dec 15;45(24):1708-13.
To quantify the changes of the spatial relations between the vertebral body and the thoracic aorta in main right thoracic adolescent idiopathic scoliosis (AIS) following anterior and posterior instrumentation and fusion.
Twenty-nine patients with main right thoracic AIS were divided into 2 groups. Group A included 13 females and 1 male with an average age of 14.3 years old and average main thoracic Cobb angle of 44.9 degrees, these patients underwent mini-incision thoracic anterior spinal fusion. Group B included 12 females and 3 males with an average age of 14.2 years old and average main thoracic Cobb angle of 46.4 degrees, all of them were treated with posterior spinal fusion. Patients underwent CT scanning from T5 to T12 Pre-and post-operatively. Five parameters pertaining to the spatial relations between the vertebral body and the thoracic aorta including the angle for safety screw placement (gamma), the angle of the aorta relative to the vertebral body (beta), vertebral rotation angle (gamma), distance from the aorta to the closest point of the vertebral body cortex (a) and distance from the posterior wall of the aorta to the anterior edge of the left rib head (b) were analyzed and were correlated with the curve correction.
In Group A, the alpha angle and 3 angle increased while gamma decreased after curve correction, and significant difference were found at T8 and T9 levels (P < 0.05); the a value decreased and b value increased after curve correction and reached significant difference at T9 (P < 0.05). No significant change of these parameters was found in Group B post-operatively. In Group A, the increment of alpha angle, beta angle and b value show great correlation with the decrement of gamma angle (P < 0.01). At the periapical the increment of alpha angle, beta angle and b value show great correlation with decrement of apical vertebral translation, while decrement of a value show great correlation with increment of kyphosis from T5 to T12 (P < 0.01).
Under anterior instrumentation and correction, the aorta moved anteromedially toward vertebral body on CT scanning. The factors contributing to the aorta shifting included releasing of aorta from vertebrae, vertebral derotation and curve correction.
量化前路和后路内固定融合术后青少年特发性脊柱侧凸（AIS）主要累及右胸段时椎体与胸主动脉之间空间关系的变化。
29例主要累及右胸段的AIS患者分为2组。A组包括13名女性和1名男性，平均年龄14.3岁，主胸弯Cobb角平均为44.9度，这些患者接受了小切口胸段前路脊柱融合术。B组包括12名女性和3名男性，平均年龄14.2岁，主胸弯Cobb角平均为46.4度，所有患者均接受了后路脊柱融合术。患者在术前和术后进行了T5至T12的CT扫描。分析了与椎体和胸主动脉之间空间关系相关的五个参数，包括安全螺钉置入角度（γ）、主动脉相对于椎体的角度（β）、椎体旋转角度（γ）、主动脉到椎体皮质最接近点的距离（a）以及主动脉后壁到左肋骨头前缘的距离（b），并将其与侧弯矫正情况进行关联分析。
A组在侧弯矫正后，α角和β角增大，γ角减小，在T8和T9水平差异有统计学意义（P<0.05）；侧弯矫正后a值减小，b值增大，在T9水平差异有统计学意义（P<0.05）。B组术后这些参数无明显变化。在A组中，α角、β角和b值的增加与γ角的减小高度相关（P<0.01）。在顶椎区，α角、β角和b值的增加与顶椎平移的减小高度相关，而a值的减小与T5至T12后凸增加高度相关（P<0.01）。
在前路内固定和矫正下，CT扫描显示主动脉向椎体前内侧移动。导致主动脉移位的因素包括主动脉与椎体的分离、椎体去旋转和侧弯矫正。
