中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2015年
6期
419-423
,共5页
颈椎%椎弓根%颈脊髓%内固定%解剖学
頸椎%椎弓根%頸脊髓%內固定%解剖學
경추%추궁근%경척수%내고정%해부학
Cervical vertebrae%Pedicle of vertebral arch%Cervical spinal cord%Internal fixation%Anatomy
目的 探讨颈椎椎弓根与受压脊髓间的关系.方法 选取2011年12月至2013年1月中国医科大学附属盛京医院收治的105例脊髓型颈椎病患者的临床资料,男性53例,女性52例,年龄29 ～ 80岁,平均53.4岁.平行于C4～C7椎体双侧椎弓根轴的横切面做MRI平扫检查,图片发送至工作站.应用PACS系统测量与椎弓根螺钉安全性有关的解剖参数,包括左侧和右侧颈椎椎弓根内侧缘到脊髓的最短距离(LH和RH)、左侧和右侧颈椎椎弓根中轴线与假定螺钉刚触及脊髓的最小夹角(LSA和RSA).依据每个节段是否存在压迫,分为受压迫组与无压迫组.选取12例同时行颈椎MRI和颈椎三维CT检查的患者资料,对两侧椎弓根内缘间直线距离,即椎管宽度(D)进行MRI测量和CT测量.两组间数据比较采用独立样本的t检验,同一指标的两种方法测量结果的比较采用配对t检验.结果 测量结果显示,C4的LH为(7.2±1.3)mm,RH为(6.7±1.4)mm,平均(6.9±1.4) mm;C5的LH为(7.7 ± 1.4)mm,RH为(6.7±1.4)mm,平均(7.2±1.5) mm;C6的LH为(8.2±1.5)mm,RH为(6.9±1.3)mm,平均(7.5±1.5)mm;C7的LH为(8.2±1.4)mm,RH为(7.3±2.1)mm,平均(7.7±1.8) mm;C4的LSA为34.4°±4.2°,RSA为34.4°±5.2°,平均34.4°±4.7°;C5的LSA为35.9°±5.2°,RSA为34.6°±5.4°,平均35.3°±5.3°;C6的LSA为37.4±4.8°,RSA为34.8°±4.8°,平均36.1°±5.0°,C7的LSA为39.2°±5.8°,RSA为37.1°±5.2°,平均38.1°±5.6°.存在脊髓压迫和无压迫的节段间的LH、RH、LSA、RSA、D比较,差异均无统计学意义(P值均＞0.05).结论 受压颈脊髓与椎弓根内侧壁之间存在安全空间,且存在个体变异,术前应根据颈椎MRI检查结果明确安全范围,强调个体化进钉,避免损伤脊髓.
目的 探討頸椎椎弓根與受壓脊髓間的關繫.方法 選取2011年12月至2013年1月中國醫科大學附屬盛京醫院收治的105例脊髓型頸椎病患者的臨床資料,男性53例,女性52例,年齡29 ～ 80歲,平均53.4歲.平行于C4～C7椎體雙側椎弓根軸的橫切麵做MRI平掃檢查,圖片髮送至工作站.應用PACS繫統測量與椎弓根螺釘安全性有關的解剖參數,包括左側和右側頸椎椎弓根內側緣到脊髓的最短距離(LH和RH)、左側和右側頸椎椎弓根中軸線與假定螺釘剛觸及脊髓的最小夾角(LSA和RSA).依據每箇節段是否存在壓迫,分為受壓迫組與無壓迫組.選取12例同時行頸椎MRI和頸椎三維CT檢查的患者資料,對兩側椎弓根內緣間直線距離,即椎管寬度(D)進行MRI測量和CT測量.兩組間數據比較採用獨立樣本的t檢驗,同一指標的兩種方法測量結果的比較採用配對t檢驗.結果 測量結果顯示,C4的LH為(7.2±1.3)mm,RH為(6.7±1.4)mm,平均(6.9±1.4) mm;C5的LH為(7.7 ± 1.4)mm,RH為(6.7±1.4)mm,平均(7.2±1.5) mm;C6的LH為(8.2±1.5)mm,RH為(6.9±1.3)mm,平均(7.5±1.5)mm;C7的LH為(8.2±1.4)mm,RH為(7.3±2.1)mm,平均(7.7±1.8) mm;C4的LSA為34.4°±4.2°,RSA為34.4°±5.2°,平均34.4°±4.7°;C5的LSA為35.9°±5.2°,RSA為34.6°±5.4°,平均35.3°±5.3°;C6的LSA為37.4±4.8°,RSA為34.8°±4.8°,平均36.1°±5.0°,C7的LSA為39.2°±5.8°,RSA為37.1°±5.2°,平均38.1°±5.6°.存在脊髓壓迫和無壓迫的節段間的LH、RH、LSA、RSA、D比較,差異均無統計學意義(P值均＞0.05).結論 受壓頸脊髓與椎弓根內側壁之間存在安全空間,且存在箇體變異,術前應根據頸椎MRI檢查結果明確安全範圍,彊調箇體化進釘,避免損傷脊髓.
