WU Tao,SUN Xu,ZHU Ze-zhang,et al.The radiological features and clinical relevance of children with scoliosis secondary to Chiari malformation Type I.[J].Journal of Clinical Pediatric Surgery,2010,9(04):0.
儿童Chiari畸形伴脊柱侧凸的影像学特点与临床意义
- Title:
- The radiological features and clinical relevance of children with scoliosis secondary to Chiari malformation Type I.
- 关键词:
- Arnold-chiari畸形; 脊柱侧凸/先天性; 磁共振成像; 儿童
- Keywords:
- Arnold-chiari Malformation; Scolisis/CN; Magnetic; Resonance Imaging; Child
- 摘要:
- 目的 研究Chiari畸形伴脊柱侧凸患儿的临床及影像学特征，探讨其临床意义。 方法 研究对象为2001年7月至2008年12月本院脊柱外科年龄10岁以下的Chiari畸形伴脊柱侧凸患儿。观察临床及影像学资料，测量胸椎后凸、腰椎前凸、MRI扫描上小脑扁桃体下坠程度、空洞的形态和长度以及空洞与脊髓的最大比值( S / C 最大比值) , 对以上测量指标进行比较分析。 结果 共40例患儿入选，男23例（23 / 40，57.5%）,女17例（17 / 40，42.5%），其中累及胸弯37例,包括左胸弯9例，占22.5%（9 / 40）。典型侧凸模式中不典型特征发生率为72.7%（16 / 21）。胸椎后凸角平均为25.4°，胸椎正常后凸与过度后凸24例（24 / 40，60%）；腰椎前凸角平均53.1°，MRI扫描发现其中36例（36 / 40，90%）伴有脊髓空洞。 结论 儿童Chiari畸形以胸弯累及多见，不典型弯型及典型弯型中不典型特征较多见，胸椎后凸角较大，对于具有上述特征的低龄患儿，建议行MRI扫描。
- Abstract:
- Objective To analyze the clinical and imaging features of scoliosis secondary to Type I Chiari malformation in children, and to discuss their clinical significance. Methods We retrospectively reviewed the records of children (age < 10 years old) diagnosed as scoliosis secondary to Type I Chiari malformation from 2001 to 2008. These indexes were measured as follow: thoracic kyphotic angle, lumbar lordotic angle, degree of cerebellar tonsillar descent, configuration, length of syrinx, the maximal ratio of syrinx to cord (S / C ratio). The correlation among them were investigated. Results In this study, 40 Chiari I malformation children were included. There were 23 male and 17 female patients with average age of 7.4 years (range: 4 ~ 10 years). In these patients, there were 37 (92.5%) children with thoracic curve, 2 children with a thoracolumbar curve and 1(2.5%) child with a lumbar curve. The overall frequency of atypical curve patterns was 47.5% (19 / 40) in our series. Left- sided thoracic curve patterns occurred in 22.5% patients(9 / 40). Sixteen of twenty one（72.7%）patients with typical curve patterns had atypical features in this group.The average thoracic kyphotic angle was 25.4°. 60% of patients had a normal to hyperkyphotic thoracic spine. The average lumbar lordotic angle was 53.1°.36(90%) patients also had a syrinx. Conclusions Thoracic cuvre, atypical curve patterns, atypical features in typical cuvre patterns and a normal to hyperkyphotic thoracic spine are usually found in children with scoliosis secondary to Type I Chiari malformation.We suggest it is necessary for scoliotic children with features above to make a MRI scan.
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备注/Memo
南京大学医学院附属鼓楼医院脊柱外科（210093），通讯作者：邱勇，E-mail: scoliosis2002@sina.com.cn，本研究为江苏省自然科学基金创新学者攀登项目（项目号：BK2009001）