MORFOMETRI TIGA DIMENSI VERTEBRA TORAKAL PADA POPULASI INDONESIA

EDDY SETYO WIBOWO, Dr. Rahadyan Magetsari, Sp.OT (K)., Ph.D., FICS.

2017 | Tesis-Spesialis | SP ORTHOPAEDIK DAN TRAUMATOLOGI

Latar Belakang: Saat ini sebagian besar pedicle screw khususnya di vertebra torakal yang tersedia secara komersial dan digunakan di Indonesia dibuat berdasarkan populasi Barat. Sehingga aplikasi pedicle screw saat ini nampaknya tidak cocok karena dalam beberapa studi vertebra torakal populasi Asia memiliki ukuran yang lebih kecil. Sehingga pedicle screw torakal yang dibuat berdasarkan pengukuran morfologi yang akurat dan dengan perbedaan jenis kelamin diharapkan dapat memberikan keluaran yang lebih baik. Hasil penelitian ini dapat memberikan data dasar untuk merancang ukuran pedicle screw torakal yang ideal bagi penduduk Indonesia. Metode: Penelitian ini merupakan penelitian cross sectional deskriptif analitik yang dilakukan pada 100 subyek ras Mongoloid Indonesia dalam rentang usia 20- 40 tahun berdomisili di Yogyakarta, Indonesia. Rekonstruksi tomografi tiga dimensi digunakan untuk mengukur parameter. Parameter yang digunakan dalam penelitian ini adalah Anteroposterior Vertebral Body (APVB), Transverse Diameter Vertebral Body (TDVB), Vertebral Body Height (VBH), Pedicle Length (PL), Pedicle Width (PW), Transverse Pedicle Angle (TPA), Height of Lamina (HL), Transverse Length of Lamina (TLL), dan Anteroposterior Diameter of Vertebral Canal (APDC). Data yang diperoleh dianalisis secara statistik menggunakan uji Independent t-test dan korelasi Pearson. Hasil: Penelitian ini menunjukkan bahwa populasi Indonesia memiliki morfometri vertebra torakal lebih kecil dibandingkan dengan populasi Barat. Usia pria dan wanita dalam penelitian ini tidak berbeda secara signifikan dan hampir semua nilai rata-rata parameter pria lebih besar dari perempuan yaitu corpus vertebra, diameter pedicle dan kanal vertebra. Parameter APVB terbesar di T12 (35,34+-3,69 mm) dan terkecil di T4 (23,35+-2,5 mm), TDVB terpanjang di T12 (26,35+-3,9 mm) dan terpendek di T1 (14,42+-2,5 mm), VBH minimum di T1 (15,45+-1,86 mm) dan maksimum di T12 (23,33+-2,22 mm). Pedicle terpanjang di T12 (10,39+-1,89 mm) dan terpendek di T1 (7,64+-1,49 mm) sedangkan pedicle terlebar di T12 (7,94+-1,34 mm) dan tersempit di T5 (5,84+-1,17 mm), TPA terbesar di T1 (39,79+-5,84) dan terkecil di T7 (21,24+-5,75). Lamina vertebra torakal tertinggi di T11 (21,17+-2,56 mm) dan terpendek di T1 (14,84+-17,7 mm) sedangkan lamina terpanjang di T1 (18,67+-3,99 mm) dan terpendek di T12 (13,29+-3,09 mm). APDC bernilai maksimum di T8 (17.03+-2.08 mm) and nilai minimum T12 (20.96+-2.07 mm). Terdapat korelasi lemah antara tinggi badan dan berat badan dengan diameter pedicle pada semua level vertebra torakal (r < 0.3). Kesimpulan: Vertebra torakal populasi Indonesia memiliki morfometri lebih kecil dibandingkan dengan populasi Barat.

Background: Currently most of pedicle screws, especially in the thoracic vertebrae which are commercially available and used in Indonesia, are made based on Western population. Therefore, the pedicle screw application is not suitable because some studies showed that Asian population have smaller size of thoracic vertebrae. Hence, the thoracic pedicle screws which were made based on accurate measurements of morphology and gender is then expected to give a better outcome. The results of this study can provide basic data in designing ideal size of thoracic pedicle screws for Indonesian population. Methods: This study was a descriptive analytic study with cross sectional design, conducted in 100 subjects of Indonesian population, age range from 20-40 years living in Yogyakarta, Indonesia. Three-dimensional tomographic reconstruction was used to measure the parameters. The parameters in this study were: the Anteroposterior Vertebral Body (APVB), Transverse Diameter Vertebral Body (TDVB), Vertebral Body Height (VBH), pedicle length (PL), pedicle width (PW), transverse pedicle angle (TPA), Height of Lamina (HL), Transverse Length of Lamina (TLL), and anteroposterior diameter of Vertebral Canal (APDC). The data obtained were analyzed statistically using Independent T-Test and Pearson correlation. Results: This study showed that Indonesian population have smaller thoracic vertebral morphometry compared to Western population. There were no significant differences between age groups. The mean of vertebral body dimensions, pedicle diameter and vertebral canal were larger in male than female. The anteroposterior diameter was largest at T12 (35.34 +- 3.69 mm) and smallest at T4 (23.35 +- 2.5 mm), transverse diameter was longest at T12 (26.35 +- 3.9 mm) and smallest at T1 (14,42 +- 2.5 mm), body height was shortest at T1 (15.45 +- 1.86 mm) and highest at the T12 (23.33 +- 2.22 mm). The pedicle was longest at T12 (10.39 +- 1.89 mm) and shortest at T1 (7.64 +- 1.49 mm) while the pedicle diameter was widest at T12 (7.94 +- 1.34 mm) and narrowest at T5 (5, 84 +- 1.17 mm), the TPA was largest at T1 (39.79 +- 5.84) and smallest at T7 (21.24 +- 5.75). The Lamina was highest at T11 (21.17 +- 2.56 mm) and shortest at T1 (14.84 +- 17.7 mm), while the longest lamina was at T1 (18.67 +- 3.99 mm) and shortest at T12 ( 13.29 +- 3.09 mm). The anteroposterior vertebral canal had maximum value at T8 (17.03+-2.08 mm) and the minimum value was at T12 (20.96+-2.07 mm). There was a weak correlation between the body height and body weight with the pedicle diameter at all levels of thoracic vertebrae (r <0.3). Conclusion: Indonesian thoracic vertebrae have smaller build compared with Western counterpart.

Kata Kunci : Morfometri, CT Scan tiga dimensi, vertebra torakal, pedicle screw, populasi Indonesia, Morphometry, three dimensional CT Scan, thoracic vertebrae, pedicle screw, Indonesian population