数字化三维测量下胸椎节段血管应用解剖的临床意义☆

背景:脊柱下胸段疾患较为多见,但其解剖结构较为复杂,节段血管走行尚缺乏系统研究。目的:通过三维数字化重建测量分析下胸段节段血管结构关系。方法:选择2010至2011年无胸腰椎骨折病者32例。采用高压注射器肘静脉注射碘海醇后24-30s后采用CT机对其进行连续水平扫描,扫描后数据导入Mimics软件三维重建下胸段节段血管结构并测量节段血管间距,比较左右侧别、性别、身高的差异和关系。结果与结论:下胸段节段血管位置分布较为恒定,且随着脊柱节段增加距离逐渐增加,相同节段左右血管对称分布,男性节段血管间距大于女性,差异有显著性意义,节段血管间距与身高成正相关。提示临床选择侧前方置钉点时及钉棒或钢板时,随着脊髓节段的增加,要加长钉棒和钢板的长度,以避免其损伤。身高高的男性患者要选择更长的钉棒和钢板,以合理避开节段性血管。

Clinical significance of lower thoracic vertebral segment blood vessel with digital three-dimensional measurement

BACKGROUND： The diseases of lower thoracic vertebral segment are common, but it’s anatomical structure is complex, and there lacks of the studies on segmental blood vessel. OBJECTIVE： To analyze the structure of lower thoracic vertebral segment blood vessel with digital three-dimensional reconstruction measurement. METHODS： We selected 32 cases without thoracolumbar fracture from 2010 to 2011. Intravenous injection of iohexol was performed with high pressure injector, and at 24-30 seconds after injection, CT machine was used for the continuous horizontal scan, then the scanning data were imported to the Mimics software for the three-dimensional reconstruction of lower thoracic vertebral segment blood vessel structure and the measurement of distance of segmental blood vessel. The difference of sides, genders and height was compared, as well as the relationship between them. RESULTS AND CONCLUTION： The location and distribution of lower segment of thoracic blood vessel werehomeostasis, and with the increasing of spinal segments, the distance was gradually increased; the left and the right blood vessels in the same segment were distributed symmetrically, but the segmental vessels spacing of the male patients was bigger than that of the female patients, and the difference was significant, the segmental vessels spacing was positive correlated with height. It indicates that when we clinically select the lateral anterior point as the placement point for the screw, as well as the nail rods or steel plate, we have to lighten the length of the nail rods and the steel plate in order to avoid the injury with the increasing of the spinal segment. The male patients with higher height should select the longer nail rods and steel plate to avoid the segmental blood vessel reasonably.