颈椎解剖形态特征的螺旋CT分析

Morphologic evaluation of cervical spine anatomy with helical CT

目的:观察螺旋CT分析颈椎的横断面、正中矢状面图像重建各椎体间隙高度,各椎体间宽度以及颈长肌间宽度,为颈椎前路椎体次全切除、移植物的选择、钢板和螺丝长度的选择提供相关解剖学依据。方法:选择2004-12/2005-01惠州市中心人民医院骨科收治怀疑颈椎损伤患者60例,男30例,平均年龄(41.5±15.1)岁,女30例,平均年龄(36.5±12.1)岁。排除颈椎病理改变。60例患者行颈椎CT扫描,扫描范围C2～T1,扫描电压140kV,200～250mA,横断面扫描层厚3mm。矢状面和冠状面重建。在横断面图像中测量:①C3～7各椎体正中平面的颈长肌内侧缘距离,精确到0.1mm。②测量各椎体正中平面的椎体横径。在正中矢状面重建图像中测量:①C3～7各椎体的上终板、椎体正中、下终板的最大前后径。②C3,C4,C5,C6下终板正中分别至C4～7,C5～7,C6～7,C7各椎体上终板正中距离。③C3,C4,C5,C6下终板前缘分别至C4～7,C5～7,C6～7,C7各椎体下终板前缘距离。结果:纳入患者60例,均进入结果分析。①男女性患者C3～4,C4～5,C5～6,C6～7平均椎间隙高度分别为(5.6±1.0),(5.1±0.8)mm,女性低于男性(P<0.05)。②男女性患者平均椎体间宽度分别为(26.6±4.1),(24.1±3.1)mm。男性最窄的椎体是20.3mm,位于C3,最宽的椎体是36.0mm熏位于C7。女性最窄的椎体为19.2mm,位于C3,C4,最宽的椎体是32mm,位于C7。在每一椎体水平,女性比男性的更窄(P<0.05)。③男女性患者椎体正中颈长肌内侧缘宽度平均为(14.3±2.7),(13.0±2.3)mm,女性低于男性(P<0.05)。④男性在正中矢状面中椎体上终板、正中、下终板前后径平均为(17.4±1.5),(17.0±1.3),(18.1±1.5)mm。除C3椎体外,所有椎体平均正中前后径比上下终板前后径略小,C3椎体正中前后径比上终板前后径稍大,但比下终板前后径小。椎体前后矢状径最小13.9mm,位于C6中矢状径,最大21.5mm,位于C5下终板矢状径。女性在正中矢状面中椎体上终板、正中、下终板前后径平均为(14.9±1.3),(14.7±1.2),(15.8±1.3)mm。椎体前后矢状径最小12.5mm,位于C3上终板,最大19.4mm,位于C4下终板。结论:颈前路手术,术前需行CT测量以上数据,有利于术中减少脊髓、椎动脉损伤等并发症,有利于术中选择长度合适的移植物、钢板、螺丝。

AIM： To observe the height of vertebral interspace, width of each vertebra and width of longus colli of reconstruction imaging of cross section and midsagittal place of cervical vertebra analyzed with spiral CT so as to provide anatomic data for cervical anterior corpectomy, selection of transplant graft, the length of plate and screw in cervical anterior surgery. METHODS： Totally 60 patients with suspected cervical vertebra injury, who were treated at the Department of Orthopaedics, Huizhou Municipal Central People＇s Hospital between December 2004 and January 2005, were selected, including 30 males with an average age of （41.5±15.1） years and 30 females,with an mean age of （36.5±12.1）. Change of pathology of cervical vertebra was excluded. CT scanning on cervical vertebra was performed in 60 patients with the range of C2-T1, electric pressure was 140 kV, 200-250 mA, and depth of cross section was 3 mm. Sagittal plane and coronal plane were reconstructed. Measurement in cross section image： ①Distance of medial border of longus eolli of central plane of C3-7 each vertebral body was 0.1 mm exactly. ②Transverse diameter of central plane of each vertebral body was measured. Measurement in reconstruction imaging of midsagittal plane： ①Maximal occipitofrontal diameter of upper end plate, central vertebral body and lower end plate of C3-7 each vertebral body. ②Distance from C3,C4,C5,C6 central lower end plate to C4-7,C5-7,C6-7,C7 upper end plate, respectively. ③ Distance from C3,C4,C5,C6 anterior lower end plate to C4-7,C5-7,C6-7,C7 anterior end plate, respectively. RESULTS： Totally 60 included patients were involved in the result analysis. ①The height of the C3-4, C4-5, C5-6,C6-7 mean disc spaces of males and females were （5.6±1.0） and （5.1±0.8） mm respectively, and the height of disc spaces of females were lower than the height of males （P 〈 0.05）. ②The average width of the vertebral bodies at the midpoints of males and females were （26.6±4.1） and （24.1±3.1） mm, and the width of the narrowest vertebral bodies of males was 20.3 mm, which was found at C3, the widest one was 36.0 mm at C7. The narrowest vertebral bodies of females were 19.2 mm, which was found at C3 and C4, and the widest was 32.0 mm at C7, at each level, the females had significantly narrower vertebral bodies than the males （P 〈 0.05）. ③The distance between the medial beders of longus coli muscles at midpoints of each vertebral body of males and females were （14.3±2.7） and （13.0±2.3） mm respectively, and the females had significantly narrower distance than the males （P 〈 0.05）. ④In the males patients, the average occipitofrontal diameter depths for the vertebral bodies measured at their upper endplate, midbody, and lower endplate were （17.4 ±1.5）, （17.0±1.3）, （18.1±1.5） mm. The average midsagittal occipitofrontal diameter at the vertical midpoint of the body was slightly less than that measured at the upper and lower endplates for all vertebral bodies except for C3, in which it was slightly greater than at the upper endplate but still less than at the lower endplate. The minimum arrowshape diameter throughout the cervical spine was 13.9 mm at the midbody of C6, and the maximum anteropesterior depth was 21.5 mm at the lower endplate of C5. In the females patients, the average midsagittal plane depths for the vertebral bodies measured at their upper endplate, midbody, and lower endplate were （14.9±1.3）, （14.7±1.2）, （15.8±1.3） mm. The minimum midsagittal plane depth throughout the cervical spine was 12.5 mm at the upper endplate of C3, and the maximum anteroposterior depth was 19.4 mm at the lower endplate of C4. CONCLUSION： The above data should be detected with CT before cervical anterior approach, which is beneficial to decrease complications such as injuries of cervical spinal cord and vertebral artery and helpful for selecting suitable length of graft, plate and screw.