목적 탐토경추추궁근여수압척수간적관계.방법 선취2011년12월지2013년1월중국의과대학부속성경의원수치적105례척수형경추병환자적림상자료,남성53례,녀성52례,년령29 ～ 80세,평균53.4세.평행우C4～C7추체쌍측추궁근축적횡절면주MRI평소검사,도편발송지공작참.응용PACS계통측량여추궁근라정안전성유관적해부삼수,포괄좌측화우측경추추궁근내측연도척수적최단거리(LH화RH)、좌측화우측경추추궁근중축선여가정라정강촉급척수적최소협각(LSA화RSA).의거매개절단시부존재압박,분위수압박조여무압박조.선취12례동시행경추MRI화경추삼유CT검사적환자자료,대량측추궁근내연간직선거리,즉추관관도(D)진행MRI측량화CT측량.량조간수거비교채용독립양본적t검험,동일지표적량충방법측량결과적비교채용배대t검험.결과 측량결과현시,C4적LH위(7.2±1.3)mm,RH위(6.7±1.4)mm,평균(6.9±1.4) mm;C5적LH위(7.7 ± 1.4)mm,RH위(6.7±1.4)mm,평균(7.2±1.5) mm;C6적LH위(8.2±1.5)mm,RH위(6.9±1.3)mm,평균(7.5±1.5)mm;C7적LH위(8.2±1.4)mm,RH위(7.3±2.1)mm,평균(7.7±1.8) mm;C4적LSA위34.4°±4.2°,RSA위34.4°±5.2°,평균34.4°±4.7°;C5적LSA위35.9°±5.2°,RSA위34.6°±5.4°,평균35.3°±5.3°;C6적LSA위37.4±4.8°,RSA위34.8°±4.8°,평균36.1°±5.0°,C7적LSA위39.2°±5.8°,RSA위37.1°±5.2°,평균38.1°±5.6°.존재척수압박화무압박적절단간적LH、RH、LSA、RSA、D비교,차이균무통계학의의(P치균＞0.05).결론 수압경척수여추궁근내측벽지간존재안전공간,차존재개체변이,술전응근거경추MRI검사결과명학안전범위,강조개체화진정,피면손상척수.
Objective To study the relationship between cervical pedicle and compressed spinal cord.Methods One hundred and five patients (53 male,52 female,age from 29 to 80 years) with cervical spondylotic myelopathy who needed surgery were included from December 2011 to January 2013 in Shengjing Hospital.Plain MRI scan was used for cross section of C4-C7 vertebral bodies parallel to the axis of bilateral pedicle,and the images were sent to the workstation.PACS system was applied to measure the anatomical parameters related to the security of cervical pedicle screw,including the shortest distance from medial left/ right cervical pedicle to the cervical spinal cord (LH/RH),and the smallest angle between the longitudinal axis of left/right cervical pedicle and the screw which was assumed to just touch the cervical spinal cord (LSA/RSA).All these data in each segment were classified according to compression or not:with compression and without compression.Twelve cases were selected and measured by MRI and 3D cervical CT for spinal canal width D,namely the straight-line distance between the medial margins of cervical pedicle.And the results of two methods were compared to see whether there were statistical differences.Results At C4,LH was (7.2 ± 1.3) mm,RH was (6.7 ± 1.4) mm,and the average was (6.9 ± 1.4) mm;at C5,LH was (7.7 ± 1.4) mm,RH was (6.7 ± 1.4) mm,and the average was (7.2 ± 1.5) mm;at C6,LH was (8.2 ± 1.5) mm,RH was (6.9 ± 1.3) mm,and the average was (7.5 ± 1.5) mm;at C7,LH was (8.2 ± 1.4) mm,RH was (7.3 ± 2.1) mm,and the average was (7.7 ± 1.8) mm.At C4,LSA was 34.4° ± 4.2°,RSA was 34.4° ± 5.2° and the average angle was 34.4° ± 4.7°;at C5,LSA was 35.9° ± 5.2°,RSA was 34.6° ±5.4° and the average angle was 35.3° ±5.3°;at C6,LSA was 37.4° ±4.8°,RSA was 34.8° ±4.8° and the average angle was 36.1° ± 5.0°;at C7,LSA was 39.2° ± 5.8°,RSA was 37.1° ± 5.2° and the average angle was 38.1 ° ± 5.6°;There were no statistically significant differences between segments with and without compression in H,SA and D (all P ＞ 0.05).Conclusions There is security space between the medial vertebral pedicle and compressed spinal cord.There is individual variation in security space.It is very necessary to identify security space before surgery by MRI,emphasize individual procedure and avoid spinal cord injury.
