Wang Weijun, Zhu Zezhang, Zhu Feng, Wang Bin, Chu Winnie C W, Cheng Jack C Y, Qiu Yong
Spine surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing 210008, China.
Eur Spine J. 2008 Aug;17(8):1019-26. doi: 10.1007/s00586-008-0691-0. Epub 2008 May 31.
The risk of impingement of the aorta associated with thoracic vertebral screw or pedicle screw instrumentation in the treatment of thoracic scoliosis has been an important concern. To understand this phenomenon more systematically, the relative position of the aorta with reference to the thoracic vertebrae in right thoracic adolescent idiopathic scoliosis (AIS) following anterior and posterior spinal instrumentation was analyzed in detail quantitatively; 34 patients underwent anterior (n = 14) or posterior (n = 20) spinal instrumentation were recruited in the present study. The relative position of the thoracic aorta, vertebral rotation, apical vertebral translation and thoracic kyphosis were measured from pre- and post-operative CT images from T5 to T12. The aorta was found to shift antero-medially in the anterior instrumentation group but not in the posterior spinal instrumentation group. It is likely that the disc removal, soft tissue release and spontaneous vertebral derotation of the scoliosis could account for the antero-medial shifting of the aorta. By the shifting, the space for contralateral screw penetration was reduced.
在治疗胸椎侧弯时，与胸椎椎弓根螺钉或椎弓根螺钉器械相关的主动脉撞击风险一直是一个重要问题。为了更系统地了解这一现象，对右胸青少年特发性脊柱侧弯（AIS）患者在前后路脊柱器械置入术后，主动脉相对于胸椎的相对位置进行了详细的定量分析；本研究招募了34例行前路（n = 14）或后路（n = 20）脊柱器械置入术的患者。从术前和术后T5至T12的CT图像测量胸主动脉的相对位置、椎体旋转、顶椎平移和胸椎后凸。结果发现，前路器械置入组主动脉向前内侧移位，而后路脊柱器械置入组则无此现象。很可能是椎间盘切除、软组织松解和脊柱侧弯的自发椎体去旋转导致了主动脉向前内侧移位。通过这种移位，对侧螺钉置入的空间减小。
