枢椎椎弓根峡部复合体三维形态学特征及其临床意义  

Three-dimensional morphological characteristics and clinical significance of the pedicle-isthmus complex of axis

作　　者：刘珊珊 唐强 廖烨晖 冷叶波 王清 唐超 钟德君 LIU Shanshan;TANG Qiang;LIAO Yehui(Department of Orthopedics,Affiliated Hospital of Southwest Medical University,Luzhou,643200,China)

机构地区：[1]西南医科大学附属医院骨科,泸州市643200 [2]四川省眉山市天府新区人民医院骨科,620564 [3]陆军军医大学新桥医院骨科,重庆市400030

出　　处：《中国脊柱脊髓杂志》2025年第3期225-235,共11页Chinese Journal of Spine and Spinal Cord

基　　金：四川省自然科学基金项目(2024NSFSC0682);泸州市人民政府与西南医科大学科技战略合作项目(2020LZXNYDJ22);西南医科大学自然科学青年项目(2022QN058)。

摘　　要：目的:测量正常枢椎椎弓根峡部复合体(pedicle isthmus complex,PIC)解剖形态学参数,分析PIC三维结构特征并讨论其临床意义。方法:收集西南医科大学附属医院2022年1月~2022年12月收治的颈椎或颈部CTA检查的100例无椎动脉高跨患者[男性57例,女性43例;年龄56.1±1.8岁(18~79岁)]和后路枢椎椎弓根螺钉固定且术后复查颈椎CT的28例患者[男性15例,女性13例;年龄55.5±14.6岁(18~80岁)]的影像资料。将原始CT数据上传至Mimics 21.0软件,利用软件从枢椎上分割出双侧PIC,通过多平面重建技术(multiplanar reconstruction,MPR)重建坐标轴,在新坐标轴上对PIC复合体的上、中、下行断层切割,并确定PIC最前端、最狭部和最后端。在三维图像上测量PIC上、中、下断层最前端宽度、最狭部宽度、最后端宽度以及内倾角度。基于后路枢椎椎弓根置钉患者的螺钉是否穿破PIC分为穿破组及未穿破组。并以枢椎椎弓根螺钉为参照,测量螺钉中心点距离PIC上壁高度、PIC内壁宽度以及螺钉内倾角。结果:100例患者PIC各参数左右侧比较均无统计学差异,合并统计。男性在各分割层面PIC宽度均大于女性,差异有统计学意义(P<0.05)。冠状位视角PIC宽度结果显示:上层整体宽度为9.6±1.3mm,中层整体宽度为9.5±1.4mm,下层整体宽度为8.0±1.1mm,上层、中层整体宽度无统计学差异(P=0.41),其余各层之间差异有统计学意义(P<0.05)。横断位视角PIC整体宽度结果显示:最前端整体宽度为8.8±1.4mm,最狭部整体宽度为7.2±1.3mm,最后端整体宽度为11.0±1.5mm,各层之间差异有统计学意义(P<0.05)。PIC内倾角结果显示:上层内倾角为15.1°±8.7°,中层内倾角为19.5°±8.4°,下层内倾角为26.3°±9.0°,各层之间差异有统计学意义(P<0.05)。28例后路枢椎椎弓根螺钉内固定患者,共计50枚螺钉置入,未穿破组和穿破组各有25枚。未穿破组螺钉中心点距离PIC上壁高度[4.4(3.6~5.3)mm]�Objectives:To analyze the 3D structural characteristics and discuss the clinical significance of pedicle-isthmus complex(PIC)through measuring the anatomical and morphological parameters of normal axis PIC.Methods:The imaging data of 100 patients without high-riding vertebral artery[57 males,43 females,56.1±1.8(18-79)years]undergone CT angiography(CTA)examinations of the cervical spine or neck and admitted to the Affiliated Hospital of Southwest Medical University between January 2022 and December 2022,and another 28 patients[15 males,13 females,55.5±14.6(18-80)years]undergone posterior C2 pedicle screw fixation and examined with CT scan of the cervical spine during the same period were collected.The original CT data were uploaded to Mimics 21.0 software,and bilateral PICs were segmented from the axis to construct a new coordinate axes with multiplanar reconstruction(MPR)technology.The upper,middle and lower faults of the PIC were cut on the new axes,and the front-most,narrowest and back-most parts of the PIC were determined.The widths of the front-most,narrowest and,back-most parts and inclination angles of the upper,middle and lower faults of PIC were measured on 3D images.Based on whether the PIC was punctured or not,the patients implanted with posterior C2 pedicle screws were divided into punctured group and non-punctured group.Using the axis pedicle screw as reference,the image parameters of screw position were measured,including the height from the screw midpoint to the PIC upper wall,the width of the screw midpoint to the PIC inner wall,and the screw inclination angle.Results:There was no statistical difference between the left and right side of PIC parameters in 100 patients.The width of PIC in males was greater than that in females at all levels,and the difference was statistically significant(P<0.05).The results of PIC width from a coronal perspective showed that the overall width of the upper layer was 9.6±1.3mm,the overall width of the middle layer was 9.5±1.4mm,and the overall width of the lower

关 键 词：枢椎 椎弓根-峡部复合体 三维结构 形态特征 MIMICS软件 

分 类 号：R602[医药卫生—外科学]