下颈椎椎弓根的数字化影像学观测

摘要

目的:探讨成人下颈椎椎弓根螺钉内固定的相关解剖学参数,为临床选择应用螺钉的直径、长度、角度,进钉点定位及判断手术复位等提供理论依据.方法:采集颈椎CT图像,并依据性别与身高等因素分组,对椎弓根具有临床意义的数据进行测量.结果:椎弓根皮质、松质骨高度、宽度,第3～7颈椎同节段侧别间比较因性别和身高因素差异有统计学意义.男性较女性均宽大,第3～7颈椎总的趋势均逐渐增大.椎弓根轴线骨性长度、椎弓根长同节段侧别间比较与性别和身高因素关系密切,男性第3颈椎椎弓根轴线骨性长度最短,第7颈椎椎弓根长度最短；女性第4颈椎椎弓根轴线骨性长度最短,第7颈椎椎弓根长度最短.椎弓根外展角度及向头、尾侧倾斜角度,无性别差异.结论:下颈椎椎弓根等骨性结构个体差异较大(性别、身高因素关系密切),但仍是有规律可循的.术中螺钉直径的选择主要取决于下颈椎椎弓根松质骨的宽度,但应注意个体差异,第3～7颈椎均可用3.5mm的螺钉；螺钉长度选用范围29～32 mm,置入角度有明显规律性,是术中螺钉进钉定位、判断手术复位程度的重要依据.%Objective:To investigate the radiological data of the vertebral arch pedicles of the lower cervical vertebrae, and to provide the references for internal fixation and judgment of postsurgical repositioning, including the diameter and length of screw, orientation and inserting pointing of fixation. Methods: CT images of the lower cervical vertebrae were collected and grouped according to gender and height, and then, were submitted to data collection. Results: The height and width of both cortical bone and spongy bone of vertebral arch pedicles in the lower cervical vertebrae in male was statistically bigger than those in female regarding to same vertebra, and increased gradually from C3 to C7 in both genders. The axial osseous length and the length of ipsilateral pedicles of the vertebral arch in same cervical vertebra had statistically correlation to gender and height. In male, the most minimal axial osseous length and the length of vertebral arch pedicle were found in C3 and C7, respectively. And, the same minimal parameters in female were in C4 and C7, respectively. However, gender differences were undetectable regarding to abduction angle and sagittal angle. Conclusion: The osseous parameters of the vertebral arch pedicles in the lower cervical vertebrae have individual property, and are statistically correlated to gender and height. Choice of diameter of screw depends on the width of spongy bone of the vertebral arch pedicles in the lower cervical vertebrae. Generally, screws with 3. 5 mm in diameter can be used to fix C3 to C7, but individual property should be paid attention during surgery. The screws ranged from 29 to 32 mm in length are available, and insert orientations are regular, which is an important basis to judge the surgical reposition.