脊柱颈段的年龄变化及其临床意义

目的 为临床应用提供脊柱颈段年龄性变化的解剖学资料。方法 观察并测量了颈椎干骨标本50套(G3-7)、脊柱颈段标本正中矢状切标本15例(30侧,其中童尸2例,青年5例,中老年8例)、脊柱颈段X线正侧位片320张、CT片50张,分年龄段作统计,对特例作摄影和绘图记录。结果 (1)青少年时期同一椎体的前后面接近平行,并基本等高。随着年龄增加,前面逐渐变斜,朝向前上,前高则逐渐缩短,特别以C4-C6椎为显著,而后面的高度和斜度无显著变化。(2)在老年侧位片上,对同一椎的前、后面分别作垂线,两线相夹的角度C5-6均超过4°,而两端各椎则为3°。(3)颈椎间盘的前高和后高均随年龄老化而降低,但前高降低的总量约为后高者的2倍。(4)钩突年青时呈尖棘状,随着年龄老化向后扩展,变成矢状位的嵴状,此嵴前后长度在上位椎可超过同椎椎体的正中矢状径。(5)骨赘多见于钩突和C4-6椎体前面的上下缘,也可见于关节突和钩椎关节的斜坡,椎体后面可偶见后纵韧带骨化所成的骨赘或骨刺,罕见与前面相当的上、下缘骨唇形成。结论 颈曲随年龄增加而减小,决定因素是椎体前份和椎间盘前份高度的持续降低。

Observation on the aging changes of cervical vertebra and its clinical significance

Objective To provide anatomical data of cervical vertebra for clinical use. Methods 50 sets(C3-7) of dry cervical vertebrae,30 sagittal sections of cervical spinal specimens (including young, middle and old age), 50 CT scan films and cervical lateral radiographs of 320 subjects were observed and measured. Photos of special samples were taken. Results (1) The anterior and posterior surfaces of the same vertebral body of young persons were tended to parallel to each other and equal in height, the anterior one becomes shortened and sloping forward with age especially in C4-6 while the height and gradient of posterior one had no obvious changes. (2)On the old person's radiograph, the angle between two lines which meet with the anterior and posterior surfaces of the same vertebral body vertically and respectively increase in sign. It was more than 4° at the middle vertebral and about 3°at both ends. (3)The heights of anterior and posterior position of intervertebral disc were decreased with age simultaneously, but the total loss amount of anterior height was twice more than the posterior one. (4) The uncinate processes appearing as a sharp spine at the young become sagittal ridges at the old. The length of the ridge may be longer than the median sagittal diameter of the same vertebral body at the upper vertebrae. (5)The osteophyte was commonly presented at the uncinate process, the upper and lower borders of anterior surface of vertebral body, the articular process, and the slope of Luschka's joint. On the body' s posterior surface, the posterior longitudinal ligumental osteosis some time can be seen, but the type of osteophyte appearing on anterior surface was rarely seen on the posterior surface. Conclusion The structural cervical curvature (lordosis) is straightened with age owing to the lowering height occurred on the anterior position of cervical spine.