颈椎解剖形态特征的螺旋CT分析

目的：观察螺旋CT分析颈椎的横断面、正中矢状面图像重建各椎体间隙高度，各椎体间宽度以及颈长肌间宽度，为颈椎前路椎体次全切除、移植物的选择、钢板和螺丝长度的选择提供相关解剖学依据。 方法：选择2004-12／2005-0l惠州市中心人民医院骨科收治怀疑颈椎损伤患者60例，男30例，平均年龄（41．5&;#177;15．1）岁，女30例，平均年龄（36．5&;#177;12．1）岁。排除颈椎病理改变。60例患者行颈椎CT扫描，扫描范围C2～T1，扫描电压140kV，200～250mA。横断面扫描层厚3mm。矢状面和冠状面重建。在横断面图像中测量：①C3-7各椎体正中平面的颈长肌内侧缘距离，精确到0．1mm。②测量各椎体正中平面的椎体横径。在正中矢状面重建图像中测量：①C3-7各椎体的上终板、椎体正中、下终板的最大前后径。②C3，C4，C5，C6下终板正中分别至C4-7，C5-7，C6-7，C7各椎体上终板正中距离。③C3，C4，C5，C6下终板前缘分别至C4-7，C5-7，C6-7，C7各椎体下终板前缘距离。 结果：纳入患者60例，均进入结果分析。①男女性患者C3-4，C4-5，C5-6，C6-7。平均椎间隙高度分别为（5．6&;#177;1．0），（5．1&;#177;0．8）mm，女性低于男性（P〈0．05）。②男女性患者平均椎体间宽度分别为（26．6&;#177;4．1），（24．1&;#177;3．1）mm。男性最窄的椎体是20．3mm，位于C3，最宽的椎体是36．0mm，位于C7。女性最窄的椎体为19．2mm，位于C3，C4，最宽的椎体是32mm，位于C7。在每一椎体水平，女性比男性的更窄（P〈0．05）。③男女性患者椎体正中颈长肌内侧缘宽度平均为（14．3&;#177;2．7），（13．0&;#177;2．3）mm，女性低于男性（P〈0．05）。④男性在正中矢状面中椎体上终板，正中、下终板前后径平均为（17．4&;#177;1.5），（17．0&;#177;1．3），（18．1&;#177;1．5）mm。除C3椎体外，所有椎体平均正中前后径比上下终板前后径略小。C3椎体正中前后径比上终板前后径稍大，但比下终板前后径小。椎体前后矢状径最小13．9mm，位于C6中矢状径，最大21．5mm，位于C5下终板矢状径。女性在正中矢状面中椎体上终板、正中、下终板前后径平均为（14．9&;#177;1．3），（14．7&;#177;1．2），（15．8&;#177;1．3）mm。椎体前后矢状径最小12．5mm，位于C3上终板，最大19．4mm，位于C4下终板。 结论：颈前路手术，术前需行CT测量以上数据，有利于术中减少脊髓、椎动脉损伤等并发症，有利于术中选择长度合适的移植物、钢板、螺丝。     

螺旋CT扫描下测量颈椎椎弓根尺寸及螺钉置入角度

背景:在所有固定颈椎的技术上,椎弓根螺钉内固定可提供最大稳定性,但如进钉角度不正确易伤及颈髓、神经根和椎动脉。目的:测量下颈椎椎弓根尺寸和螺钉置入角度。设计、时间及地点:以正常人颈椎为对象的对比观察,于2004-12/2008-05在惠州市中心人民医院放射科完成。对象:选择惠州市中心人民医院骨科收治怀疑颈椎损伤患者60例,男30例,平均(42.9±18.9)岁;女30例,平均(42.2±14.9)岁。排除颈椎病理改变。CT下画经过椎弓根内外侧2条平行线与中线分别成50°和25°角,测量2条平行线间的垂直距离。方法:60例患者行颈椎CT扫描,扫描范围C2～T1,扫描电压140kV,电流200～250mA。主要观察指标:测量C3～C7椎弓根外径、内径和内壁皮质骨厚度,椎弓根轴长度、椎弓根进钉点到中线的垂直距离、椎弓根长轴与中线的夹角及椎弓根螺钉的有效距离。结果:颈椎椎弓根平均内径为1.3～3.3mm,平均外径为4.0～7.0mm,最小的椎弓根宽度在女性C3椎体,最小的椎弓根外径为3.2mm,最大椎弓根宽为C7,男性为11.1mm,女性为6.6mm。平均内壁皮质骨厚度为1.5～1.9mm,平均椎弓根轴长度29.3～33.7mm,平均椎弓根长轴与中线的夹角40.6°～49.6°,颈椎弓根钉进钉点到中线的垂直距离平均为20.2～23.7mm。椎弓根螺钉的有效距离(与中线成50°角)平均值3.8～6.6mm,最小值2.2mm,与中线成25°角的平均值2.8～4.4mm,最小值1.4mm。结论:颈椎椎弓根螺钉的置入应行CT测量,螺钉角度接近50°,进钉时保持向内的倾斜角度,防止损伤脊髓和椎动脉。     

