颈椎椎弓根与受压脊髓间的空隙研究  

Spatial relation study between the compressed spinal cord and the cervical pedicle

作　　者：祝乃强 王欢[2] 金国鑫[2] 张磊[2] 

机构地区：[1]承德医学院附属医院脊柱外二科 [2]中国医科大学附属盛京医院脊柱外科,沈阳110004

出　　处：《中华外科杂志》2015年第6期419-423,共5页Chinese Journal of Surgery

摘　　要：目的 探讨颈椎椎弓根与受压脊髓间的关系.方法 选取2011年12月至2013年1月中国医科大学附属盛京医院收治的105例脊髓型颈椎病患者的临床资料,男性53例,女性52例,年龄29 ～ 80岁,平均53.4岁.平行于C4～C7椎体双侧椎弓根轴的横切面做MRI平扫检查,图片发送至工作站.应用PACS系统测量与椎弓根螺钉安全性有关的解剖参数,包括左侧和右侧颈椎椎弓根内侧缘到脊髓的最短距离（LH和RH）、左侧和右侧颈椎椎弓根中轴线与假定螺钉刚触及脊髓的最小夹角（LSA和RSA）.依据每个节段是否存在压迫,分为受压迫组与无压迫组.选取12例同时行颈椎MRI和颈椎三维CT检查的患者资料,对两侧椎弓根内缘间直线距离,即椎管宽度（D）进行MRI测量和CT测量.两组间数据比较采用独立样本的t检验,同一指标的两种方法测量结果的比较采用配对t检验.结果 测量结果显示,C4的LH为（7.2±1.3）mm,RH为（6.7±1.4）mm,平均（6.9±1.4） mm;C5的LH为（7.7 ± 1.4）mm,RH为（6.7±1.4）mm,平均（7.2±1.5） mm;C6的LH为（8.2±1.5）mm,RH为（6.9±1.3）mm,平均（7.5±1.5）mm;C7的LH为（8.2±1.4）mm,RH为（7.3±2.1）mm,平均（7.7±1.8） mm;C4的LSA为34.4°±4.2°,RSA为34.4°±5.2°,平均34.4°±4.7°;C5的LSA为35.9°±5.2°,RSA为34.6°±5.4°,平均35.3°±5.3°;C6的LSA为37.4±4.8°,RSA为34.8°±4.8°,平均36.1°±5.0°,C7的LSA为39.2°±5.8°,RSA为37.1°±5.2°,平均38.1°±5.6°.存在脊髓压迫和无压迫的节段间的LH、RH、LSA、RSA、D比较,差异均无统计学意义（P值均＞0.05）.结论 受压颈脊髓与椎弓根内侧壁之间存在安全空间,且存在个体变异,术前应根据颈椎MRI检查结果明确安全范围,强调个体化进钉,避免损伤脊髓.Objective To study the relationship between cervical pedicle and compressed spinal cord.Methods One hundred and five patients （53 male,52 female,age from 29 to 80 years） with cervical spondylotic myelopathy who needed surgery were included from December 2011 to January 2013 in Shengjing Hospital.Plain MRI scan was used for cross section of C4-C7 vertebral bodies parallel to the axis of bilateral pedicle,and the images were sent to the workstation.PACS system was applied to measure the anatomical parameters related to the security of cervical pedicle screw,including the shortest distance from medial left/ right cervical pedicle to the cervical spinal cord （LH/RH）,and the smallest angle between the longitudinal axis of left/right cervical pedicle and the screw which was assumed to just touch the cervical spinal cord （LSA/RSA）.All these data in each segment were classified according to compression or not：with compression and without compression.Twelve cases were selected and measured by MRI and 3D cervical CT for spinal canal width D,namely the straight-line distance between the medial margins of cervical pedicle.And the results of two methods were compared to see whether there were statistical differences.Results At C4,LH was （7.2 ± 1.3） mm,RH was （6.7 ± 1.4） mm,and the average was （6.9 ± 1.4） mm;at C5,LH was （7.7 ± 1.4） mm,RH was （6.7 ± 1.4） mm,and the average was （7.2 ± 1.5） mm;at C6,LH was （8.2 ± 1.5） mm,RH was （6.9 ± 1.3） mm,and the average was （7.5 ± 1.5） mm;at C7,LH was （8.2 ± 1.4） mm,RH was （7.3 ± 2.1） mm,and the average was （7.7 ± 1.8） mm.At C4,LSA was 34.4° ± 4.2°,RSA was 34.4° ± 5.2° and the average angle was 34.4° ± 4.7°;at C5,LSA was 35.9° ± 5.2°,RSA was 34.6° ±5.4° and the average angle was 35.3° ±5.3°;at C6,LSA was 37.4° ±4.8°,RSA was 34.8° ±4.8° and the average angle was 36.1° ± 5.0°;at C7,LSA was 39.2° ± 5.8°,RSA was 37.1° ± 5.2° and the average angle was 38.1 ° ± 5.6°;There were no statisti

关 键 词：颈椎 椎弓根 颈脊髓 内固定 解剖学 

分 类 号：R687.3[医药卫生—骨科学]