多层螺旋CT三维重建国人下颈椎椎弓根的临床解剖学意义

背景：因颈椎解剖结构复杂以及个体化差异较大，导致颈椎弓根钉置入内固定技术应用受到很大限制。目的：应用螺旋CT三维重建国人的下颈椎椎弓根，并对重建图像进行测量评估。方法：对60例需行颈椎CT扫描的患者C₃~C₇进行颈椎CT扫描，使用Syngo应用软件对原始CT图像进行所需面的重建，测量CT重建后的椎弓根各项指标。结果与结论：颈椎绝大部分椎弓根峡部的宽度小于高度，男性高度和宽度C₄~C₇逐渐增大，女性则从C₃开始逐渐增大。C₃~C₇椎弓根侧块投射点到上关节突下缘的距离并无规律性，而到侧块外缘的距离从头端到尾端是不断增大的。男性与女性的椎弓根水平角在C₇均最小。结果提示，国人女性患者的C₃及C₄椎体行经颈椎椎弓根内固定应谨慎，大部分国人的C₅到C₇椎体是适合行椎弓根内固定的，但考虑到颈椎弓根个体的差异较大，内固定前颈椎弓根的CT扫描及重建后的评估是必要的。

Clinical anatomic study of lower cervical pedicle in a Chinese population by three dimensional reformations of multi-slice spiral CT

BACKGROUND:Anatomic variations between individuals in the size and shape of cervical pedicles limit the application of pedicle screw. OBJECTIVE:To evaluate lower cervical pedicle (C3-7) dimensions in a Chinese population by multiplanar reformations (MPR) of multi-slice spiral CT.METHODS:The dimensions of the pedicles (C3-7) were determined in 60 patients with cervical spinal lesions from CT images. Measurements of pedicle height, width, pedicle axis length, effective length, and two angles of the pedicles, the distances from the projection point of the pedicle axis to the lateral edge of the lateral mass and the inferior edge of the superior facet were measured. RESULTS AND CONCLUSION:The outer pedicle width was smaller than the height in most of the pedicles. This measurement was significantly different between male and female patients in outer pedicle width of pedicle at C₃ and C₄. The distances from the projection point to inferior edge of the superior facet did not show uniform pattern of change from C₃ to C₇, whereas the distances from the projection point to the lateral edge of the lateral mass consistently increased from cephalad to caudal. The smallest pedicle transverse angle was at C₇ in male and female. Transpedicular screw placement for the cervical pedicle of C₃, C₄ must be cautious in the Chinese female population before the exact pedicle transverse diameters are known. Most of cervical pedicle (C_5-7) in a Chinese population is suited for pedicle fixation of 3.5 mm screw. Taking into consideration some variations between individuals, these data combined with evaluation of results of preoperative computed axial tomography are required before operation.