骶椎椎板发育及骶椎隐性脊柱裂发生率年龄变化规律的多层螺旋CT影像研究

doi:10.3760/cma.j.cn101202-20220608-00178

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摘要目的探讨基于多层螺旋CT（MSCT）影像的国人骶椎椎板发育情况,以及骶椎隐性脊椎裂（SBO）发生率随年龄变化的规律。方法横断面调查分析2020年1月—2021年11月广州市妇女儿童医疗中心和广州市干部健康管理中心共1 197例非骶尾椎疾病受检者的下腹部MSCT影像资料,其中男692例、女505例,年龄2 d~48岁。1 197例按年龄分为新生儿组（≤1个月,23例）、婴儿组（>1个月~1岁,83例）、幼儿组（>1~3岁,202例）、学龄前组（>3~6岁,345例）、学龄组（>6~12岁,457例）、青春期组（>12~18岁,67例）和成人组（>18~48岁,20例）7组。患者均行MSCT容积扫描,采用标准算法对骶尾椎行容积再现（VR）成像。观察指标：（1）1 197例受检者中选择研究后期纳入的636例观察各年龄段受检者S₁~S₅骶椎椎板、棘突发育情况。（2）在1 197例受检者中对比各年龄段组受检者SBO发生情况及S₁~S₅不同椎体缺裂发生情况。结果（1）新生儿期69.6%（16/23）S₁~S₄椎板骨化中心已分化发育为椎弓根和椎板,并在婴儿期完成;S₅椎板的骨化始于婴儿期,99.0%（208/210）在学龄前期完成,但从学龄期至青春期1.5%（4/265）的S₅椎板骨化中心未进一步分化发育为椎弓根和椎板并最终闭合。S₁~S₄椎板、棘突的融合始于婴儿期,并随着年龄的增长而逐渐增加;学龄前期S₁~S₄椎板、棘突的全融合率分别为3.3%（7/210）、1.0%（2/210）,成人后全融合率分别为95.0%（19/20）和85.0%（17/20）。（2）7组骶椎SBO总体发生率随年龄的增长而逐渐下降,差异有统计学意义（χ²=630.95,P<0.001）;从新生儿组至学龄期组,骶椎SBO发生率的组间两两比较差异均无统计学意义（P值均>0.05）;青春期组、成人组与其余各组间比较,以及青春期组与成人组,SBO发生率差异均有统计学意义（P值均<0.05）。（3）S₁~S₅的缺裂发生率由高至低依次为S₅（97.7%,1 169/1 197）、S₄（85.9%,1 028/1 197）、S₁（65.7%,786/1 197）、S₃（63.7%,762/1 197）、S₂（47.3%,566/1 197）,骶椎缺裂发生率差异有统计学意义（χ²=933.82,P<0.001）。结论 S₁~S₄骶椎椎板的骨化始于新生儿期,学龄前期完成椎弓根和椎板的分化;椎板的闭合始于婴儿期,跨越青春期,SBO发生率随年龄的增长而降低。S₅骶椎椎板的发育无明显的年龄规律。

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	王桂枝
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关键词 ：隐性脊柱裂, 骶椎, 多层螺旋CT, 容积再现, 发育规律

Abstract：Objective This study aims to investigate the age changes of sacral lamina development and closure and its spina bifida occulta (SBO) of the sacral verebra in healthy Chinese based on multislice spiral CT (MSCT). Methods A total of 1 197 patients (692 males and 505 females, aged 2 days to 48 years) without sacrococcygeal diseases in Guangzhou Women and Children's Medical Center and Guangzhou Cadre Health Management Center from January 2020 to November 2021 were cross-sectional analyzed. The patients were divided into seven groups: neonatal group (≤1 month, 23 cases), infant group (>1 month-1 year, 83 cases), toddler group (>1-3 years, 202 cases), preschool group (>3-6 years, 345 cases), school-aged group (>6-12 years, 457 cases), adolescent group (>12-18 years, 67 cases), and adult group (>18-48 years, 20 cases). All patients were volume scanned by MSCT, and volume rendering (VR) image was used to observe the lamina fracture, closure, and ossification development of the sacral vertebral plate. Observation indicators:(1)Among 1 197 subjects, 636 subjects included in the later period of the study were selected to observe the development of S₁-S₅ sacral lamina and spinous process in different age groups.(2)Among 1 197 subjects, the incidence of SBO and S₁-S₅ vertebral cleft in different age groups were compared. Results (1) In the neonatal period, 69.6% (16/23) ossification centers of the laminae in S₁-S₄ were differentiated and developed into pedicles and laminae, which were completed in infancy. The ossification of S₅ lamina began in infancy 99.0% (208/210) completed in early school years. However, from school age to adolescence, 1.5% (4/265) ossification centers of S₅ lamina did not further differentiate into pedicles and lamina and finally closed. The fusion of S₁-S₄ lamina and spinous process began in infancy and gradually increased with age. The total fusion rates of S₁-S₄ lamina and spinous process were 3.3% (7/210) and 1.0% (2/210) in pre-school age and 95.0% (19/20) and 85.0% (17/20) in adult age, respectively. (2) The overall incidence of SBO in the sacral vertebrae of the seven groups decreased gradually with increasing age, and the difference was statistically significant (χ²=630.95, P<0.001). No significant difference in the incidence of SBO in sacral vertebrae was found from neonate to school-aged groups (all P values >0.05). The incidence of SBO significantly differed among adolescent, adult, and other groups as well as between adolescent and adult groups (all P values <0.05). (3) The incidence rates of SBO in S₁-S₅ from high to low were S₅ (97.7%,1 169/1 197), S₄ (85.9%, 1 028/1 197), S₁ (65.7%, 786/1 197), S₃ (63.7%, 762/1 197), S₂ (47.3%, 566/1 197), and the difference was statistically significant (χ²=933.82, P<0.001). Conclusion The ossification of lamina in S₁-S₄ starts in the neonatal period, and the differentiation of pedicle and lamina is completed in the preschool period. The closure of the lamina begins from infancy to adolescence, and the incidence of SBO decreases significantly with age. There is no obvious age pattern in the development of sacral lamina in S₅.

Key words： Spina bifida occulta Sacral vertebra Multislice spiral computed tomography Volume rendering Growth rule

收稿日期: 2022-06-08

通讯作者: 李建明, Email：13538807616@139.com

引用本文:

王桂枝, 李建明. 骶椎椎板发育及骶椎隐性脊柱裂发生率年龄变化规律的多层螺旋CT影像研究[J]. 中华解剖与临床杂志, 2023, 28(5): 295-300.
Wang Guizhi, Li Jianming. Multislice spiral CT imagine study on the development rule of sacral lamina and the age change rule of the incidence of spina bifida occulta of the sacral vertebra in Chinese. Chinese Journal of Anatomy and Clinics, 2023, 28(5): 295-300.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20220608-00178 或 http://www.cjac.com.cn/CN/Y2023/V28/I5/295

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