下颈椎椎弓根轴线与椎板平面夹角的影像学测量及其临床意义

摘要

目的:探讨下颈椎椎弓根轴线与椎板平面夹角的影像学测量及其临床意义.方法:对排除颈椎畸形的30例患者颈椎行三维重建CT扫描,在重建后的C3～C7特定CT图像上测量椎弓根轴线与椎板平面夹角.结果:1)C3～C7左右两侧横向椎弓根-同侧椎板角分别为98.3°±6.3°,98.0°±5.1°,97.5°±6.9°,95.1°±5.0°,85.8°±5.4°和96.7°±8.2°,98.7°±7.1°,97.8°±3.6°,93.2°±6.2°,86.8°±5.7°;C3～C6的夹角大于90°,C7的夹角小于90°,呈逐渐减小趋势.除了C6与C3和C7与其他节段外,其余各节段间的差异均无统计学意义(均P＞0.05).2)C3～C7左右两侧横向椎弓根-对侧椎板角分别为0.2°±4.5°,1.2°±7.2°,-0.8°±6.8°,-3.3°±5.4°,-14.7°±4.0°和-1.6°±5.4°,1.9°±4.6°,-0.5°±6.0°,-4.6°±5.3°,-13.7°±3.4°,呈先增大后减小趋势,C4的夹角最大.除了C6与C3,C6与C4,C7与其他节段外,其余各节段间的差异均无统计学意义(均P＞0.05).3)C3～C7左右两侧纵向椎弓根-同侧椎板角分别为77.7°±7.6°,77.0°±7.1°,85.3°±8.4°,94.1°±2.2°,94.9°±3.8°和78.5°±7.1°,76.2°±6.2°,86.4°±6.4°,94.0°±2.7°,95.6°±3.8°,呈逐渐增大趋势,C3～C4的夹角均小于90°,Cs的夹角变异较大,C6～C7的夹角均大于90°.除了C3与C4,C6与C7外,其余各节段间的差异均有统计学意义(均P＜0.05).以上指标每节段左右两侧比较,差异均无统计学意义(均P＞0.05).结论:下颈椎椎弓根轴线与椎板平面存在一定的角度关系,可为临床确定椎弓根螺钉的进钉角度提供参考.%Objective:To explore the imaging measurement and clinical significance of the angle between the axis ofpedicle and the plane of lamina in lower cervical vertebra.Methods:Three dimensional reconstruction of CT scan was performed in 30 patients with cervical deformity,and the angle between the axis ofpedicle and the plane of lamina was measured with the specific reconstructed CT image of C3-C7.Results:1) The left and right transverse angle of C3-C7 between the axis of pedicle and the ipsilateral plane oflamina were 98.3°±6.3°,98.0°±5.1°,97.5°±6.9°,95.1°±5.0°,85.8°±5.4°and 96.7°±8.2°,98.7°±7.1°,97.8°±3.6°,93.2° ±6.2°,86.8° ±5.7°,respectively,which showed a gradual decreasing trend.Meanwhile the angle ofC3-C6 was more than 90 degrees and C7 was less than 90 degrees.In addition to C6 with C3 and C7 with other segments,the rest of the differences between the sections was not statistically significant (all P＞0.05).2) The left and right transverse angle of C3-C7 between the axis of pedicle and the pedicle of vertebral arch of lamina were 0.2°±4.5°,1.2°±7.2°,-0.8° ±6.8°,-3.3°±5.4°,-14.7° ±4.0° and-1.6°±5.4°,1.9°±4.6°,-0.5° ±6.0°,-4.6° ±5.3°,-13.7°±3.4°,respectively,which showed a first increasing and then reducing trend.Meanwhile the angle of C4 was maximum angle.In addition to C6 with C3;C6 with C4,and C7 with other segments,the differences between the sections was not statistically significant (all P＞0.05).3) The left and right sagittal angle of C3-C7 between the axis of pedicle and the ipsilateral plane of lamina were 77.7°±7.6°,77.0°±7.1°,85.3° ±8.4°,94.1°±2.2°,94.9°±3.8° and 78.5° ±7.1°,76.2° ±6.2°,86.4°±6.4°,94.0°±2.7°,95.6°±3.8°,respectively,which showed a gradual increasing trend.The angle of C3-C4 was less than 90 degrees.Cs showed large variation and C6-C7 was more than 90 degrees.In addition to C3 with C4 and C6 with C7,the differences between the sections was statistically significant (all P＜0.05).There was no significant difference between the two sides of the above indexes (all P＞0.05).Conclusion:In low cervical vertebra,there is a certain angle relationship between the axis of pedicle and the plane of lamina,which can provide reference for the clinical determination of angle of pedicle screw insertion.