利用CT测量指导退变颈椎长节段前路钢板的设计构思  

Design of an anterior plate for multilevel degenerative cervical spondylosis based on CT measurement

作　　者：张帆[1] 侯藏龙[1] 唐沂星[1] 李凤宁[1] 宋庆鑫[1] 王毅峰[1] 沈洪兴[1] 

机构地区：[1]上海长海医院脊柱外科,上海200433

出　　处：《中国骨与关节损伤杂志》2015年第9期897-901,共5页Chinese Journal of Bone and Joint Injury

基　　金：上海市新百人计划项目(XBR2013099)

摘　　要：目的 利用CT测量退变颈椎矢状径、横径、椎体高度及螺钉间距,探讨适用于长节段退变颈椎的钢板要求及设计思路。方法 随机选取本院自2013-06—2014-06诊治的颈椎病80例,所有患者术前常规进行CT平扫和三维重建,在PACS系统上测量颈椎CT参数。横断面上,分别测量矢状径、横径,在椎间隙水平测量钩椎关节内径;矢状面上,测量颈椎各椎体和椎间隙高度,测量预期螺钉间距和实际螺钉间距并进行统计比较。结果 颈椎各椎体的矢状径从上缘到正中到下缘逐渐增加,C2-7各椎体相同水平矢状径逐渐增加,C2下缘水平为（16.75±1.16）mm,C6下缘达到（19.28±2.08）mm。颈椎各椎体的横径从上缘到正中变化不大,从中分到下缘逐渐增加,从C2-7各椎体相同水平横径逐渐增加,C7水平横径为（31.01±2.28）mm。钩椎关节内径从C3-7逐渐增加,C3水平为（16.07±1.07）mm,C4水平为（17.42±1.58）mm,C5水平为（18.44±1.37）mm,C6水平为（20.79±1.40）mm,C7水平为（23.22±2.68）mm。颈椎前缘椎间隙和椎体高度无显著的从头段向尾端递增趋势。按照现有钢板设计,头尾两侧的螺钉间距在（16.96±1.95）mm到（17.51±1.59）mm之间,均显著高于实际需要的间距（12.84±1.53）mm到（14.50±1.69）mm。结论 退变颈椎虽然存在一定的个体差异,但其横径和矢状径均向尾端逐渐递增,尤其是颈椎横径头尾两端的差异较大。现有的宽度均一、螺钉间距相等的钢板不完全适用于长节段颈椎前路手术,根据CT测量结果,可考虑设计螺钉间距不等的梯形钢板以满足长节段颈椎前路手术。Objective To measure the sagittal diameter, transverse diameter and height of vertebral body and screw spacing of degenerative cervical spine in CT imaging and design an anterior plate for multilevel degenerative cervical spondylosis.Methods A total of 80 patients who were diagnosed of cervical spondylosis from June 2013 to June 2014 were enrolled,including 40 males and 40 females. All patients accepted routine CT scan and 3D reconstruction preoperatively. Various cervical spine parameters of CT were measured in the PACS system. The sagittal diameter, transverse diameter of vertebral and disc were evaluated as well as Luschka Joint diameter in CT axial plane. The cervical vertebral body, disc height and screw spacing were evaluated in sagittal plane. Results The sagittal diameter increased gradually from superior edge to inferior edge in each vertebral body. The sagittal diameter also increased from cranial to caudal in cervical spine,（16.75 ±1.16）mm in inferior edge of C2,（19.28±2.08）mm in inferior edge of C6. The transverse diameter increased gradually from middle point to inferior edge in each vertebral body. The transverse diameter also increased from cranial to caudal in cervical spine,（31.01 ±2.28）mm in superior edge of C7. The transverse diameter of Luschka joint also increased gradually from C3 to C7,（16.07±1.07）mm in C3,（17.42±1.58）mm in C4,（18.44±1.37）mm in C5,（20.79±1.40）mm in C6,（23.22±2.68）mm in C7. There was no tendency of increasing of the height of disc and vertebral body from cranial to caudal of cervical spine. The screw spacing was（16.96±1.95）mm to（17.51±1.59）mm based on current plate, higher than（12.84±1.53）mm to（14.50±1.69）mm of true screw spacing needed in operation. Conclusion There are some individual differences among degenerative cervical vertebra. The transverse diameter and sagittal diameter increase gradually from cranial to caudal of cervical spine. Especially the difference of transverse diameter is significant between C2 a

关 键 词：颈椎退变 多节段 CT测量 钢板设计 

分 类 号：R687.3[医药卫生—骨科学]