【摘要】 背景:现有的下颈椎椎弓根钉固定技术均以关节突和侧块为参考标志,由于术者主观判断的差异,加之关节突增生的影响,进钉点的选择常有一定误差,易发生椎动脉或颈髓损伤等严重并发症,限制了该技术临床推广。目前临床上选择一个恒定的下颈椎椎弓根钉进钉点标志显得尤为重要。目的:通过三维重建CT图像测量明确下颈椎椎弓根钉进钉点与"关节突间侧凹"的定位关系。方法:对排除颈椎畸形的30例患者颈椎行三维重建CT扫描,观察"关节突间侧凹"的出现率和形态特征。在重建后的C₃-C₇特定CT图像上测定以下参数:（1）进钉点至侧块外缘的距离:经双侧椎弓根轴线横断面图像上椎弓根轴线在后柱表面投影点与侧块最外缘的距离;（2）进钉点至"关节突间侧凹"的距离:经单侧椎弓根轴线斜矢状面图像上椎弓根轴线在后柱表面投影点与"关节突间侧凹"的距离。统计每组参数的平均值和标准差,并比较各节段统计数据的差异。结果与结论:（1）下颈椎"关节突间侧凹"明显,出现率为100%,解剖标志恒定且少有增生;（2）利用三维重建CT技术,可以成功获取C₃-C₇经双侧椎弓根轴线横断面和经单侧椎弓根轴线斜矢状面的图像;（3）在经双侧椎弓根轴线横断面图像上,C₃-C₇左右两侧进钉点至侧块外缘的距离分别为（4.1±0.9）mm和（4.3±0.9）mm,差异无显著性意义（P=0.609）。除了C₃与C₇、C₄与C₇,各节段同侧测量值的差异均无显著性意义（P>0.05）;（4）在经单侧椎弓根轴线斜矢状面的图像上,C3-C7左右两侧进钉点至"关节突间侧凹"的距离距离分别为（-0.3±1.7）mm和（-0.3±1.6）mm,差异无显著性意义（P=0.916）。除了C3与C4,各节段同侧测量值的差异均有显著性意义（P<0.05）;（5）以上结果提示,下颈椎椎弓根钉进钉点与"关节突间侧凹"在横断面上存在相对恒定的定位关系,而在矢状面上变异较大。更多还原

【Abstract】 BACKGROUND: The existing technique takes articular process and lateral mass as a reference mark. Due to differences of subjective judgment in operation and the impact of articular hyperplasia, some errors of screw entry point selection and serious complications such as vertebral artery or cervical spinal cord injury easily occurred, which limit the clinical application of the technique. At present, it is very important to select a constant reference mark of cervical pedicle screw entry point. OBJECTIVE: Three-dimensional reconstruction CT images were made to measure the relationship between the lower cervical pedicle screw entry point and "the lateral concave between articular process". METHODS: Three-dimensional reconstruction of CT scan was performed in 30 patients with cervical deformity, and the occurrence rate and morphological characteristics of "the lateral concave between articular process" were observed. The following parameters were determined on specific reconstructed CT image of C₃-C₇:（1） the distance between pedicle axis projection point in the posterior surface and the outer edge of lateral mass in transversal section through bilateral pedicle axis and（2） the distance between the point and "the lateral concave between articular process" in oblique sagittal section through homolateral pedicle axis. Mean value and standard deviation were counted and statistics difference was compared. RESULTS AND CONCLUSION:（1） "The lateral concave between articular process" in lower cervical vertebrae was a obvious and less constant proliferative anatomical landmark and its occurrence rate was 100%.（2） Using CT technology of 3D reconstruction, C₃-C₇ lower cervical transversal section through bilateral pedicle axis and oblique sagittal section through homolateral pedicle axis were successfully obtained.（3） In transversal section, the left and right distances between C₃-C₇ pedicle axis projection point in the posterior surface and the outer edge of lateral mass were（4.1±0.9） mm and（4.3±0.9） mm, and the difference was not statistically significant（P=0.609）. Except for C₃ and C₇, C₄ and C₇, there was no significant difference in the measured values of the same side（P > 0.05）.（4） In oblique sagittal section, the left and right distances between C₃-C₇ point and "the lateral concave between articular process" were（-0.3±1.7） mm and（-0.3±1.6） mm, and the difference was not statistically significant（P=0.916）. Except for C₃ and C₄, there was significant difference in the measured values of the same side（P < 0.05）.（5） The above results suggest that the lower cervical pedicle entry point and "the lateral concave between articular process" have a relatively constant orientation relationship in transversal section and a large variation in the sagittal section.更多还原