基于 CT 的腰椎矢状位和冠状位终板形态分析：与终板深度相关因素的多元分析。
CT-based analysis of sagittal and coronal lumbar endplate morphology: multivariate analysis of factors associated with endplate depth.
机构信息
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan.
出版信息
Eur Spine J. 2023 May;32(5):1546-1552. doi: 10.1007/s00586-023-07642-3. Epub 2023 Mar 15.
PURPOSE
Lumbar endplate morphology varies in individuals; thus, custom-made implants are sometimes more useful than standardized implants. This study aimed to analyze endplate morphology and factors associated with endplate depth using computed tomography (CT) in a non-symptomatic population.
METHODS
In total, 118 lumbar CT images of non-symptomatic individuals without severe degenerative change (aged 20-79 years) were retrospectively reviewed. The following radiographic parameters were measured in each lumbar vertebral segment (T12-S1) to determine endplate depth: superior/inferior endplate depth in the midsagittal and midcoronal planes, disk angle, and height. The relationship between baseline demographics (age, sex, body mass index [BMI], Hounsfield unit of the L1 vertebral body, and pelvic incidence [PI]) and endplate depth was analyzed.
RESULTS
Toward the caudal level, the superior endplate depth increased, sagittal inferior depth decreased, and coronal inferior depth increased. Multivariate analysis revealed that endplate depth was significantly associated with age (p < 0.001), while inferior endplate depth was associated with PI (p = 0.01). Superior endplate depth was associated with female sex (sagittal: p = 0.005, coronal: p = 0.002). Endplate depth, except for the inferior coronal region, was associated with low BMI (sagittal superior: p = 0.005; coronal superior and sagittal inferior: p = 0.02).
CONCLUSION
Endplate depths tend to be larger toward the caudal level, particularly in the superior endplate. Surgeons should thoroughly evaluate the preoperative CT image because various endplate morphologies require attention to cage shape when performing lumbar interbody fusion, especially in patients who are older, are female, have low BMI, and have large PI.
LEVEL OF EVIDENCE I
Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
目的
腰椎终板形态在个体间存在差异；因此，定制植入物有时比标准化植入物更有用。本研究旨在通过计算机断层扫描（CT）分析非症状人群的终板形态和与终板深度相关的因素。
方法
回顾性分析了 118 例无严重退行性改变的非症状个体（年龄 20-79 岁）的腰椎 CT 图像。在每个腰椎节段（T12-S1）的正中矢状面和正中冠状面测量以下影像学参数以确定终板深度：上/下终板在正中矢状面和正中冠状面的深度、椎间盘角度和高度。分析基线人口统计学特征（年龄、性别、体重指数[BMI]、L1 椎体的 Hounsfield 单位和骨盆入射角[PI]）与终板深度的关系。
结果
向尾端方向，上终板深度增加，矢状下终板深度减小，冠状下终板深度增加。多变量分析显示，终板深度与年龄显著相关（p<0.001），而下终板深度与 PI 相关（p=0.01）。上终板深度与女性性别相关（矢状面：p=0.005，冠状面：p=0.002）。除了下冠状区域外，终板深度与低 BMI 相关（矢状上终板：p=0.005；冠状上终板和矢状下终板：p=0.02）。
结论
终板深度倾向于向尾端方向增大，特别是在上终板。外科医生在进行腰椎椎间融合时，应仔细评估术前 CT 图像，因为各种终板形态需要注意椎间融合器的形状，尤其是在年龄较大、女性、BMI 较低和 PI 较大的患者中。
证据等级 I：诊断：具有一致应用参考标准和盲法的个体横断面研究。
Zotero 插件