寰椎沟桥与椎动脉V3段形态异常相关性的多层CT血管成像

Correlation between ponticulus of atlas and abnormal morphology of V3 segment of vertebral artery using multi-slice spiral CT angiography

目的：探讨寰椎沟桥与椎动脉V3段血管形态异常的相关性。方法利用头颈部CT血管成像（CTA）检查病例原始扫描数据，在工作站中对寰椎椎骨及椎动脉进行三维重建，观察沟桥位置、形态及沟桥与椎动脉的空间位置关系，对椎动脉V3段血管管径、形态、走行等进行测量、分析。结果分析采用χ^2检验。结果本组613例头颈部血管CTA检查病例，157例共195侧发生沟桥。椎动脉V3段形态异常103侧，其中合并沟桥69侧，按侧计算其发生率：总体为8.4%（103/1226），合并沟桥侧为35.4%（69/195），无沟桥侧为3.3%（34/1031）。合并沟桥侧椎动脉V3段形态异常发生率高于总体及无沟桥侧（χ^2=215.679，P=0.001）。同时，椎动脉异常发生率还与沟桥数量、位置及形态有关，在复合桥发生率（57.1%，12/21）高于单纯桥（32.8%，57/174）（χ^2=4.873，P=0.027）、在单纯桥中的边桥（68.8%，11/16）高于后桥（27.2%）及侧桥（36.4%）（χ^2=11.357，P=0.030）、在不完整型沟桥构桥突端口尖锐者（64.2%）高于圆钝者（14.6%）（χ^2=26.813，P=0.001）、不完整吻状突型沟桥对吻口间距与椎动脉管径差值较小者高于较大者（χ^2=9.212，P=0.010）、完整型沟桥沟桥孔孔径较小者（87.5%）高于孔径较大者（28.6%）（χ^2=18.193，P=0.001）。结论沟桥的存在明显增加了椎动脉V3段血管形态异常发生风险；沟桥发生的数量、位置、构桥突形态都对其发生率有影响。

Objective To explore the correlation between ponticulus of atlas and abnormal morphology of V3 segment of vertebral artery. Methods All patients included in this study were underwent CTA and 3D reconstruction examination of intracranial ponticulus and cervical in our workstation, as well as the site, shape of petals and its relationship with vertebral artery was observed. The diameter, shape and trail of vertebral V3 segment were measured and analyzed. The results were analyzed byχ^2 test. Results A total of 195 sides （157 cases） ponticulus were detected in 613 cases （1 226 sides）, the abnormal morphology of V3 segment of vertebral artery were 103 sides and combined with ponticulus 69 sides among them, including （according to side）： the collectivity was 8.4% （103/1 226）, combination ponticulus was 35.4% （69/195）, uncombination ponticulus was 3.3%（34/1 031）, and the risk with ponticulus was increased compared with no ponticulus, and showed statistical significance by Chi-square test（χ^2=215.679,P=0.001）. The difference of abnormality of vertebral artery was performanced in number, site and shape of ponticulus, we found that the ponticulus composite was 57.1%（12/21） and higher than ponticulus simple 32.8%（57/174）（χ^2=4.873,P=0.027）, the ponticulus borderl was 68.8%（11/16） which was also higher than ponticulus posticus（27.2%） and ponticulus lateralis（36.4%）in the ponticulus simple（χ^2=11.357,P=0.030）, the sharp ones （64.2%） were higher than the blunt（14.6%）in the tip of bony processes of the incomplete type ponticulus（χ^2=26.813,＆amp;nbsp;P=0.001）,the smaller ones were higher than the larger in the distance of the gap between the two tips of bony processes in the incomplete type ponticulus（χ^2=9.212,P=0.010）, and the smallerones（87.5%）were also higher than the larger（28.6%）in the diameter of the hole of complete type ponticulus（χ^2=18.193,P=0.001）, all of the above ones showed statistical significance among all groups by Chi-square test （P〈0.05）. Conclusions Ponticulus of atlas can significantly increase the risk of abnormal morphology of V3 segment of vertebral artery, and the differences of abnormality of vertebral artery were performed in number, site and shape of ponticulus, which included the ponticulus composite, ponticulus borderland, the shape tip of bony processes, the moderate distance between the two lip of bony processes, and the smaller diameter of complete type Ponticulus.