下颌角不能准确定位颈椎节段:影像学研究  

Mandibular angle could not be regarded as a constant surgical landmark in identification of cervical spinal level:image evidence

作　　者：侯黎升[1] 白雪东[1] 李欢迎[2] 葛丰[1] 何勍[1] 阮狄克[1] 程实[1] 庄严 魏冰 刘娅[4] HOU Li-sheng;BAI Xue-dong;LI Huan-ying;GE Feng;HE Qing;RUAN Di-ke;CHENG Shi;ZHUANG Yan;WEI Bing;LIU Ya(Department of Orthopaedics,Navy General Hospital,Beijing 100048;Department of Radiology,Navy General Hospital,Beijing 100048;Department of Computer Management Center,Navy General Hospital,Beijing 100048;Department of Otorhinolaryngology,Navy General Hospital,Beijing 100048)

机构地区：[1]海军总医院骨科 [2]海军总医院放射科 [3]海军总医院计算机管理中心 [4]海军总医院耳鼻喉科

出　　处：《脊柱外科杂志》2018年第2期103-108,共6页Journal of Spinal Surgery

基　　金：海军总医院创新培育基金(CXPY2014-13)

摘　　要：目的依据颈椎侧位数字摄影(DR)资料,探讨下颌角(MDA)是否可作为颈椎节段体表定位的恒定参考。方法选取57例男性和66例女性的颈椎闭口标准侧位(中立位)及过伸过屈位的DR资料(照射野含下颌骨全部),半定量测量不同体位下MDA与颈椎节段的对应关系。设定C_2/C_3水平为0,每上升半个椎体或一个椎间隙,数字减1,反之加1。定量测量不同体位下上颈椎角(AUCS)与全颈椎角(ACS)及其变化,并进行统计学分析。结果同性别比较,各体位下MDA对应的颈椎节段差异均有统计学意义(P<0.05);不同性别间比较,过屈位及中立位MDA对应的颈椎节段差异无统计学意义(P>0.05);过伸位时女性MDA对应的颈椎节段高于男性,差异有统计学意义(P<0.05)。不同性别间比较,各体位下AUCS及ACS差异均无统计学意义(P>0.05)。同性别比较,各体位下AUCS及ACS差异均有统计学意义(P<0.05)。过屈位向中立位及过伸位变换过程中,AUCS和ACS逐渐增大,过屈位到中立位的角度变化均小于中立位到过伸位的角度变化。结论中立位时MDA并非恒定对应于C_2/C_3水平,颈椎屈伸时MDA与颈椎节段的对应关系发生变化,且不局限于1个椎体高度,MDA不能作为颈椎体表定位的恒定参考。Objective To explore the reliability of the mandibular angle(MDA)as a constant landmark for the location of cervical segment based on lateral digital radiography(DR)data of the cervical spine.Methods DR image data of the cervical spine at standard lateral(neutral),hyperflexion and hyperextension postures with closed mouth from 57 males and 66 females were introduced while whole mandible was covered in the radiation field for observation and measurement.Semiquantitative measurement of the relationship between MDA and cervical segments was done at different postures.C2/C3 level was assigned as 0,and minus 1 if the spinal level increased 1/2 vertebral body height or 1 disc height,while plus 1 if the spinal level decreased 1/2 vertebral body height or 1 disc height.Quantitative measurement was done to record the angle of upper cervical spine(AUCS)and angle of whole cervical spine(ACS)at different postures.Statistical analyses were done then.Results Compared with the same gender,there were significant differences in the relationship between MDA and cervical segments at different postures(P<0.05).There was no statistical significance in the relationship between MDA and cervical segments in hyperflexion and neutral postures in different gender(P>0.05).At hyperextension posture,the relationship between MDA and cervical segments of female was higher than that of the male,and the difference was statistically significant(P<0.05).Comparison between different genders,there was no significant difference in AUCS and ACS at different postures(P>0.05).Compared with the same gender,the differences of AUCS and ACS at different postures were statistically significant(P<0.05).In the process of the hyperflexion posture to the neutral and hyperextension postures,AUCS and ACS increased gradually,and the angle change of the hyperflexion to the neutral posture was less than that of the neutral posture to the hyperextension posture.Conclusion MDA position is not parallel to C2/C3 level constantly when the neck is at neutral posture.The rel

关 键 词：颈椎 下颌骨 放射摄影影像解释 计算机辅助 

分 类 号：R681.531[医药卫生—骨科学]