C7棘突的体表定位观测及其临床意义

目的　研究健康成年人C7棘突体表触诊定位的准确性，探讨其原因及临床意义。 方法　选取健康成年志愿者500名（男性354名、女性146名），由3名骨科主治医师应用触诊法，对其进行C7棘突的体表定位并用铝片标记，再拍摄颈椎正侧位X线片，然后观察C7棘突的体表触诊定位准确率。同时，通过X线、CT三维重建测量C6、C7、T1棘突的长度，并对测量结果进行分析。 结果　98.8%（494名）的被检者能通过体表触诊准确定位C7，1.2%（6名，均为男性）的被检者体表触诊定位于C6。在X线中，C6的棘突长度为(2.97±0.11) cm，C7为(3.16±0.16) cm，T1为(3.20±0.15) cm；在CT三维重建中，C6的棘突长度为(2.98±0.12) cm，C7为(3.18±0.17) cm，T1为(3.50±0.16) cm。无论是X线还是CT三维重建，三个椎体棘突长度都具有统计学差异（P<0.01），但两种影像学检查手段所测得的C6、C7、T1棘突长度不具有统计学差异（P>0.05）。 结论　C7棘突的体表触诊定位方法受到多种因素的影响，可能存在一定的误差。临床可利用颈椎X线、CT等辅助方法确保其诊治的准确性、安全性。

Positioning surface observation of C7 spinous process and clinical significance

Objective　The aim of this study is to study the accuracy of C7 spinous process on palpation positioning of healthy adults, and to explore the causes and clinical significance.　Method　500 healthy adult volunteers (354 males and 146 females) were enrolled into this study. Three orthopedic physicians used palpation to locate the surface mark of the C7 spinous process with an aluminum sheet, and then the surface palpation positioning accuracy of the C7 spinous process was observed by cervical lateral X-ray. Meanwhile, the length of C6, C7 and T1 was measured by X-ray and CT 3D reconstruction, and the results were analyzed. Result 98.8% (494) of the subjects’ C7 could be accurately positioned through surface palpation, but surface palpation of 1.2% (six subjects were male) subjects was positioned in C6. In X-ray, the length of C6 spinous process was （2.97±0.11）cm, the length of C7 spinous process was （3.16±0.16）cm, the length of T1 spinous process was（3.20±0.15）cm; in CT 3D reconstruction, the length of C6 spinous process was （2.98±0.12）cm, the length of C7 spinous process was （3.18±0.17）cm, the length of T1 spinous process was （3.50±0.16）cm. In X-ray and CT 3D reconstruction, there was statistically significant difference (P< 0.01) in three vertebral spinous process length, but there wasn’t statistically significant difference (P> 0.05) in the length of C6, C7, T1 spinous process as measured by the two kinds of imaging examination. Conclusion The surface palpation positioning method of C7 spinous process was affected by many factors, so there may be some errors. X-ray, CT and other auxiliary methods can be used to ensure the accuracy and safety of clinical diagnosis and treatment.