新型上颈椎前路钩状钛板的研制及应用解剖学基础

目的:通过解剖测量C1～3获得形态学参数为研制上颈椎前路钩状钛板提供解剖学依据.方法:采用40套正常成人干燥寰枢椎骨标本及50例正常成人颈椎侧位X线片测量C1～3的相关参数,并进行统计学分析,据此设计上颈椎前路钩状钛板,并在3具成人尸体标本上模拟钩状钛板置入并植骨术.结果:寰椎前弓宽度(AW)为(20.06±1.16)mm、前弓高度(AH)(10.61±1.04)him、前弓厚度(AT)(4.09±0.66)mnl;齿突横径(DW)(9.80±0.83)mm、齿突前后径(DD)(10.13±0.63)mm;寰枢椎体前缘高(VAH)(22.03±1.99)nHn、前缘横径(TD)(16.80±1.26)mm、前后径(AP)(16.14±1.06)mm;寰枢椎前缘总高度(AAOH)(37.44±3.2)mm、C2/3椎间盘前缘高(C2/3IVDHA)(4.55±0.64)mm、C3椎体前缘高(C3BHA)(13.31±1.39)mm.前路钩状钛板由一对钩形钛板和配套螺钉构成,其中钛板分为C1～2和C1～3两种型号.结论:颈椎前路钩状钛板的设计在形态学上具有可行性,各部件参数有一定的选取范围,其能在颈前侧咽后入路下安装,既能够避免进口咽入路的并发症又能重建寰枢关节的稳定性,具有牢靠安全、操作简便的特点.     

下颈椎侧方椎间孔镜入路的应用解剖

目的　探讨经下颈椎侧方臂丛后解剖间隙进行椎间孔镜手术的可行性。 方法　40侧成人尸体标本,沿胸锁乳突肌后缘对应C3~7椎体作纵切口,由浅入深经臂丛前、后方按临床手术显露椎间孔途径逐层解剖观测至椎体及附件结构,并模拟手术,牵拉相应组织,测量其牵拉角度、范围。 结果　①臂丛C5~8根长度、根角度及根间距测量结果表明臂丛前、后入路均可直视神经根对椎间孔周围病变进行操作;② C4~6横突与膈神经的距离测量结果表明与臂丛前入路相比,臂丛后入路不易伤及膈神经;③C3~7横突与颈交感干的距离测量结果表明与臂丛前入路相比,臂丛后入路不易伤及颈交感干;④胸导管70%在C7~T1水平汇入静脉角,C7水平臂丛前入路要注意保护胸导管,臂丛后入路不易损伤胸导管;⑤在C7横突水平处将椎动脉向外牵拉的距离为(2.5±0.4)cm,臂丛前、后入路均应注意保护椎动脉;⑥C7横突末端下方至胸膜顶的距离为(1.9±0.4)cm,C7水平臂丛前、后入路均可能伤及胸膜顶。 结论　下颈椎侧方臂丛后解剖间隙可为颈椎间孔镜手术提供安全的手术入路。     

Osteophytes on the zygapophyseal (facet) joints of the cervical spine (C3–C7): A skeletal study

Previous studies have reported that osteophytes in the cervical vertebrae may cause immobility, neck stiffness, osteoarthritis, headaches, nerve entrapment syndromes, and compression of the vertebral artery. Our objective was to explore the osteophytes' expression on zygapophyseal joints C3–C7. This is a cross-sectional observational skeletal study. The study sample comprised 273 human skeletons of both sexes, aged 20–93, housed at the Natural History Museum, OH, USA. A grading system assessed the presence and severity of osteophytosis on the zygapophyseal joints. The chi-square test (SPSS 25.0) examined the association between osteophytes and demographic factors. The level of significance (α) was set at .05. The highest prevalence of osteophytes was found on C5 vertebra, the lowest on C7. On vertebrae C3, C4, C6, the rate of moderate and severe osteophytes found on the superior and inferior facets were comparable. Moderate and severe degrees of osteophytes were observed more frequently on the superior facets, whereas, on vertebra C7, osteophytes were found on the inferior facet joints. Osteophytes' prevalence was significantly higher in the elderly compared to the younger population. Osteophytes in the C3–C7 zygapophyseal joints are age-dependent. No significant sex and ethnic differences were observed. Vertebra C5 was most prone to develop osteophytes, most probably due to its location in the cervical lordotic peak, C5 in the superior ZF; C7 in the inferior ZF are significant (p = .05). The zygapophyseal joints of C7 were least frequent overall, yet, the C7 inferior facets had significantly more moderate–severe osteophytes compared to other cervical vertebrae.     

