甲状软骨和环状软骨对颈椎前路手术影响的影像学研究

The radiologic anatomy of thyroid cartilage and cricoid cartilage： implications for anterior cervical spine surgery

目的 测量甲状软骨和环状软骨相关影像学参数，探讨其对颈椎前路手术的影响。方法 选取2015年1月至2017年2月309例正常颈椎CT影像资料，男195例，女114例；年龄24~77岁，平均（54.1±10.0）岁；身高148~180 cm，平均（164.8±7.8）cm；体重41~90 kg，平均（63.2±10.1）kg。测量甲状软骨上缘（superior border of the thyroid cartilage, SBTC）、甲状软骨下缘（inferior border of the thyroid cartilage, IBTC）和环状软骨下缘（inferior border of the cricoid cartilage, IBCC）平面的甲状软骨或环状软骨横径和对应的颈椎椎体或椎间盘横径，并记录各平面对应的颈椎椎体序数。分析各横径与身高、体重的相关性，统计不同平面、不同性别解剖学参数的差异。结果 各平面甲状软骨或环状软骨横径和对应的颈椎椎体或椎间盘横径与身高、体重明显相关。SBTC、IBTC和IBCC平面甲状软骨或环状软骨横径自上而下逐渐减小，分别为（44.30±4.97）mm、（41.39±4.62）mm和（26.36±3.79）mm；对应的颈椎椎体或椎间盘横径逐渐增大，分别为（27.47±2.66）mm、（29.00±3.15）mm和（31.48±3.49）mm。各平面所测甲状软骨或环状软骨横径、对应的颈椎椎体或椎间盘横径差异均有统计学意义。甲状软骨和环状软骨横径存在个体差异,男性各平面平均横径均大于女性，差异均有统计学意义。甲状软骨在颈椎前方主位于C5以上（男性为56.9%，女性为86.0%）。男性与女性各平面对应颈椎节段分布的差异均有统计学意义。结论 甲状软骨位置、甲状软骨和环状软骨大小存在个体差异和性别差异，并可以预测颈椎前路手术中显露的难易程度，以及术后早期吞咽困难和咽食管壁损伤的发生率。

Objective To measure anatomic data related to the thyroid cartilage and cricoid cartilage and to analyze their implications for anterior spine surgery.Methods From January 2015 to February 2017, Cervical spine CT image data of 309 normal adults （195 males, 114 females） in our department were retrospectively analyzed. The transverse diameters of the thyroid cartilage and the cricoid cartilage was measured at three different levels as follows： the superior border of the thyroid cartilage（SBTC）, the inferior border of the thyroid cartilage（IBTC）, and the inferior border of the cricoid cartilage（IBCC）. At those levels, the corresponding level and transverse diameter of the cervical vertebra or intervertebral disc were also determined. Differences of anatomic parameters for each gender and level, and the relationship between the transverse diameter and height and weight were analyzed.Results The transverse diameters of the thyroid cartilage or cricoid cartilage and the corresponding cervical vertebra or intervertebral disc were associated significantly with height and weight. The transverse diameters of the thyroid cartilage or cricoid cartilage gradually decreased from the level of SBTC （44.30±4.97 mm） to the level of IBTC （41.39±4.62 mm）, and the latter to the level of IBCC （26.36±3.79 mm）, but increased from the level of SBTC （27.47±2.66 mm） to the level of IBTC（29.00±3.15 mm）, and the latter to the level of IBCC （31.48±3.49 mm） for the cervical vertebra or intervertebral disc. Differences of the transverse diameters of the thyroid cartilage or cricoid cartilage and the cervical vertebra or intervertebral disc on three levels had statistical significance. The transverse diameters of each level had individual differences, while men were greater than those for women. The thyroid cartilage was routinely located above the C5 （56.9% for male, 86.0% for female）. Differences of the frequency between men and women on three levels had statistical significance.Conclusion The Individual and sex differences in the location of the thyroid cartilage and the size of the thyroid cartilage and the cricoid cartilage provided anatomical basis for predicting the difficulty of intraoperative exposure, incidence of esophageal injuries and early postoperative dysphagia.