强直性脊柱炎患者上气道矢状位解剖结构分析：CT三维重建法

Analysis of sagittal anatomic structure of upper airway in patients with ankylosing spondylitis： computed tomography-based three-dimensional reconstruction

目的 采用CT三维重建技术探讨强直性脊柱炎患者上气道解剖结构的特点.方法 选择2007年1月至2011年2月在本院行头颈部上气道螺旋CT扫描的强直性脊柱炎患者31例（强直组）,无困难气道因素普通患者41例（对照组）,年龄20 ～ 60岁,男性,采用AW 4.4 workstation 3D-CT重建软件获取患者上气道正中矢状位图像,并测量以下10项指标：上中切牙至会厌根部的弧线距离（D1）和直线距离（D2）,上颌骨长度（D3）,下颌骨长度（D4）,会厌根部至声门中点的距离（D5）,下颌骨下缘至声门中点的距离（D6）,上切牙下缘、会厌根部、声门中点三者分别以会厌根部和上切牙下缘为交点所成角的度数（角α、β）,上切牙下缘、下颌骨下缘最远端、声门中点三者以下颌骨下缘最远端为交点所成角的度数（角γ）,上切牙下缘、硬腭后缘、会厌根部三者以硬腭后缘为交点所成角的度数（角δ）.结果 与对照组相比,强直组D1、D2、D3、D4和D5差异无统计学意义（P＞0.05）,D6、角α和角δ增大,角β和角γ减小（P＜0.05）.结论 强直性脊柱炎患者上气道解剖结构具有特异性改变,选择相应弯曲度大的喉镜镜片可能有助于气管插管的成功.

Objective To investigate the characteristics of sagittal anatomic structure of the upper airway in patients with ankylosing spondylitis using three-dimensional reconstruction based on computed tomography （CT）.Methods Thirty-one male patients with ankylosing spondylitis,aged 20-60 yr （AS group）,and 41 common patients （male） without difficult airways,aged 20-60 yr （control group）,who underwent spiral CT scan of the head and neck using Helical CT from January 2007 to February 2011 in our hospital,were enrolled in the study.Reconstructed images of the upper airway were obtained using AW4.4 workstation and six distances （D1-D6） and four angles （α-δ） were recorded and analyzed：（1）D1,the arc distance between the upper central incisor and root of epiglottis; D2,the distance between the upper central incisor and root of epiglottis; D3 and D4,the lengths of maxilla and mandible ; D5,the distance between the root of epiglottis and midpoint of glottis; D6,the distance between the end of mandible and midpoint of glottis; （2） angle α,the angle of line D2 and D5; angle β,the angle of line D2 and the lower edge of the upper central incisor to the midpoint of glottis; angle γ,the angle of line D4 and D6; angle δ,the angle of the point of the lower edge of the upper central incisor to the trailing edge of the hard palate and then to the root of epiglottis.Results Compared with control group,no significant change was found in D1,D2,D3,D4 and D5 （P 〉 0.05）,and D6,angle α and angle δ were significantly increased,whereas angle β and angle γ were decreased in AS group （P 〈 0.05）.Conclusion The anatomic structure of the upper airway has the characteristics of specific changes and a laryngoscope blade with a large degree of curvature may be helpful for successful tracheal intubation in patients with ankylosing spondylitis. Keywords：Spondylitis, ankylosing; Tomography, X-Ray ; Imaging, three-dimensional ; Anatomy,regional