寰椎后弓-横突髓腔钉道的影像解剖学参数及其临床意义  

Anatomical parameter on image of intramedullary trajectory of posterior arch-transverse process of atlas and its clinical significance

作　　者：阎崇楠[1] 王欢[1] 李雷[1] 崔少千[1] 祁英[2] 徐昕[3] 段景柱[1] 金国鑫[1] 张磊[1] 陈健华[1] 李成[1] YAN Chong-nan;WANG Huan;LI Lei;CUI Shao-qian;QI Ying;XU Xin;DUAN Jing-zhu;JIN Guo-xin;ZHANG Lei;CHEN Jian-hua;LI Cheng(Department of Spinal Surgery,Shengjing Hospital,China Medical University,Shenyang 110004,Liaoning,China;Department of Radiology,Shengjing Hospital,China Medical University,Shenyang 110004,Liaoning,China;Department of Clinical Epidemiology,Shengjing Hospital,China Medical University,Shenyang 110004,Liaoning,China)

机构地区：[1]中国医科大学附属盛京医院脊柱外科,辽宁110004 [2]中国医科大学附属盛京医院影像科,辽宁110004 [3]中国医科大学附属盛京医院临床流行病学教研室,辽宁110004

出　　处：《脊柱外科杂志》2018年第2期92-97,共6页Journal of Spinal Surgery

摘　　要：目的通过影像归档和通信系统(PACS)测量成人寰椎后弓-横突髓腔钉道的解剖学参数,并结合临床病例探讨其临床意义。方法选择2016年1月—2017年6月本院PACS中18~70岁患者的颈椎三维CT数据,共200例,男女各100例,年龄(54.95±11.93)岁。选取寰椎后弓-横突髓腔最长轴切面为测量截面,利用PACS测量软件手工测量该截面入钉点与后结节距离、入钉角度与矢状面夹角、入钉角度与横截面夹角、钉道长度、椎动脉沟狭窄处髓腔高度和入钉点髓腔最大高度等解剖学参数,所得数据纳入统计学分析。结合临床病例探讨其可行性。结果入钉点与后结节距离为(7.45±1.75)mm,入钉角度与矢状面夹角为54.26°±6.06°,入钉角度与横截面夹角为9.15°±3.40°、钉道长度为(18.55±3.75)mm,椎动脉沟狭窄处髓腔高度为(2.09±0.81)mm,入钉点髓腔最大高度为(4.93±0.37)mm。男性寰椎后弓-横突髓腔钉道在入钉点与后结节距离、钉道长度、椎动脉沟狭窄处髓腔高度和入钉点髓腔最大高度均大于女性,差异有统计学意义(P<0.05),不同性别之间入钉角度与矢状面夹角和入钉角度与横截面夹角差异无统计学意义(P>0.05)。经有限病例初步证实该置钉方式具有可行性。结论寰椎后弓-横突髓腔的解剖学特点能够满足置钉要求,在常规寰椎椎弓根螺钉进钉点狭小无法置钉或钉道破裂置钉失败时,可以当做替代置钉钉道方案。Objective To measure the anatomical parameters of intramedullary trajectory of posterior arch-transverse process of the atlas in adults through picture archiving and communication system(PACS),and discuss its clinical significance by combining with clinical cases.Methods The data were transmitted onto the PACS,including 200 adults who received three-dimensional CT scan of the cervical spine.There were 100 cases each in male and female groups,and the average age was(54.95±11.93)years.The longest axis of the medullary cavity of posterior arch-transverse process of the atlas was chosen as the measurement section.The relative parameters including distance between the entry point and posterior tubercle,angle between the trajectory and sagittal section,angle between the trajectory and transverse section,length of the trajectory,height of minimal medullary cavity of the vertebral artery groove and height of maximal medullary cavity of the entry point were measured manually.Statistical analysis was then performed to obtain the general mean and standard deviation,and to compare between the male and female subjects.The feasibility of the method was explored through clinical cases.Results The distance between the entry point and posterior tubercle was(7.45±1.75)mm,angle between the trajectory and sagittal section 54.26°±6.06°,angle between the trajectory and transverse section 9.15°±3.40°,length of the trajectory(18.55±3.75)mm,height of minimal medullary cavity of the vertebral artery groove(2.09±0.81)mm and height of maximal medullary cavity of the entry point(4.93±0.37)mm.The distance between the entry point and posterior tubercle,length of the trajectory,height of minimal medullary cavity of the vertebral artery groove and height of maximal medullary cavity of the entry point of the males were significantly higher than those of the females,and the differences were statistically significant(P<0.05).There was no difference between the males and females in angle between the trajectory and sagittal section or angl

关 键 词：寰椎 解剖学 放射摄影术 

分 类 号：R681.531[医药卫生—骨科学]