累及枢椎的双开门椎管扩大成形术开槽角度的测量及意义  

The measurement and clinical significance of slotting angle in double door laminoplasty involving axis

作　　者：宋显吉 朱灏宇[2] 陈晶[1] 尹若峰[1] 武云涛[1] 孟春阳[1] 孙嘉阳[1] 黄飞[1] 朱庆三[1] 

机构地区：[1]吉林大学中日联谊医院骨科, 长春130033 [2]吉林大学中日联谊医院放射科,长春130033

出　　处：《中华骨科杂志》2016年第10期611-617,共7页Chinese Journal of Orthopaedics

摘　　要：目的 测量CT扫描中C2～7各节段椎板开槽角的相关参数,并探讨其临床意义.方法 随机选取2015年4月至2015年8月门诊正常颈椎CT检查数据资料,男87例,女63例;年龄27～62岁,平均42.35岁.应用CT三维重建软件测量C2～7各节段的理想开槽角和最小安全开槽角,在冠状面各节段椎板正中层面,定位椎板上缘与棘突交界处内外侧骨皮质连线的中点,以及椎板下缘与下关节面交界处连线的中点,穿过两中点的直线为椎板中轴线.开槽点（A点）选择在关节面与椎板交界的外侧骨皮质处,在开槽点垂直于椎板中轴线开槽,槽沟延长线为理想开槽角度线（X线）;X线与正中矢状线（Y线）夹角为理想开槽角（α角）.在各节段椎弓根最厚层面,开槽点处做椎管最外侧缘切线（Z线）,与Y线的夹角为最小安全开槽角（β角）.测量C2-7各节段双侧理想开槽角和最小安全开槽角,测量角度精确至0.01°.根据颈椎不同节段、不同侧别和不同性别进行分组,对测得数据进行统计学分析.结果 C2～7各节段α角分别为42.37°±2.53°、37.45°±3.36°、37.20°±3.59°、37.99°±2.99°、37.78°±3.59°、40.16°±2.41°;β角分别为35.50°±1.21°、14.83°±2.72°、15.23°±2.94°、15.18°±2.96°、14.93°±2.29°、20.16°±2.74°.C2与C3-7各组间比较差异有统计学意义,C7与C3～6各组间比较差异具有统计学意义.不同侧别间α、β角差异均无统计学意义.男性α角均大于女性,差异有统计学意义;β角男性C7为20.68°±2.67°,女性为18.67°±2.48°,组间比较有统计学意义义.结论 颈椎双开门椎管扩大成形术需减压C2节段时,其开槽角应较C3～7增大;术前应用螺旋CT扫描测量需减压节段开槽角,制定个体化的手术方案,降低手术风险.Objective To provide the theoretical basis for slotting angle in double-door expansive laminoplasty of cervical spine and investigate the clinical significance by CT and measuring the associated parameters of laminar slotting angle on each segment of C2-7.Methods 87 male and 63 female cases of normal cervical-spine CT scanning result,aged from 27-62 with an average age of 42.35,were randomly selected during April 2015 to August 2015.Measured the ideal slotting angle and mini safety slotting angle of each segment of C2-7 by CT three-dimensional restruction software,on the central layer of laminar on cross section,a point from both lateral and medial cortex were selected respectively that are located at the junction of superior border of laminar and spinous process,and midpoint was selected from the connecting line of the 2 points.Another midpoint was selected in the same way from the junction of inferior border of laminar and zygopophysis.The connecting line by threading the 2 midpoints was the axis of laminar.Slotting point A was selected from the lateral cortex that is located at the junction of inferior zygopophysis and laminar,then slot at the axis which was perpendicular to laminar.The extension line of the groove was the ideal slotting angle line （X）,and the angle between line X and median sagittal line （Y） was ideal slotting angle （α）.On the thickest vertebral pedicle of each segment,made a tangent line （Z） of the most lateral border of canalis spinalis with the slotting point,then the angle （β） between line Z and Y was the mini safe slotting angle.Measured the ideal slotting angle α and the mini safe slotting angle β on bilateral of each segment of C2-7 accurated to 0.01°.Then group based on difference segment,lateral and gender to analyze the data measured.Results α on each segment of C2-7 were 42.37°±2.53°,37.45°±3.36°,37.20°±3.59°,37.99°±2.99°,37.78°±3.59°,40.16°±2.41°,and β were 35.50°±1.21°,14.83°±2.72°,15.23°±2.94°,15.18°±2.96°,14.93°±2.29°

关 键 词：颈椎病 枢椎 体层摄影术 

分 类 号：R687.3[医药卫生—骨科学]