| 李小海,郭亮,李晓兰,邓小丽,陈思浩,袁亮,叶龙.CT多平面重建术前评估枢椎椎弓根螺钉植入入路的可行性[J].中国医学影像技术,2017,33(6):933~937 |
| CT多平面重建术前评估枢椎椎弓根螺钉植入入路的可行性 |
| Feasibility of helical CT multiplanar reconstruction in evaluation of C2 pedicle screw placement |
| 投稿时间：2016-10-10 修订日期：2017-03-21 |
| DOI：10.13929/j.1003-3289.201610027 |
| 中文关键词: 枢椎 椎弓根 螺钉植入 体层摄影术,X线计算机 |
| 英文关键词:Axis Pedicle Screw placement Tomography, X-ray computed |
| 基金项目:重庆市卫生计生委医学科研项目（2016MSXM059）。 |
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| 中文摘要: |
| 目的 通过CTMPR评估后路枢椎椎弓根螺钉植入（C2PSP）入路的可行性。方法 对250例（500侧）患者头颈部CTA扫描数据行MPR，测量骨参数椎弓根直径（D）、椎弓峡部厚度（T）、内侧高度（H），动脉参数枢椎段椎动脉（IAVA）走行偏移方向；IAVA骑跨程度。计算椎弓根狭窄、高骑动脉（HRVA）和IAVA分型发生率，并分析椎弓根狭窄、HRVA、IAVA分型及枢椎椎动脉沟（C2VAG）损伤的关系。结果 椎弓根狭窄和HRVA分别为14.40%（72/500）和24.60%（123/500），差异有统计学意义（χ2=141.984，P<0.001）。模拟C2PSP损伤C2VAG的发生率为19.40%（97/500）。椎弓根狭窄和HRVA患者中模拟C2PSP损伤C2VAG的发生率高于无椎弓根狭窄和无HRVA患者（P均<0.001）。椎弓根狭窄与HRVA同时伴发58侧（58/500，11.60%）。椎弓根狭窄、HRVA及C2VAG损伤在IAVA各型中发病率差异有统计学意义（P均<0.001），均以M-a型最多，分别为55.56%（40/72）、46.34%（57/123）、48.45%（47/97）。结论 C2VAG损伤多发于椎弓根狭窄、HRVA或IAVAM-a型的患者；MPR可综合评估骨性和动脉参数，为C2PSP提供解剖学依据。 |
| 英文摘要: |
| Objective To evaluate the feasibility of the posterior C2 pedicle screw placement (C2 PSP) by MPR techniques of helical CT. Methods Totally 250 patients (500 sides) who underwent head and neck CTA examination were enrolled. The bony parameters and the arterial parameters were measured after MPR. The bony parameters included pedicle diameter (D), isthmus height (T), internal height (H), and the arterial parameters included medial shifting:lateral (L), neutral (N), medial (M); and the degree of riding included below (b), within (w), above (a). The prevalence of narrow pedicles, high-riding vertebral arteries (HRVA) and the subtypes of IAVA in the general population were calculated, and the statistical analysis between narrow pedicles, HRVA, IAVA and C2 vertebral arteries groove (C2 VAG) injury were performed. Results The rate of narrow pedicles and HRVA were 14.40% (72/500) and 24.60% (123/500; χ2=141.984, P<0.001). When it came to the simulation of the C2 PSP inserting, the incidence of C2 VAG injuries was 19.40% (97/500). In narrow pedicle and HRVA patients, the C2 VAG injuries incidence were higher than that of without narrow pedicle and HRVA patients (both P<0.001). In 58 sides (58/500, 11.60%), the narrow pedicles and HRVA occurred simultaneously. There were statistical significance differences of narrow pedicles and HRVA and the C2 VAG injuries in different types of IAVA (all P<0.001), the subtypes of IAVA M-a consisted most common, which account for 55.56% (40/72), 46.34% (57/123) and 48.45% (47/97), respectively. Conclusion Most of the C2 VAG injuries happened in narrow pedicles, HRVA or IAVA M-a type patients. MPR can be used to comprehensively evaluate osseous and arterial parameters, which will provide anatomy foundation to the screw placement of C2 pedicles. |
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