脊柱胸腰段结构变化断层切片与CT三维重建测量比较

Comparison between cross-sectional anatomy and CT scanning for observing thoracolumbar vertebrae structure

背景:单纯CT三维重建数据难以完全保证手术过程安全,火棉胶包埋断层切片已广泛用于头颅、眼眶和膝等多部位解剖研究,国内外至今少有脊柱经改良火棉胶包埋后断层切片报道。目的:探讨断层切片和CT扫描后三维重建对胸腰段脊髓及脊神经走行过程中各结构的诊断价值。方法:40例胸腰段脊柱标本行螺旋CT薄扫后重建,用e-film软件观测相关解剖参数,同时经改良火棉胶包埋法行冠状、矢状和水平位薄层切片,用Amira4.1软件重建并测算对应指标。结果与结论:断层切片较CT二维图像更能详细直观观测胸腰段椎管、椎间管内伴行结构关系;断层切片和CT薄扫后重建在测量椎间管高度、宽度、椎管斜径及硬膜囊直径时差异有显著性意义,在测算椎弓根纵径、横径及椎间管长度时差异无显著性意义。说明:①由于CT软组织窗或骨窗窗宽、窗位和分辨率的影响,其二维图像在一定程度上难以精确辨认软组织结构,而断层切片却可直观观察脊髓、脊神经根及伴行血管或椎间管韧带分布。②断层切片重建对骨性及非骨性结构皆可清晰识别,更利于观测实际上有软组织贴附的椎管及椎间管各结构参数,而CT薄扫重建一般仅能准确观测骨性结构指标,但两法在观测骨性结构数据时基本一致。③CT和断层切片重建在观测靶结构随脊椎序数变化的演变过程时一致。

BACKGROUND： Simple CT three-dimensional reconstruction data cannot keep safety of the surgery completely, and celloidin embedding cross-sectional slice has been widely used in the research on skull, fossa orbitalis and knee joint.There are few reports on the spinal cross-section slice treated with celloidin embedding.OBJECTIVE： To investigate the diagnostic value of sectional slices and CT scanning three-dimensional reconstruction in observing and measuring structural parameters of thoracolumbar intervertebrae.METHODS： Forty adult thoracolumbar vertebrae specimens were enrolled for CT scanning and reconstruction, and the anatomic parameters were measured with imageology software called ＇e-flim＇. Meanwhile,above-mentioned samples were made into serially coronal, sagittal and horizontal sections with upgraded ceUoidin embedding technique. Corresponding anatomic features were surveyed and re-established via Amira4.1 software.RESULTS AND CONCLUSION： Sectional slices were more convenient for direct-viewing the adjacent relationship of individual structures which exist in vertebral canal or intervertebral canal than CT two-dimensional images; there were significant differences in measuring height, width of intervertebral canals, oblique diameter of vertebral canal and diameter of spinal cord between two methods; there was no significant difference in measuring the length of intervertebral canal, vertical and transverse diameter of vertebral pedicle. Due to the influence of soft tissue or bone window width, window level and resolving power,the CT two-dimensional images could not precisely identify the structure of soft tissues, however, sectional slices cold distinctly discriminate the distribution of lumbosacral spinal cord, nerve root, accompanying vessel,intervertebral canal ligament, etc. Reconstruction for sectional slices could clearly identify the osseous structure and non-osseous structure, and helpful to observe the different structure parameters of vertebral canal or intervertebral canal adhered with soft tissues, while the CT scanning reconstruction can only observe the parameters of bone architecture. But the bone architecture data observed by these two methods were similar. CT scanning and sectional slice reconstruction showed the same results in observing simultaneous variation of target structures.