利用螺旋CT数据建立上颈椎三维有限元模型

目的：建立上颈椎三维有限元模型．以期应用于临床相关的生物力学实验研究。方法：通过对正常人的CT薄层扫描获得原始DICOM图像数据．采用CAD数据处理技术进行计算机三维重建．改良建立的模型导进ANSYS9．0软件进行计算机模拟仿真生物力学研究。结果：所建模型外观清晰逼真。几何相似性好。三维重建结构可以单独或联合显示。甚至可行结构的任意取舍，重建结构的任意径线及角度均可进行适时三维测量。结论：该技术为临床医生对枕颈交界区有限元三维模型的建立提供了一种便捷而精确的方法，对计算机分析及研究该模型局部结构在各种受力情况下的生物力学表现创造条件。     

64层螺旋CT对肺静脉的形态定量分析

目的用64层螺旋CT定量分析肺静脉直径、截面积及形状。方法分析102例病人,除外影响肺静脉疾病者,进行心脏冠状动脉增强螺旋CT扫描。在工作站用肺静脉血管分析软件,测量4条肺静脉主干的直径(平均直径,最大值,最小值)及截面积。比较男女之间肺静脉直径、截面积和圆率的差异性、4条肺静脉圆率的差异性及4条肺静脉年龄分组的差异性。结果4条肺静脉口平均直径变化较大,右上肺静脉口直径为20.3 mm,右下肺静脉口直径为17.0 mm,左上静脉口直径为18.1 mm,左下肺静脉口直径为13.9 mm。右下肺静脉的平均直径和截面积在男女之间有明显统计学差异性(P值分别为0.022和0.017),肺静脉皆不是完全的圆形,右下肺静脉圆度最大,左下肺静脉圆度、直径和截面积最小(P≈0.000<0.05),4条肺静脉皆由细逐渐增粗进入左心房。左侧肺静脉的平均直径和截面积在年龄分层上有统计学差异(P=0.01及0.008)。结论肺静脉的直径、截面积及形状变化较大,在评估肺静脉狭窄时应特别注意。64层螺旋CT可以无创性地评估肺静脉。     

肠系膜扭转的多层螺旋CT与X线平片征象分析

目的探讨多层螺旋CT对肠系膜扭转的诊断价值.方法回顾性分析15例经手术和临床证实肠系膜扭转患者的多层螺旋CT表现,并与X线平片征象对比分析。结果 13例肠系膜扭转CT显示"漩涡征",而X线平片11例显示气液平,1例显示正常,1例显示腹腔密度增高,未见气液平。2例肠系膜扭转CT显示"鸟嘴征",X线平片显示正常。结论诊断肠系膜扭转,多层螺旋CT检查优于X线平片。     

定量CT测量女性颈椎与腰椎骨密度

目的 探讨女性颈椎骨密度与腰椎骨密度的差异及相关性。方法 对46名女性志愿者于同一天行颈椎及腰椎定量CT(QCT)扫描,记录各椎体骨密度数据。分别应用配对样本t检验及Pearson相关分析比较颈椎与腰椎平均骨密度的差异及相关性;采用方差分析比较各椎体骨密度均数,采用LSD法进行组间的两两比较。结果 颈椎平均骨密度为(281.81±76.13)mg/cm³,腰椎为(147.49±39.65)mg/cm³,二者差异有统计学意义(t=19.462,P<0.001)。颈椎与腰椎平均骨密度的相关性高(r=0.86,P<0.001)。结论 女性颈椎平均骨密度高于腰椎,并与腰椎平均骨密度相关性高。     

多层螺旋CT诊断急性颈椎损伤35例分析

对我院2003年以来临床及多层螺旋CT诊断急性颈椎损伤35例分析如下。     

上颈椎骨折的多层螺旋CT重建分析

对我院2005-01～2006-02收治的上颈椎骨折患行多层螺旋CT（MSCT）重建分析如下. 1 对象和方法 1.1 对象 男20例,女8例,平均35（15～49）岁.其中寰椎骨折4例,枢椎椎体骨折6例,Hangman骨折5例,枢椎侧块骨折6例,齿状突骨折7例.     