Double Foramen Transversarium in Cervical Vertebra an Osteological Study

50 sets of typical dried cervical vertebrae of human were studied for no. of foramen transversarium present on each transverse process of vertebra. So double foramen transversarium were detected unilaterally or bilaterally in 16 vertebrae out of 200 typical (C3-C6) cervical vertebrae. The variation of foramina appears to follow a pattern at various vertebral level.The course of vertebral artery may be distorted under such conditions. The normal factor responsible for such anomalies of foramen transversarium is developmental or related to the variation of course of vertebral artery.     

下颈椎观测对颈椎前路手术的意义

目的为下颈椎前方入路提供应用解剖学基础。方法测量广东地区出土成人干燥下颈椎(C3～C7)标本40套。测量项目包括椎体的前高、中高、后高、上矢径、中矢径、下矢径、上横径、中横径、下横径以及钩突间距。结果下颈椎椎体上横径平均为19.2mm,中横径21.1mm,下横径22.2mm;椎体上矢径平均为15.3mm,中矢径14.9mm,下矢径16.1mm。结论本文的测量数据为改进下颈椎前路手术及减少手术并发症提供了解剖学依据。     

Osteophytes in the Cervical Vertebral Bodies (C3–C7)—Demographical Perspectives

Vertebral osteophytes are an age-dependent manifestation of degenerative changes in the spine. We aimed to determine the prevalence and severity of cervical osteophytosis in a large study population. To do so, we developed a grading system for osteophytosis, enabling the assessment of their presence and severity in the cervical spine, and applied it to the analysis of dried cervical vertebral bodies (C3–C7) from 273 individuals. Statistical analyses were carried out per motion segment, while testing for the effect of age, sex, and ethnicity. The highest prevalence of osteophytes was found in motion segment C5/C6 (48.2%), followed by C4/C5 (44.1%), and last C6/C7 and C3/C4 (40.5%). Severe osteophytes are most commonly seen in motion segment C5/C6. In all motion segments, the inferior discal surface of the upper vertebra manifests more osteophytes than the superior discal surface of the lower one. Osteophytes prevalence is sex-dependent only in the upper cervical vertebrae (C3–C4), and age- and ethnicity-dependent for all vertebrae. Anat Rec, 302:226–231, 2019. © 2019 Wiley Periodicals, Inc.     

生物力学评价颈椎前路椎弓根螺钉植入骨质疏松椎骨内的稳定性

背景：前路颈椎间盘切除植骨融合是治疗颈椎病的有效术式,该术式能够提供坚强固定且植骨融合率相对较高。但是,对于2个节段以上同时受累的颈椎,由于植骨跨度较大,内固定和植骨块稳定性较差,容易产生植骨融合失败、假关节形成等并发症,影响疗效。 目的：观察颈椎前路椎弓根螺钉植入骨质疏松椎骨内的生物力学稳定性。 方法：纳入12具人颈椎骨,包括6具骨密度正常颈椎骨和6具骨质疏松颈椎骨,共60个椎骨标本资料进行分析,将30个骨质疏松椎骨标本植入颈椎前路椎弓根螺钉设为颈椎前路椎弓根螺钉组,将30个骨密度正常椎骨标本植入前路椎体螺钉设为前路椎体螺钉组。从上述两组中根据骨密度值抽取40个椎骨,分别设置为即时正常骨密度组、即时骨密度疏松组、疲劳正常骨密度组以及疲劳骨质疏松组,每组10个椎骨。采用双能X射线骨密度仪测定各椎体骨密度值,采用ElectroForce 3510材料试验机对两种螺钉进行生物力学指标测试。 结果与结论：颈椎前路椎弓根螺钉组骨矿盐含量、椎体螺钉拔出力、椎体螺钉拔出刚度、椎弓根螺钉拔出力、椎弓根螺钉拔出刚度均显著高于前路椎体螺钉组(P < 0.05)。颈椎前路椎弓根螺钉即时正常骨密度标本最大轴向拔出力、即时骨质疏松标本最大轴向拔出力、疲劳正常骨密度标本最大轴向拔出力、疲劳骨质疏松标本最大轴向拔出力均显著高于高于前路椎体螺钉(P < 0.05)。结果证实,与颈椎前路椎体螺钉相比,颈椎前路椎弓根螺钉在骨质疏松椎骨内生物力学性能更加稳定。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

