上颈椎临床解剖学影像数据的一体化研究

An integrated research about the clinical anatomy image data on the upper cervical spine

目的测量国人上颈椎临床解剖的影像学数据,为该区域手术内固定置入提供解剖学依据。方法从2013年7月-2015年2月,收集国人正常上颈椎影像学资料55例（其中男47例,女8例）,包括DR正侧位、张口位片和CT横断面片、二维及三维重建片,采用直形标尺、量角器测量。结果寰椎上关节面外倾角、下关节面内倾角两侧不对称分别占17.6%、14.5%;后弓内侧半距约为外侧半距的1/2;手术时寰椎前弓向外剥离不宜超过20mm,后弓向外剥离不宜超过25mm,后弓向外切除不宜超过15mm;所有横突孔的内径（横径＆纵径）均〉4mm,所有侧块横径（短轴）均〉11mm,椎弓根钉道理想距离约为（27.8±1.5）mm,侧块螺钉钉道理想长度约为（24.8±1.3）mm;枢椎椎弓根内倾角变异较大（-6.8-15.3°）,上倾角变异不大;椎弓根螺钉置钉时须采用较大的上倾角,置钉点在椎弓根偏上部,钉道平行于椎弓根的上缘走行攻取,钉道止点也在枢椎体上部;枢椎椎弓根置钉理想内倾角度约为（12.9±2.0）°;理想上倾角度约为（38.3±2.1）°。齿状突的DR张口位侧位测量与CT二维重建测量无明显差异;齿状突后倾角变异较大（12.4-34.5°）,腰部内径（纵径＆横径）〈9mm者占38.3%;齿状突理想钉道的后倾角度约为（28.2±3.2）°;齿突螺钉置入枚数应由术前CT检测决定。结论对上颈椎影像学的多角度测量,能够较全面的观察到其立体结构,为区域内内固定的置入提供了切实依据。

Objective To measure the clinical anatomy imaging data of the upper cervical spine and provide anatomical basis for placing the internal fixing in the surgical region. Methods The cervical spine imaging data of 55 cases of the normal Chinese people（47 males and 8 females） were gathered and measured by straight ruler and protractor from July 2003 to February 2015, including the ordinary anterior-posterior films and open-mouth anterior-posterior plain films and lateral films of digital X-ray data, cross-section and two-dimensional and three-dimensional reconstruction data of computed tomography. Results Atlas： 17.6% of the outside oblique angle of superior articular face and 14.5% of inside oblique angle of inferior articular face were asymmetry. Inside semi-diameter of posterior atlantisarcus was half of the outside.The distance/margin by means of stripping out anterior and posterior arch of atlas and removing of the posterior arch of atlas should be no more than 20 mm, 25 mm and 15 mm respectively during the operation. The anterior-posterior diameter and transverse diameter were all more than 4mm in all of the transverse foramen. All of the transverse diameter of the atlas lateral mass were more than 11 mm. The ideal distance of pedicle screw path and lateral mass screw path was approximately（27.8±1.5） mm and（24.8±1.3） mm respectively. Axis： the variation on inside oblique angle of axial pedicle was significant（-6.8 to 15.3°）, but its upward inclination angle variation was not significant. It is appropriate to place the screw on the upper part of pedicle with a larger upward inclination angle through drilling the screw channel parallelly to the upper edge of the pedicle and terminally at the upper of axial body. The ideal inside oblique angle and upward inclination angle of axial pedicle screw was approximately（12.9±2.0） °and（38.3±2.1） ° respectively. The digital X-ray databeen collected of odontoid proces open-mouth anterior-posterior plain films and two-dimensional reconstruction data of computed tomography had no significant difference. The variation on posterior oblique angle of odontoid proces wassignificant（12.4 to 34.5°）. The odontoid proces diameter（long diameter diameter） of the waist with less than 9mm was accounting for 38.3%. The ideal posterior oblique angle of odontoid proces screw channel was approximately（28.2±3.2） °. The number of inserted screws in dens depends on the result of preoperative CT. Conclusion The three-dimensional structure of the upper cervical spine could be more fully observed by multi-angle measurements on cervical imaging, which provided a practical basis for installation inner fixation in the surgical area.