64层螺旋CT观察双侧肾动脉解剖变异

目的 利用64层螺旋CT血管造影探讨肾动脉解剖变异的类型及双侧肾动脉解剖变异的临床意义.方法 回顾性分析250例患者的肾动脉64层MSCTA影像资料,观察肾动脉的解剖变异并根据主肾动脉的数量对肾动脉解剖进行分类、分型.结果 肾动脉解剖变异分别占病例数和肾脏数的39.20%(98/250)和22.80%(114/500),其中肾动脉提前分支和副肾动脉变异发生率分别为9.60%(48/500)和11.80%(59/500),性别、左右肾之间肾动脉变异发生率无显著性差异.单侧和双侧肾动脉解剖变异的发生率分别为32.80%(82/250)和6.40%(16/250),双侧肾动脉的解剖变异组合呈现多样性.结论 64层螺旋CT血管造影可清晰显示肾动脉的解剖变异.双侧肾动脉解剖变异类型对于肾脏移植手术供肾的选择具有重要临床意义.     

基于64层螺旋CT的筛板解剖研究

目的 以64层螺旋CT测量筛板相关解剖学指标及其发育特点.方法 按年龄组随机选取420例(840侧)接受鼻窦或眼眶64层螺旋CT检查的患者,冠状位及矢状位均以硬腭为参考平面,分别测量筛板水平板中点高度、筛板水平板宽度及前后倾斜度、筛板外侧板高度及其与水平板的夹角.结果 ≤12岁男性及≤11岁女性筛板水平板中点高度与年龄呈高度线性相关(男:r=0.82.女:r=0.80).男、女左侧筛板水平板中点高度高于右侧(t=7.81,P＜0.001),男、女左侧筛板水平板中点高度差异有统计学意义(t=6.63,P＜0.001),男、女右侧筛板水平板中点高度差异有统计学意义(t=6.45,P＜0.001).筛板水平板宽度为(2.81±0.47)mm,各年龄组差异无统计学意义(F=1.25,P=0.24),男、女及左、右筛板水平板宽度差异无统计学意义(t=1.79、0.98,P=0.07、0.33).各年龄组筛板水平板前后倾斜度差异无统计学意义(F=1.33.P=0.22);男、女及左、右筛板水平板前后倾斜度差异无统计学意义(t=0.79、1.43,P=0.43、0.15).各年龄组筛板外侧板的高度差异无统计学意义(F=1.11,P=0.35);左侧筛板外侧板高度高于右侧(t=4.70,P＜0.001),男、女左侧、右侧筛板外侧板高度差异无统计学意义(t=1.32、1.51,P=0.17、0.13).左右侧、男女筛板外侧板角度差异无统计学意义(t=0.78、1.03,P=0.43、0.30).筛板外侧板与水平板的夹角为(120.70±9.85)°,与年龄呈低度线性相关(r=0.18),筛板外侧板高度与筛板外侧板及水平板的夹角呈低度线性相关(r=0.25).结论 ≤12岁男性及≤11岁女性筛板高度有随年龄增长的趋势,男性筛板高于女性,左侧高于右侧.筛板水平板宽度及前后倾斜度、筛板外侧板高度、角度无明显随年龄增长趋势.     

The anatomy of surgical approaches to the cervical spine

The authors present the anatomical basis of surgical approaches to the cervical spine. The posterior, anterior, and transpharyngeal approaches are described, with particular attention to orientation structures, incisions, surgical dissection, and anatomical considerations regarding various hazards encountered during surgery of the cervical spine.     

颈椎旋转对颈椎间孔形态的影响

目的　分析旋转对颈椎间孔形态的影响 ,并探讨其对临床工作的指导意义。方法　对 10名健康志愿者分别于颈椎中立位及旋转位利用多层螺旋CT进行自C3 椎体上缘至C7椎体下缘的横断面扫描 ,并在C3～ 4、C4～ 5、C5～ 6、C6～ 7椎间孔斜 45°的重建图像上测量椎间孔的上下径、上前后径、下前后径及截面面积 ,比较旋转时颈椎间孔形态的变化。结果　旋转时旋转侧颈椎间孔截面面积减小 ,对侧椎间孔截面面积增大 ,C3～ 4椎间孔面积变化率与C3 、C4间旋转角度亦存在相关性。结论　旋转可影响颈椎间孔的形态 ,且其相互间存在一定的相关性。此结果对颈椎病 ,尤其是神经根型颈椎病的预防、诊断和治疗有临床指导意义。     