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。     

下颈椎椎动脉孔及其毗邻的解剖学和影像学观测

目的：为下颈椎前路手术预防椎动脉损伤提供解剖学数据。方法：(1)取20具尸体的C3～7段作为解剖标本,作两侧椎动脉孔内缘间距、椎体横、矢径、椎动脉孔内缘和椎弓根内缘间距、椎动脉孔内缘和椎体外缘间距、 椎动脉孔内缘和钩突关节内外缘间距、椎动脉孔前后缘与椎体前后缘的垂直距离、 椎动脉孔矢径的测量。(2)选30例已确诊为颈椎病患者和50例正常人作为检测对象,用CT测量上述数据。 结果： (1) C_3～7两侧横突孔内缘间距、椎体横径、椎体矢径、C_3～6椎动脉孔矢径逐渐增大。(2) 钩突内缘与椎动脉孔内缘间距在6 mm之内, C_3～6椎体外缘与椎动脉孔内缘间距不超过3 mm。(3) C_3～6 横突孔矢径和椎体矢径比值恒定(30.32%～31.86%), C_3～5 椎动脉孔前缘与椎体前缘距离逐渐减小,C_3～5椎动脉孔后缘与椎体后缘距离逐渐增加。结论：本文的测量数值与不同个体的椎动脉资料相结合,为预防椎动脉损伤提供了解剖学依据。     

颈椎横突孔及其附近骨性结构的观察

作者观察356个颈椎(51具成人干燥骨骼)的横突孔。观察有关横突孔指向、圆度、变异及其附近骨性结构的骨赘和横突孔内骨棘诸项内容,对变异、骨赘和骨棘的好发部位及临床意义进行讨论。     

颈神经根槽和颈椎间孔的应用解剖

目的：为颈椎病的病因、诊断和治疗提供补充的定量数据。方法：在干燥的颈椎椎骨标本和福尔马林固定的颈椎标本上，测量颈神经根槽和颈椎椎间孔。结果：内侧区的平均长度，内侧区前缘中点到椎体中线的距离从C3～C7逐渐增加。C3内侧区的宽度较大，C7上、下关节突及峡部高度之和的后中点到颈神经根槽后壁的前后距离最小。结论：研究结果为影像诊断和外科手术提供了相关的应用解剖数据。     

Sacralization is not associated with elongated cervical costal process and cervical rib

Cervical rib/elongated costal process of the seventh cervical vertebra and sacralization of a lumbar vertebra are associated with clinical problems-neurological, vascular, and obstetrical. A previous study reported an association between these morphologies, and suggested that clinicians use presence of one trait to predict presence of the other. This study tested three hypotheses from this association: costal process length among individuals with sacralization differs from that among individuals without sacralization for: (1) only the seventh cervical vertebra, (2) only transitional presacral vertebrae-seventh cervical, twelfth thoracic, and fifth lumbar, and (3) presacral vertebrae in general. Skeletons of 961 individuals between ages 20 and 49 years from the United States were surveyed for sacralization. Costal process length was measured on 100 individuals with sacralization and 184 without sacralization for cervical vertebrae 3 to 7, thoracic vertebrae 11 and 12, and all lumbar vertebrae. Cervical rib was evaluated for 102 individuals with sacralization and 472 without sacralization. Results showed that 11% (105 of 961) of individuals have sacralization. Compared to individuals without sacralization, those with sacralization: (1) have significantly longer costal process for the last lumbar vertebra, but are nonsignificantly different for costal process lengths of other vertebrae, (2) are nonsignificantly different in prevalence of cervical rib-2.9% with sacralization and 0.4% without sacralization, and (3) are significantly more likely to have an extra presacral vertebra. Clinically, results suggest that sacralization is not a predicate for either cervical rib or elongated costal process of the seventh cervical vertebra.     

下颈椎前路椎弓根皮质骨螺钉的解剖学研究

目的 测量正常成人下颈椎椎弓根的解剖学参数,探讨下颈椎前路椎弓根皮质骨螺钉内固定技术的可行性。 方法 随机选取80例正常成人颈椎CT影像资料,将扫描数据导入MIMICS 19.0软件。测量C3~C7椎体的椎弓根宽度（OPW）、椎弓根高度（OPH）、内侧皮质骨厚度（MCT）以及颈前路椎弓根皮质骨螺钉置钉参数,进行统计学分析。 结果 各节段左右两侧 OPH 和 MCT 参数的差异有统计学意义（P<0.05）。测量男性的 OPH 和 OPW 参数均大于女性,差异有统计学意义（P<0.05）。C3~C4进钉点位于椎体正中矢状面椎弓根的对侧1.0~3.0 mm,距椎体上终板平面1.0~3.5 mm;C5进钉点位于椎体正中矢状面椎弓根同侧或对侧1.0~2.0 mm,距椎体上终板平面3.0~4.0 mm;C6~C7进钉点位于椎体正中矢状面椎弓根的同侧2.0~4.5 mm,距椎体上终板平面4.5~7.0 mm。C3~C7的皮质骨螺钉总体内倾角平均值分别是：39.13°、41.00°、40.91°、37.28°、31.84°,总体矢状角是：90.85°、97.23°、108.97°、111.60°、104.83°。螺钉的直径为3.5 mm,长度选择30 mm,32 mm较为适宜。 结论 下颈椎前路椎弓根皮质骨螺钉内固定技术在理论上具有可行性,并总结出置钉规律,为其下一步的临床应用提供了理论依据。     

