强直性脊柱炎继发胸腰椎/腰椎后凸患者主动脉相对于脊柱的位置。
Position of the aorta relative to the spine in patients with thoracolumbar/lumbar kyphosis secondary to ankylosing spondylitis.
机构信息
From the Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
出版信息
Spine (Phila Pa 1976). 2013 Sep 15;38(20):E1235-41. doi: 10.1097/BRS.0b013e31829ef890.
STUDY DESIGN
A computed tomographic study.
OBJECTIVE
To explore the anatomic relationship between the aorta and the spine in patients with thoracolumbar/lumbar kyphosis secondary to ankylosing spondylitis (AS).
SUMMARY OF BACKGROUND DATA
The lumbar spinal osteotomy has been widely adopted for the correction of thoracolumbar/lumbar kyphosis caused by AS. During this procedure, the aorta may be stretched at the osteotomized level and in proximity to the tip of the pedicle screw, both of which imply a potential risk of the aortic injury. To date, no reports have been specifically published for describing the position of the aorta relative to the spine in patients with AS with fixed thoracolumbar/lumbar kyphosis.
METHODS
Thirty-three patients with AS with thoracolumbar/lumbar kyphosis and 38 age- and sex-matched patients with a normal spine were included in this study. For each subject, the left pedicle-aorta angle and distance were measured from T9 to L3 on the computed tomographic scans. Radiographs were analyzed to measure the global kyphosis, lumbar lordosis, and to record the apex of the kyphotic curve.
RESULTS
At T9-L3 levels, patients with AS with thoracolumbar/lumbar kyphosis exhibited significantly smaller left pedicle-aorta angles (from 10.23° to -11.56°) and larger distances (from 39.0 to 55.5 mm) than those with a normal spine. With increased global kyphosis, the aorta shifted more laterally to the right at periapical levels (L1 and L2, P < 0.05). Notably, the aorta was located at the middle front of the vertebrae at T12-L1 levels and far away from the vertebrae at L2 and L3 levels.
CONCLUSION
In patients with AS with thoracolumbar/lumbar kyphosis, the aorta is positioned more anteromedially relative to the vertebral body than that in the normal subjects. The aorta is far away from the vertebral body at L2 and L3 levels, thus it could be much safer to perform osteotomy below L1.
LEVEL OF EVIDENCE
研究设计
计算机断层扫描研究。
目的
探讨强直性脊柱炎（AS）引起的胸腰椎/腰椎后凸患者主动脉与脊柱的解剖关系。
背景资料概要
腰椎截骨术已广泛应用于 AS 引起的胸腰椎/腰椎后凸的矫正。在此过程中，主动脉可能在截骨水平处和靠近椎弓根螺钉尖端处被拉伸，这两者都意味着主动脉损伤的潜在风险。迄今为止，尚无专门针对固定性胸腰椎/腰椎后凸 AS 患者主动脉相对于脊柱位置的报告。
方法
本研究纳入 33 例强直性脊柱炎伴胸腰椎/腰椎后凸患者和 38 例年龄和性别匹配的正常脊柱患者。对每位患者，在 CT 扫描上从 T9 到 L3 测量左侧椎弓根-主动脉角和距离。对 X 线片进行分析以测量整体后凸角、腰椎前凸角，并记录后凸曲度顶点。
结果
在 T9-L3 水平，胸腰椎/腰椎后凸的强直性脊柱炎患者的左侧椎弓根-主动脉角明显较小（10.23°至-11.56°），距离明显较大（39.0 至 55.5mm）。随着整体后凸角的增加，在根尖水平（L1 和 L2），主动脉向右侧更偏外侧移动（P < 0.05）。值得注意的是，在 T12-L1 水平，主动脉位于椎体的中前侧，远离 L2 和 L3 水平的椎体。
结论
在胸腰椎/腰椎后凸的强直性脊柱炎患者中，主动脉相对于椎体的位置比正常受试者更靠前内侧。在 L2 和 L3 水平，主动脉远离椎体，因此在 L1 以下进行截骨术可能更安全。
证据等级
4。
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