下颈椎椎弓根置钉偏差的CT多平面及三维重建研究  

Study on Multiplanar and Three-dimensional CT Reconstructive Images of Subaxial Cervical Vertebrae for Transpedicular Screw Fixation

作　　者：侯黎升[1] 阮狄克[1] 何勍[1] 叶晓健[2] 贾连顺[2] 徐云科[3] 徐成[1] 崔洪鹏[1] 姜庆军[4] 

机构地区：[1]海军总医院骨科,北京100037 [2]上海第二军医大学长征医院骨科 [3]海军总医院放疗科 [4]济南军区总医院放射科

出　　处：《解剖与临床》2008年第1期3-7,共5页Anatomy and Clinics

基　　金：海军总医院攻关课题

摘　　要：目的:通过颈椎CT多平面和三维重建资料的观测,了解下颈椎椎弓根螺钉置入的可行性,评价置钉偏差后的风险。方法:对8例非颈椎椎弓根病患者进行颈椎CT多平面和三维重建观察,对C3椎弓根内外径、内倾角及四壁皮质厚度行数据测量。结果:组成横突孔的四界不在同一高度同时出现,形成内界的椎弓根明显高于外界。CT示部分椎弓根外壁及横突孔前壁存在滋养血管孔(10%和8.8%)。C3椎弓根内壁厚(1.8±0.3)mm,,外壁厚(0.9±0.3)mm,上壁厚(1.3±0.4)mm,下壁厚(1.4±0.4)mm,外径(5.3±0.6)mm,内径(2.6±0.7)mm,内倾角(45.9±4.4)°。结论:下颈椎椎弓根内径小,外壁薄,椎弓根螺钉置入时,外壁容易穿破;椎弓根主体高于横突孔外界,椎弓根螺钉穿破外壁时,椎动脉可向外逃逸,减少损伤。Objective： To clarify the feasibility and potential risk of transpodicular screw fixation of subaxial cervical vertebrae based on muhiplanar and three - dimensional CT reconstructive images. Methods： Qualitative observation and description of circumferential bony structures of transverse foramen（TF） and their spatial arrangement relative to subaxial cervical transpedicular screw fixation was done carefully on their original axial CT images, muhiplanar and three - dimensional reconstructive CT ones from 8 subaxial cervical pedicle - healthy adults. Pedicle - related dimensions （thickness of medial, lateral, superior and inferior cortex, outer and inner diameter, and medial inclination of podicle） were measured on eight C3 original axial CT images and six multiplanar reconstructive CT ones. Results： Observation on original axial CT images, multiplanar and three - dimensional reconstructive ones of subaxial cervical vertebrae indicated the main body of the cervical pedicle （ medial border of TF） located higher than the lateral border of TF, pedicle connects with the upper portion of the vertebral body anteriorly while projects posteriorly to the base of the superior articularis. The lateral cortex of pedicle was the thinnest compared with its superior, inferior or medial cortices. Entrances of nourishing vessel were detected existed on pedicle＇s lateral cortex （ 10% ） or anterior cortex of posterior tubercle （8.8%） from original axial CT images. The thickness of medial, lateral, superior and inferior cortex were 1.8 ±0.3mm,0.9 ± 0.3 mm, 1.3± 0.4mm, and 1.4± 0.4mm respectively, while the outer and inner diameters of pedicle were5. 3± 0.6mm and 2.6 ±0.7mm, respectively, the medial inclination of the pedicle was 45.9 ±4.40. Statistical analysis confirmed medial cortex was thicker than superior or inferior cortex, while lateral cortex is thinner than superior or inferior cortex of cervical pedicle. Condnsions：The lateral cortex was more likely to be perforated for its thinner thickne

关 键 词：下颈椎 椎弓根螺钉 CT多平面重建 三维重建 滋养血管 椎动脉 

分 类 号：R687.3[医药卫生—骨科学]