颈椎钩突形态特点及其在前外侧入路减压术中的意义

目的确定钩突的大小,为钩突切除提供形态学基础。方法50套颈椎C     

Shape analysis of the cervical spinous process

Most textbooks describe the bifid spinous process as a shape associated with the typical cervical vertebra. Somewhere later they may acknowledge that cervical vertebrae are not always bifid, and that its appearance may be asymmetric. A high incidence of bifid cervical spinous processes may be a human characteristic, but because of known racial/geographic variation it may not be a very good one. Rarely can one find a satisfactory explanation of the functional or developmental basis for this shape variation. This article explores the distinctive shape of the cervical spinous process. Analysis is based upon the spinous processes of the third through seventh cervical vertebrae from fifty individuals. Shape differences were evaluated using the techniques of geometric morphometrics. Statistical comparisons were based upon 1000 permutations of a MANOVA based analysis. Significant shape differences were identified among the cervical vertebrae. However, post hoc analysis failed to identify significant differences between the C3 and C4 and between the C4 and C5 spinous process shapes. Primary shape differences were due to the depth of the bifid separation and the length of the process. Vertebrae with shorter spinous processes tended to display a more pronounced bifid condition. Combined observations from this and several other investigations suggest that a combination of variation in the spinalis cervicis muscle and behavioral patterns associated with cervical load may provide the best explanation for the shape variation in the cervical spinous process. Clin. Anat. 30:894–900, 2017. © 2017 Wiley Periodicals, Inc.     

Malformations of the axial skeleton in Museum Vrolik I: homeotic transformations and numerical anomalies

The Museum Vrolik collection of anatomical specimens in Amsterdam, The Netherlands, comprises over 5,000 specimens of human and animal anatomy, embryology, pathology, and congenital anomalies. Recently, we rediagnosed a subset of the collection comprising dried human trunk skeletons and cranial base preparations presenting with homeotic transformations (vertebral phenotypic shifts) and numerical vertebral anomalies. We identified 11 trunk skeletons with either anterior or posterior homeotic transformations (AHT or PHT), 5 trunk skeletons with either less or more than the normal number of vertebrae, and well over a hundred cranial base preparations with either AHT (atlas-assimilation) or PHT (occipital vertebra). We found that, although homeotic transformations and numerical anomalies are distinct conditions, both can be described in terms of mismatch between homeotic patterning and morphological segmentation of the paraxial mesoderm. Therefore these two processes are perhaps not as tightly linked as they may seem on the basis of recent molecular studies. In homeotic transformations there is a constant mismatch between homeotic patterning and morphological segmentation throughout the affected region of the vertebral column. In numerical anomalies there is a variable mismatch between homeotic patterning and morphological segmentation, either because of stretching or squeezing of the homeotic pattern or because of oligo- or polysegmentation of the presomitic mesoderm (PSM). Homeotic transformations of the axial skeleton have an incidence of about 1%-5%, apart from their occurrence in malformation syndromes. Of the various etiological possibilities, explaining their frequent but mostly sporadic occurrence, maternal hyperthermia seems an attractive candidate.     

