【摘要】 目的:探讨气管切开套管对颈椎或上胸椎后凸畸形患者的适用性，并初步建立该类患者气管切开术的术前影像学评估体系。方法:纳入2010年1月至2020年8月北京大学第三医院骨科收治的颈椎或上胸椎后凸畸形患者11例，基于其颈部CT重建颈部三维模型，测量椎体局部后凸成角、颈椎总后凸成角及气管-皮肤距离。进而重建不同型号气管切开套管的三维图像，模拟气管切开术，测量套管尖端与气管内侧壁的距离，以分析套管在该类患者中的适配性。结果:64%的颈椎或上胸椎后凸畸形患者无法适配预制的气管切开套管。颈椎总后凸成角与套管-气管壁距离呈显著正相关(r=0.927,R² =0.860)。ROC曲线分析显示，当颈椎总后凸成角> 33.32°时，气管切开套管无法适配，灵敏度与特异度均为1.0。结论:预制气管切开套管在多数颈椎或上胸椎后凸畸形患者中难以适配。本研究初步构建了此类患者困难气管切开术的术前影像评估体系，提出以颈椎总后凸成角33.32°作为术中气管套管无法适配的参考阈值；此外，初步证实三维重建联合术前气管切开位置规划有助于减少术后套管位置不佳相关并发症。更多还原

【Abstract】 Objective: To evaluate the applicability of tracheostomy tube for patients with cervical or upper thoracic kyphosis, and establish a preoperative imaging evaluation system for tracheotomy in patients population. Methods: The three-dimensional(3D) geometry of the neck were reconstructed using computed tomography scans for patients with cervical or upper thoracic kyphosis. The local kyphosis angle of vertebral body, the total kyphosis angle of cervical spine, the distance between trachea and skin and the height of innominate artery were measured. 3D models of tracheostomy tubes were generated using geometric modeling software. Tracheostomy was simulated in the virtual 3D models. The distance between the tube tip and the inner tracheal wall was measured to analyze whether the tracheostomy tube was suitable for patients with cervical or upper thoracic kyphotic deformity. Results: 64% of patients with cervical or upper thoracic kyphosis were not fitted with the tracheostomy tubes. The Pearson coefficient is 0.927 and R~2 is 0.860 between the angle of cervical kyphosis and the distance between the cannula and tracheal wall. According to the ROC curve analysis, when the angle of cervical kyphosis exceeded 33.32 degree, the tracheostomy tube became unsuitable, with both sensitivity and specificity equal to 1.Conclusion: The tracheostomy tube is not suitable for the majority of patients with cervical or upper thoracic kyphosis. This study established a preliminary preoperative imaging evaluation system for difficult tracheotomy in patients with cervical or upper thoracic kyphosis, and proposed a 33.32 ° cervical total kyphosis angle as a reference standard for tracheostomy tube adaptation during tracheotomy for patients with cervical or upper thoracic kyphosis. In addition, this study provides initial validation that three-dimensional reconstruction and preoperative planning of tracheotomy position can avoid postoperative complications caused by poor position of the tube in these patients.更多还原