螺旋CT结合图像后处理对上颈椎椎弓根的解剖学测量数据及临床意义探究

Study on the anatomical measurement datas and clinical significance of the measurement of the upper cervical vertebral pedicle by the combination of the spiral CT and the image postprocessing

目的探讨研究螺旋CT结合图像后处理对寰枢椎椎弓根的解剖学测量数据及临床意义。方法选取我院2012年12月至2014年12月收治的30例上颈椎病变患者作为观察组,另选取30名同期在我院行常规体检的健康志愿者作为对照组。所有研究对象均采用螺旋CT结合图像后处理对上颈椎椎弓根行解剖学数据测量,依据解剖学测量数据确定对观察组患者的手术治疗方案,并观察手术效果,分析其临床意义。结果 2组研究对象上倾角(β)、寰椎椎弓根宽度(L)、椎弓根最小厚度(H1)和椎弓根最大厚度(H2)各项数据对应左侧、右侧和双侧比较差异均无统计学意义(P>0.05),且各组内左侧和双侧、右侧和双侧、左侧和右侧比较差异也均无统计学意义(P>0.05)。观察组患者有正常型21例,相对狭窄型5例,狭窄型3例,无椎弓根型1例,21例采用直径为4.0mm的椎弓根螺钉行椎弓根固定手术,5例采用直径为3.5mm的椎弓根螺钉行椎弓根固定手术,其他7例患者均行侧块螺钉固定手术。术后均未出现椎弓根皮质被穿破、内固定松动或断裂等并发症,行侧块螺钉固定手术的患者骨性融合效果良好。结论采用螺旋CT结合图像后处理技术可以对上颈椎椎弓根行精确测量,能够并依据解剖学测量数据确定手术方式,对术后并发症评估也具有重要指导意义。

Objective To investigate the upper cervical vertebral pedicle anatomical measurements and clinical significance by the spiral CT associate with image postprocessing.Methods Thirty cases of patients with upper cervical lesions in our hospital from December 2012 to December 2014 were randomly selected as the observation group,another 30 patients with normal physical examination in our hospital during the same period as the control group.All the research objects were measured by using the spiral CT and the images of postprocessing,and surgical treatment for the observation group was determined based on the datas of anatomical measurement.The operation effects were observed,and analyzed its clinical significance.Results There were no significant differences in the datas of the two groups ofβ,L,H1 and H2in left and right sides,left and right sides（P〈0.05）,and there were no significant differences in each group（P〈0.05）.In the observation group,there were 21 cases of normal type,5cases of relatively narrow type,3cases of narrow type,1case of non vertebral pedicle type,among which21 cases were treated by pedicle screw fixation with diameter of 4.0mm,5cases with the diameter of 3.5mm,and lateral mass screw was indicated for the other 7cases.There was no complications of pedicle cortex ruptured,internal fixation loosening and breakage after the operation,the bone fusion effect of lateral mass screw fixation was good.Conclusion To use of spiral CT combined with image postprocessing technology can accurately measure the upper cervical vertebral pedicle,and can be used to determine the surgical methods on the basis of the anatomical datas,which also has an important role to evaluate postoperative complications.