颈椎前路钢板并轴向螺钉固定治疗屈曲牵张型损伤的解剖学研究

目的　提出一种联合颈椎前路钢板固定治疗屈曲牵张型颈椎损伤的新术式-颈椎轴向螺钉固定术,进行解剖学可行性研究。 方法 随机调取50例正常成年志愿者的颈椎侧位片。年龄22～48岁,平均28岁。通过JW-PACS图像系统,测量C2～6椎体高度;C2/3～C5/6椎间盘高度以及椎间盘矢径;并模拟轴向螺钉固定,即下位椎体前下缘至上位椎体后上缘的连线,测量轴向螺钉最大长度、头倾角以及植骨块深度等。采用一例防腐成人尸体标本,在C臂X线机透视下,模拟颈椎前路钢板固定并颈椎轴向螺钉固定术。 结果 轴向螺钉最大长度为(41.18±3.92)mm,轴向螺钉头倾角为（25.21±3.58）°。植骨块合适深度应小于椎间盘矢径（17.09±1.50）mm,且大于（11.69±1.63）mm,即略大于12 mm。尸体模拟手术表明,颈椎前路轴向螺钉固定在C2/3、C3/4、C4/5、C5/6均可以顺利完成, C6/7节段由于胸骨阻挡,无法进行轴向螺钉固定。 结论 颈椎前路钢板并轴向螺钉固定术治疗屈曲牵张性损伤具有操作可行性。     

The diameter of the vertebral canal in dogs in cases of lumbosacral transitional vertebrae or numerical vertebral variations

From Th1 to L7 midsagittal and interpedicular vertebral canal diameters were measured in macerated spines of 162 dogs to determine, whether the presence of lumbosacral transitional vertebrae or numerical vertebral variations are associated with dislocation of the maximal enlargement of the lumbar vertebral canal. Relative to dogs with a regular number of 27 presacral vertebrae (C7/Th13/L7), the maximal enlargement of the lumbar vertebral canal was more frequently ( P < 0.05) located at vertebra 24 in dogs with 26 presacral vertebrae (C7/Th13/L6), and more frequently at vertebra 25 in dogs with 28 presacral vertebrae (C7/Th13/L8). However, in dogs with 26 presacral vertebrae, maximal agreement in the spinal position of maximal lumbar vertebral canal diameters was achieved relative to dogs with 28 presacral vertebrae by adding one additional thoracic (Th6, 7, or 8) segment. Therefore, the present findings strongly suggest that relative to the regular (C7/Th13/L7) condition, decrease in the number of presacral vertebrae (C7/Th13/L6) is associated with incorporation of a midthoracic segment, whereas increase in the number of presacral vertebrae (C7/Th13/L8) is not related to the presence of an additional vertebral segment. When using Th1 as landmark, the difference in the position of the maximal enlargement of the lumbar vertebral canal between dogs with 26 and dogs with 28 presacral vertebrae in average was only one segment. It is known from previous reports that the maximal enlargement of the lumbar vertebral canal corresponds with the maximal enlargement of the lumbar spinal cord. When using S1 or the transitional vertebra as the landmark for determination of the appropriate site for subarachnoid cannulation, this site is expected to range within the same limits regardless of the vertebral formula.     

Anatomic bases for anterior spinal surgery: surgical anatomy of the cervical vertebral body and disc space

Twenty adult cadaveric cervical spines were sectioned longitudinally through the midline to display longitudinal sections of the vertebral bodies and disc spaces from C3 to T1. Computer-assisted anatomic images were obtained for measurements of the disc spaces and vertebral bodies. Anteroposterior (AP) depth gradually increased from 16.56 ± 2.21 mm at C3 to 19.32 ± 2.30 mm at C7. Greater values of AP depth at the inferior endplate were found at C5 (20.75 ± 2.87 mm) and C6 (20.56 ± 2.31 mm) compared with the values at C3 (18.26 ± 1.82 mm), C4 (19.27 ± 2.88 mm) and C7 (19.21 ± 3.22 mm). The AP depth at the superior endplate was greater than that at the inferior endplate. The height of the disc space was found to be lowest at the posterior disc space from C2-3 to C7-T1 (2.95 ± 0.86 mm at C2-3, 2.78 ± 0.93 mm at C3-4, 2.45 ± 0.79 mm at C4-5, 2.92 ± 0.64 mm at C5-6, 2.46 ± 0.59 mm at C6-7, 2.93 ± 1.05 mm at C7-T1), when compared to the height of the disc space at the anterior disc space from C2-3 to C7-T1 (4.07 ± 0.85 mm at C2-3, 4.34 ± 1.18 mm at C3-4, 3.95 ± 1.37 mm at C4-5, 3.55 ± 1.37 mm at C5-6, 3.55 ± 0.76 mm at C6-7, 3.67 ± 1.17 mm at C7-T1). The mid-axis of the disc space was situated at approximately 3 mm above the anterior midpoint of the annulus fibrosus at the level of the lower cervical spine. To reach the posterior portion of the disc space from the anterior midpoint of the annulus fibrosus, a 5° cephalad angulation of the drill relative to the mid-axis of the disc space is necessary. All these original data from cadavers may be helpful during anterior approach for discectomy, vertebrectomy and anterior screw-plate placement.