目的 三维数字化研究0~18岁人的骶骨形态与耻骨联合位置在不同年龄段及性别间的变化规律，为制定符合未成年人骶骨发育特征的摄影体位、优化骶骨X线图像及诊断提供参考。 方法 将收集到的0~18岁全腹部CT分为0~6岁、7~12岁、13~18岁3个年龄组，导入mimics21.0，利用三维数字化图像重组技术测量骶骨倾斜角（sacral slope，SS）、骶1~2倾斜角（S1~2 T）、骶骨后凸角（sacral kyphosis，SK）、S2椎体前缘与骶4尾1倾斜线夹角（α角）、S1上终板与S2椎体前缘夹角（β角）、S4 Co1倾斜线与S1上终板夹角（θ角）、耻骨联合上缘与骶骨下缘连线和躯体长轴垂线之间的夹角（角B），比较各参数在不同性别、年龄段间的差异。 结果 骶骨解剖学参数性别间比较，角B女性大于男性（P<0.001），其余无统计学差异；年龄组间比较，0~6岁组与13~18岁组SS、SK、α、β、θ，以及7~12岁组与13~18岁组SS差异有统计学意义，其余无统计学差异。 结论 未成年人生长发育过程中骶骨形态无性别差异，女性骶骨下缘与耻骨联合上缘所成角度大于男性。随年龄增长未成年人骶骨上端倾斜程度逐渐增加，骶骨下端倾斜程度逐渐减小。为获得更加清晰的骶骨影像，需根据性别、年龄调整X线入射角度。
方源, 康志杰, 王海燕, 沙丽荣, 李筱贺, 金凤, 齐昕, 王彦超, 张云凤
. 未成年人骶骨形态与耻骨联合相对位置三维数字化测量及临床意义[J]. 中国临床解剖学杂志, 2024
, 42(2)
: 153
-158
.
DOI: 10.13418/j.issn.1001-165x.2024.2.07
Objective To provide basic reference for the formulation of photographic positions in line with the characteristics of sacral development of minors, optimization of sacral X-ray images and diagnosis of diseases by investigating the change rules of sacral morphology parameters and pubic symphysis position of minors aged 0~18 years in different age groups and genders. Methods The collected total abdominal CT scans from 0 to 18 years old were divided into 3 age groups according to age: 0 to 6 years old, 7 to 12 years old, and 13 to 18 years old. The data was imported by mimics 21.0 and 3D digital image reconstruction technology was used to analyze sacral slope (SS), sacral 1-2 inclination Angle (S1~2T), sacral kyphosis Angle (sacral kyphosis, SK), S2 anterior margin and Sacro4 caudal-1 tilt line Angle (α Angle), S1 upper endplate and S2 anterior margin Angle (β Angle), S4Co1 oblique line and S1 upper endplate Angle (θ Angle), the line between the pubic union and the lower margin of the sacrum and the Angle between the vertical line of the long axis of the body (Angle B). The parameters in different genders and ages were compared. Results Angle B of sacral morphometry was greater in females than in males, and there was no significant difference in other parameters. There were significant differences in SS, SK, α, β, θ between 0~6 years old and 13~18 years old, and between 7~12 years old and 13~18 years old, but no significant differences in other age groups. Conclusions There was no gender difference in sacral morphology during the growth and development of juveniles. The Angle between the lower sacral margin and the superior symphysis of pubis is greater in juvenile females than in males. With the increasing of age, the degree of sacral tilt increased gradually, the degree of lower sacral tilt decreased. In order to obtain a clearer image of the sacrum the X-ray incidence Angle should be adjusted according to gender, age, and examination purpose.
[1] Schicho A, Schmidt S A, Seeber K, et al. Pelvic X-ray misses out on detecting sacral fractures in the elderly-importance of CT imaging in blunt pelvic trauma[J]. Injury, 2016, 47(3): 707-710. DOI: 10.1016/j.injury.2016.01.027
[2] 张浩, 李刚, 鲁艺. 骶尾骨正常变异的影像学分析[J]. 中国矫形外科杂志, 2004, 12(18): 39-40. DOI: 10.3969/j.issn.1005-8478.2004.18.011.
