CAJ | 학술논문

目的采用CT三维重建技术探讨强直性脊柱炎患者上气道解剖结构的特点.方法选择2007年1月至2011年2月在本院行头颈部上气道螺旋CT扫描的强直性脊柱炎患者31例(强直组),无困难气道因素普通患者41例(对照组),年龄20 ～ 60岁,男性,采用AW 4.4 workstation 3D-CT重建软件获取患者上气道正中矢状位图像,并测量以下10项指标:上中切牙至会厌根部的弧线距离(D1)和直线距离(D2),上颌骨长度(D3),下颌骨长度(D4),会厌根部至声门中点的距离(D5),下颌骨下缘至声门中点的距离(D6),上切牙下缘、会厌根部、声门中点三者分别以会厌根部和上切牙下缘为交点所成角的度数(角α、β),上切牙下缘、下颌骨下缘最远端、声门中点三者以下颌骨下缘最远端为交点所成角的度数(角γ),上切牙下缘、硬腭后缘、会厌根部三者以硬腭后缘为交点所成角的度数(角δ).结果与对照组相比,强直组D1、D2、D3、D4和D5差异无统计学意义(P＞0.05),D6、角α和角δ增大,角β和角γ减小(P＜0.05).结论强直性脊柱炎患者上气道解剖结构具有特异性改变,选择相应弯曲度大的喉镜镜片可能有助于气管插管的成功.
목적 채용CT삼유중건기술탐토강직성척주염환자상기도해부결구적특점.방법 선택2007년1월지2011년2월재본원행두경부상기도라선CT소묘적강직성척주염환자31례(강직조),무곤난기도인소보통환자41례(대조조),년령20 ～ 60세,남성,채용AW 4.4 workstation 3D-CT중건연건획취환자상기도정중시상위도상,병측량이하10항지표:상중절아지회염근부적호선거리(D1)화직선거리(D2),상합골장도(D3),하합골장도(D4),회염근부지성문중점적거리(D5),하합골하연지성문중점적거리(D6),상절아하연、회염근부、성문중점삼자분별이회염근부화상절아하연위교점소성각적도수(각α、β),상절아하연、하합골하연최원단、성문중점삼자이하합골하연최원단위교점소성각적도수(각γ),상절아하연、경악후연、회염근부삼자이경악후연위교점소성각적도수(각δ).결과 여대조조상비,강직조D1、D2、D3、D4화D5차이무통계학의의(P＞0.05),D6、각α화각δ증대,각β화각γ감소(P＜0.05).결론 강직성척주염환자상기도해부결구구유특이성개변,선택상응만곡도대적후경경편가능유조우기관삽관적성공.
Objective To investigate the characteristics of sagittal anatomic structure of the upper airway in patients with ankylosing spondylitis using three-dimensional reconstruction based on computed tomography (CT).Methods Thirty-one male patients with ankylosing spondylitis,aged 20-60 yr (AS group),and 41 common patients (male) without difficult airways,aged 20-60 yr (control group),who underwent spiral CT scan of the head and neck using Helical CT from January 2007 to February 2011 in our hospital,were enrolled in the study.Reconstructed images of the upper airway were obtained using AW4.4 workstation and six distances (D1-D6) and four angles (α-δ) were recorded and analyzed:(1)D1,the arc distance between the upper central incisor and root of epiglottis; D2,the distance between the upper central incisor and root of epiglottis; D3 and D4,the lengths of maxilla and mandible ; D5,the distance between the root of epiglottis and midpoint of glottis; D6,the distance between the end of mandible and midpoint of glottis; (2) angle α,the angle of line D2 and D5; angle β,the angle of line D2 and the lower edge of the upper central incisor to the midpoint of glottis; angle γ,the angle of line D4 and D6; angle δ,the angle of the point of the lower edge of the upper central incisor to the trailing edge of the hard palate and then to the root of epiglottis.Results Compared with control group,no significant change was found in D1,D2,D3,D4 and D5 (P ＞ 0.05),and D6,angle α and angle δ were significantly increased,whereas angle β and angle γ were decreased in AS group (P ＜ 0.05).Conclusion The anatomic structure of the upper airway has the characteristics of specific changes and a laryngoscope blade with a large degree of curvature may be helpful for successful tracheal intubation in patients with ankylosing spondylitis.