Use of helical computed tomography for imaging the pediatric cervical spine

OBJECTIVE: To determine the differences in resource utilization and radiation exposure between conventional radiography (ConvRad) and helical computed tomography (HCT) when used to survey the pediatric cervical spine (CSp). METHODS: Patients aged 0-14 years who required CSp radiographic evaluation in addition to cranial CT were prospectively enrolled and assigned to undergo either HCT or ConvRad with adjunctive linear tomography. Outcomes of medication usage, emergency department (ED) length of stay (LOS), cervical spine radiation exposure, and imaging resource use (relative value unit [RVU]) were compared between the two groups. Data were analyzed by regression analysis with adjustment for confounders. RESULTS: Of 136 patients, 64 and 72 patients were assigned to the ConvRad group and HCT group, respectively. At the discretion of the trauma team, 34% of the patients enrolled crossed between the two study arms. Odds ratio (OR), based on original assignment, was 0.8 (95% CI = 0.4 to 1.8) for difference in medication usage between the two groups. Mean LOSs were 259 minutes (95% CI = 124 to 394) and 183 (95% CI = 166 to 200) minutes for HCT and ConvRad, respectively. CSp imaging RVUs were 5.5 (95% CI = 5.1 to 5.8) for HCT and 4.0 (95% CI = 3.3 to 4.6) for ConvRad. Mean CSp radiation doses were 389 mRem (95% CI = 346 to 432) for HCT and 294 mRem (95% CI = 245 to 343) for ConvRad. Adjustment for confounders did not change the direction of the results. CONCLUSIONS: As a modality to screen the pediatric CSp for blunt-force trauma, HCT results in increased radiation exposure and radiology resource use without a reduction in sedation usage or time in the ED.     

The pediatric cervical spine: developmental anatomy and clinical aspects

The radiographic interpretation of the pediatric cervical spine can be a perplexing problem for the emergency physician. Given the wide range of variances in the ossification centers, the unfused synchondroses, and the relative hypermobility of the pediatric cervical spine, radiographs may be easily misread if one is not thoroughly familiar with the developmental anatomy and variants. This paper discusses those developmental aspects of the pediatric cervical spine that impact on emergency radiographic interpretation. Frequently encountered pediatric cervical spine fracture/dislocations are reviewed with an analysis of age-related distributions. Finally, the syndrome of Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) is discussed.     

单排螺旋CT行肺低剂量扫描的应用价值

目的探讨单排螺旋CT行肺低剂量扫描的技术可行性及其应用价值。方法从132例行肺低剂量扫描的受检者中,选择13例作为单排螺旋肺低剂量扫描(50mAs)与常规剂量扫描(170mAs)的对照对象(7例已确诊肺外恶性肿瘤肺内有多发转移结节,3例有肺内孤立结节,3例有肺内类结节斑点状病灶),对比两种扫描诊断效果,从肺内结节的数量及其细节征象和肺各叶段支气管的检出几方面比较。分析单排螺旋CT肺低剂量扫描参数及其总计毫安秒量,评价该扫描技术的可行性和安全性。结果两种扫描对肺内结节数量,大小的检出均相同,对肺内结节细节征象和肺各叶段支气管的检出无显著性差异(χ2=0.123～3.39,P>0.05)。低剂量扫描毫安秒量约为常规剂量的29%。结论单排螺旋CT肺低剂量扫描,是一种安全、有效、可行的筛查早期肺内结节病变的检查方法。     

Posterior disk displacement: Morphologic assessment and measurement reliability—cervical spine

Background: Magnetic resonance imaging (MRI) is often used to assess for disk displacement after manipulation, but limited information about the true incidence of iatrogenic herniations exists. Preliminary data must be obtained concerning the size of different types of displacement to further assess this relationship. The reliability of chiropractic radiologists in assessing disks, and a comparison of measuring devices should be evaluated. Objective: To identify average measurements for normal and displaced disks and to assess the reliability of measurements by chiropractic radiologists. Study Design: Intraobserver and interobserver reliability study assessing cervical disk displacement on MRI scans. Methods: Three evaluators assessed the disks on 106 MRI scans. Six categories were assessed and compared. Thirty-seven scans were reassessed for intraobserver comparisons. Interobserver and intraobserver variations and measurement-device correlations were determined. Results: Interexaminer measurement reliability for the 2 devices was 0.80 to 0.84. Intraexaminer reliability ranged from 0.58 to 0.94. Interexaminer and intraexaminer agreement for the presence of disk displacement was 86% (κ = 0.69) and 78% to 85% (κ = 0.50-0.67), respectively; for the presence of osteophytes, 92% (κ = 0.54) and 86% to 95% (κ = 0.60-0.80); and for the classification of disk displacements, 76% (κ = 0.53) and 73% to 80% (κ 0.44-0.61). Distinguishing between normal versus bulged disks demonstrated the greatest classification disagreement. Clear size differences between the types of disk displacement were noted. The ruler and digitizer correlation coefficient was 0.96. Conclusions: Interexaminer and intraexaminer agreement were good to very good concerning measurements and fair to good concerning disk assessments. Different disk displacement types demonstrated obvious mean size differences. No significant mean difference in measurements between the ruler and the digitizer was noted. (J Manipulative Physiol Ther 2001;24:560-8)