[3] 王诗鸣, 肖智博, 陆云峰, 等. CT图像和重组技术在骶椎临床影像解剖学研究中的应用[J]. 中国临床解剖学杂志, 2022, 40(4): 410-413, 417. DOI: 10.13418/j.issn.1001-165x.2022.4.07.
[4] Hresko AM, Hinchcliff EM, Deckey DG, et al. Developmental sacral morphology: MR study from infancy to skeletal maturity[J]. Eur Spine J, 2020, 29(5): 1141-1146. DOI: 10.1007/s00586-020-06350-6.
[5] 胡伟明. 儿童第一、第二骶椎形态特征及其置钉方式的影像学研究[D]. 郑州:郑州大学, 2018. CNKI: CDMD:2.1018.115902.
[6] Mahato NK. Implications of structural variations in the human sacrum: why is an anatomical classification crucial[J]. Surg Radiol Anat, 2016, 38(8): 947-954. DOI: 10.1007/s00276-016-1667-0.
[7] Vereecke E, Herregods N, Morbée L, et al. Imaging of structural abnormalities of the sacrum: the old faithful and newly emerging techniques[J]. Semin Musculoskelet Radiol, 2022, 26(4): 469-477. DOI: 10.1055/s-0042-1754342.
[8] Peng XQ, Li ZW, Zhou L, et al. Giant posterior pararenal schwannoma: A case report and review of literature[J]. Mol Clin Oncol, 2018, 9(3): 325-328. DOI: 10.3892/mco.2018.1664
[9] 宋凯, 吴兵, 成俊遥, 等. 骶骨形态与脊柱骨盆矢状位参数的相关性研究[J]. 中国脊柱脊髓杂志, 2020, 30(6): 493-499. DOI: 10.3969/j.issn.1004-406X.2020.06.03.
[10] 李博, 宋凯, 吴兵, 等. 年龄、体位与性别对骶骨影像形态参数的影响[J]. 解放军医学院学报, 2022, 43(6): 675-680. DOI: 10.3969/j.issn.2095-5227.2022.06.012.
[11]刘尚清, 李良育, 蔡容, 等. 耻骨联合的应用解剖学研究[J]. 四川解剖学杂志, 2009, 17(4): 7-11. DOI: 10.3969/j.issn.1005-1457.2009.04.003.
[12] 师宁宁, 沈国权, 郭汝宝, 等. 骶骨倾斜移位与L5 S1椎间盘退变之间的相关性生物力学分析[J]. 中国骨伤, 2017, 30(3): 217-221. DOI: 10.3969/j.issn.1003-0034.2017.03.006.
[13]任志伟, 尹思, 杨益民, 等. 不同体位X线片上腰椎间孔的变化及在经皮椎间孔镜手术中的意义[J]. 中国脊柱脊髓杂志, 2018, 28(1): 33-37. DOI: 10.3969/j.issn.1004-406X.2018.01.05.
[14] Pal GP, Routal RV. Relationship between the articular surface area of a bone and the magnitude of stress passing through it[J]. Anat Rec, 1991, 230(4): 570-574. DOI: 10.1002/ar.1092300417.
[15]Marty C, Boisaubert B, Descamps H, et al. The sagittal anatomy of the sacrum among young adults, infants, and spondylolisthesis patients[J]. Eur Spine J, 2002, 11(2): 119-125. DOI: 10.1007/s00586-001-0349-7.
[16]李博, 宋凯, 吴兵, 等. 未成年人骶骨参数与脊柱-骨盆矢状位参数的相关性研究[J]. 中国脊柱脊髓杂志, 2021, 31(3): 193-199. DOI: 10.3969/j.issn.1004-406X.2021.03.01.
[17]Slipman CW, Whyte WS 2nd, Chow DW, et al. Sacroiliac joint syndrome[J]. Pain Physician, 2001, 4(2): 143-152. PMID: 16902687.
[18] 李阳, 刘燕, 孙超, 等. 基于三维重建技术的腰骶椎轴向融合术入路的相关解剖学测量[J]. 中国临床解剖学杂志, 2014, 32(3): 280-283. DOI: 10.13418/j.issn.1001-165x.2014.03.010.
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