枕骨外板翻转行枕颈融合术的影像学设计

Imaging designs of occipitocervical fusion for reversed transplantation of occipital outer plate flap

目的：测量及分析成人枕颈部正中矢状位CT，探讨枕骨外板翻转的术前设计。方法选取2013年8~11月在衡阳市中心医院行CT检查的90例健康成人枕颈部正中矢状位CT影像资料，分别用甲法（经枕骨大孔后缘中点上方1 cm处作板障圆弧的切线）及乙法（经枕内外隆凸连线中点作板障圆弧的切线）进行枕骨外板翻转的术前设计，通过对2种设计相关指标的测量，比较甲、乙法的可行性及枕骨外板翻转的影像学参数。结果成人依据甲法或乙法的翻转比值（所需骨瓣长度/可获取最大骨瓣长度）与最大翻转比值（100%）比较，差异有统计学意义（P＜0.05）。无论甲法或乙法翻转，成年男性组和女性组比较，差异均无统计学意义（P＞0.05）。在同一人中甲法与乙法翻转比较，差异有统计学意义（P＜0.05）。结论甲、乙法均有可行性，且乙法优于甲法。通过术前枕颈部正中矢状位行CT测量，可为术中枕骨外板的翻转提供影像学参考。

Objective By analyzing and measuring adult pillow neck midline sagittal CT image data and to investigate preoperative designs of the occipital outer plate flap. Methods Ninety pillow neck sagittal CT image datas from the patients un-derwent CT examination in Hengyang Center Hospital from August to November in 2013 were conducted preoperative designs of the occipital outer plate flap by method A（through 1 cm above the midpoint of the trailing edge of the foramen magnum,the tangent of the arc-shaped diploe image）and method B（through pillow inside and outside carina midpoint,the tangent of the arc-shaped diploe image） respectively. It was determined the feasibility of methods A and B and to obtain preoperative imaging parameters of the flipping of the occipital outer plate through the measurement of relevant indicators of methods A and B. Results There was statistical significance between the flip ratio （desired flap length/maximum flap length available ）according to method A or B and the maximum flip ratio（100%）（P〈0.05）. Either method A or method B to flip the occipital outer plate,both the adult male group and the adult female group showed no statistical significance （P〉0.05）. There was statistical significance between methods A and B to flip the occipital outer plate for the same person（P〈0.05）. Conclusion Both methods A and B are feasible,and method B is better than A. Preoperative measurement of the pillow neck sagittal CT can provide imaging parameters for the intraoperative flip-ping of occipital outer plate.