中国骨与关节外科
中國骨與關節外科
중국골여관절외과
CHINESE BONE AND JOINT SURGERY
2014年
6期
451-455
,共5页
寰椎%椎动脉沟%椎弓根%螺钉%沟环
寰椎%椎動脈溝%椎弓根%螺釘%溝環
환추%추동맥구%추궁근%라정%구배
Atlas%Vertebral artery groove%Pedicle%Screw%Ponticulus
背景：寰椎椎动脉沟处形成的骨环变异可影响椎弓根螺钉置入的准确性和安全性。<br> 目的：观测寰椎椎动脉沟环变异的形态和发生率，对变异的椎动脉沟进行三维CT测量分析，评估椎动脉沟环变异对椎弓根螺钉置入的影响。<br> 方法：从2013年9月至2014年6月行头颈CT血管造影扫描的患者中选取寰椎及头颈部血管无明确病变者405例，利用其图像数据进行寰椎三维数字化重建，在寰椎三维模型中观查椎动脉沟环变异的形态和发生率，测量出现沟环变异的寰椎椎动脉沟底部后弓的高度和宽度。<br> 结果：405例（810侧）寰椎三维解剖模型中，寰椎椎动脉沟环变异145侧，发生率为17.9%。其中后环变异112侧，发生率为13.8%，Ⅰ、Ⅱ、Ⅲ、Ⅳ型后环变异分别为31、24、17、40侧，发生率分别为3.8%、3.0%、2.1%、4.9%。侧环变异33侧，发生率为4.1%。椎动脉沟底部后弓高度：在侧环变异侧为（4.42±1.04）mm，在Ⅰ、Ⅱ、Ⅲ、Ⅳ型后环变异侧分别为（4.51±1.09）mm、（3.16±0.38）mm、（3.14±0.42）mm、（2.92±0.24）mm。椎动脉沟底部后弓宽度：在侧环变异侧为（9.14±1.20）mm，在Ⅰ、Ⅱ、Ⅲ、Ⅳ型后环变异侧分别为（9.19±1.52）mm、（9.09±1.45）mm、（9.02±1.32）mm、（8.93±1.57）mm。<br> 结论：寰椎椎动脉沟Ⅰ型后环和侧环变异侧适宜进行椎弓根螺钉固定。当寰椎发生椎动脉沟Ⅱ~Ⅳ型后环变异时不适合椎弓根螺钉固定。术前利用CT三维重建可清楚观察沟环变异的形态，为寰椎椎弓根螺钉的安全置入提供帮助。
揹景：寰椎椎動脈溝處形成的骨環變異可影響椎弓根螺釘置入的準確性和安全性。<br> 目的：觀測寰椎椎動脈溝環變異的形態和髮生率，對變異的椎動脈溝進行三維CT測量分析，評估椎動脈溝環變異對椎弓根螺釘置入的影響。<br> 方法：從2013年9月至2014年6月行頭頸CT血管造影掃描的患者中選取寰椎及頭頸部血管無明確病變者405例，利用其圖像數據進行寰椎三維數字化重建，在寰椎三維模型中觀查椎動脈溝環變異的形態和髮生率，測量齣現溝環變異的寰椎椎動脈溝底部後弓的高度和寬度。<br> 結果：405例（810側）寰椎三維解剖模型中，寰椎椎動脈溝環變異145側，髮生率為17.9%。其中後環變異112側，髮生率為13.8%，Ⅰ、Ⅱ、Ⅲ、Ⅳ型後環變異分彆為31、24、17、40側，髮生率分彆為3.8%、3.0%、2.1%、4.9%。側環變異33側，髮生率為4.1%。椎動脈溝底部後弓高度：在側環變異側為（4.42±1.04）mm，在Ⅰ、Ⅱ、Ⅲ、Ⅳ型後環變異側分彆為（4.51±1.09）mm、（3.16±0.38）mm、（3.14±0.42）mm、（2.92±0.24）mm。椎動脈溝底部後弓寬度：在側環變異側為（9.14±1.20）mm，在Ⅰ、Ⅱ、Ⅲ、Ⅳ型後環變異側分彆為（9.19±1.52）mm、（9.09±1.45）mm、（9.02±1.32）mm、（8.93±1.57）mm。<br> 結論：寰椎椎動脈溝Ⅰ型後環和側環變異側適宜進行椎弓根螺釘固定。噹寰椎髮生椎動脈溝Ⅱ~Ⅳ型後環變異時不適閤椎弓根螺釘固定。術前利用CT三維重建可清楚觀察溝環變異的形態，為寰椎椎弓根螺釘的安全置入提供幫助。
배경：환추추동맥구처형성적골배변이가영향추궁근라정치입적준학성화안전성。<br> 목적：관측환추추동맥구배변이적형태화발생솔，대변이적추동맥구진행삼유CT측량분석，평고추동맥구배변이대추궁근라정치입적영향。<br> 방법：종2013년9월지2014년6월행두경CT혈관조영소묘적환자중선취환추급두경부혈관무명학병변자405례，이용기도상수거진행환추삼유수자화중건，재환추삼유모형중관사추동맥구배변이적형태화발생솔，측량출현구배변이적환추추동맥구저부후궁적고도화관도。<br> 결과：405례（810측）환추삼유해부모형중，환추추동맥구배변이145측，발생솔위17.9%。기중후배변이112측，발생솔위13.8%，Ⅰ、Ⅱ、Ⅲ、Ⅳ형후배변이분별위31、24、17、40측，발생솔분별위3.8%、3.0%、2.1%、4.9%。측배변이33측，발생솔위4.1%。추동맥구저부후궁고도：재측배변이측위（4.42±1.04）mm，재Ⅰ、Ⅱ、Ⅲ、Ⅳ형후배변이측분별위（4.51±1.09）mm、（3.16±0.38）mm、（3.14±0.42）mm、（2.92±0.24）mm。추동맥구저부후궁관도：재측배변이측위（9.14±1.20）mm，재Ⅰ、Ⅱ、Ⅲ、Ⅳ형후배변이측분별위（9.19±1.52）mm、（9.09±1.45）mm、（9.02±1.32）mm、（8.93±1.57）mm。<br> 결론：환추추동맥구Ⅰ형후배화측배변이측괄의진행추궁근라정고정。당환추발생추동맥구Ⅱ~Ⅳ형후배변이시불괄합추궁근라정고정。술전이용CT삼유중건가청초관찰구배변이적형태，위환추추궁근라정적안전치입제공방조。
