颈椎椎动脉孔及其毗邻结构影像解剖学测量的临床意义

摘要

Objective To observe the anatomical relationship between vertebral arteries and its adjacent bony structures through radiography in order to prevent the injury of vertebral arteries during the cervical pedicle screw fixation .Methods Computed tomography angiography ( CTA) data of 57 patients whose vertebral arteries and cervical vertebra had no obvious abnormalities were se -lected.The maximum coronary diameter of transverse foramen ,the maximum sagittal diameter ,the maximum coronary diameter of verte-bral artery,the vertebral artery pedicle diameter ,the shortest/longest distance between vertebral artery and the edge of the pedicle ,the vertebral artery area ,and the transverse foramen area at the C 2 ~C6 left and right sides in transverse images were measured .The area percentage of the vertebral artery in transverse foramen was calculated .Results At the C2 ~C6 vertebral levels ,the sagittal and coro-nary diameters of the vertebral artery were greater in the left except one case that the diameters were smaller in the left .In the C2 ~C6 , coronary diameters of ipsilateral transverse foramen were greater than the sagittal diameters .The vertebral artery pedicle diameter in right side and both side of the shortest distance between the vertebral artery and the edge of the pedicle from C 2 to C6 were gradually increased .There was only one case whose right vertebral artery entered the C 5 transverse foramen .Conclusion The results of CTA are consistent with that of autopsy .CTA images can not only make a contribution to enhance the security of the cervical pedicle screw fixa -tion,but also help to design the personalized surgeries for different patients .%目的：通过影像学手段，观测椎动脉和颈椎骨性结构的毗邻关系，为预防颈椎椎弓根螺钉固定时术中椎动脉损伤提供相关解剖学参数。方法收集57例行CT血管成像（ CTA）检查椎动脉无明显异常、颈椎无明显畸形的患者的影像学资料。测量横断位图像中C2～C6左右两侧椎动脉孔及其毗邻的相关数据，即横突孔最大冠状径、最大矢状径、椎动脉最大冠状径、椎动脉最大矢状径、椎弓根直径、椎动脉与椎弓根边缘的最短及最远距离、椎动脉面积、横突孔面积、并计算椎动脉占相应横突孔的面积百分比。结果在C2～C6同一椎体水平，除1例病例左侧椎动脉矢状径和冠状径小于右侧外，其余病例左侧椎动脉的矢状径和冠状径均大于右侧；C2～C6同侧横突孔冠状径大于矢状径；C2～C6节段右侧椎弓根的直径以及双侧椎动脉到椎弓根内侧的最短距离均从C2至C6呈逐渐增大趋势。仅1例患者右侧椎动脉从C5横突孔进入。结论本研究采用CTA影像测量颈椎椎动脉孔及其毗邻结构得到的结果与尸体标本上的解剖参数一致。颈椎CTA影像不仅对提高临床颈椎椎弓根螺钉的安全性有帮助，而且有助于对患者进行个性化的手术设计。