Background:The atlas ponticulus may interfere with the pedicle screw fixation. <br> Objective:The aim of the study is to explore the form and incidence of atlas ponticulus, to measure the atlas ponticulus by three-dimensional CT imaging, and to evaluate the effect of atlas ponticulus variation on pedicle screw insertion. <br> Methods:A total of 405 patients who underwent computed tomography angiography in head and neck between September 2013 and June 2014 and had any pathological changes in craniocervical junction were enrolled in the study. Their axial im-ages were used to reconstruct 3D model of atlas and to observe the form and incidence of atlas ponticulus. The height and width of the posterior arch at the bottom of the atlantal vertebral artery groove were measured. <br> Results:A total of 405 atlantal 3D models were successfully established. The incidence of atlas ponticulus was 17.9%(145/810). Of them, the incidence of the posterior ponticulus was 13.8%(112/810), and the incidence of typeⅠ-Ⅳposterior pon-ticulus was 3.8%(31/810), 3.0%(24/810), 2.1%(17/810) and 4.9%(40/810), respectively. The incidence of lateral ponticulus was 4.1%(33/810). The height of the posterior arch at the bottom of the atlantal vertebral artery groove was (4.42±1.04) mm, (4.51±1.09) mm, (3.16±0.38) mm, (3.14±0.42) mm, (2.92±0.24) mm in the lateral ponticulus, typeⅠ-Ⅳposterior ponticu-lus, respectively. The width of the posterior arch at the bottom of the atlantal vertebral artery groove was (9.14 ± 1.20) mm, (9.19±1.52) mm, (9.09±1.45) mm, (9.02±1.32) mm, (8.93±1.57) mm in the lateral ponticulus, typeⅠ-Ⅳposterior ponticu-lus, respectively. <br> Conclusions:The pedicle screw fixation can be achieved in the atlas with typeⅠposterior ponticulus and lateral ponticulus. However, the pedicles with typeⅡ-Ⅳposterior ponticulus are not suitable to use the fixation technology of atlas pedicle screw. The preoperative three-dimensional CT reconstruction of atlas can clearly show anatomical structures of atlas pontic-ulus and improve the security of pedicle screw fixation.
