颈椎后路内镜下手术相关解剖参数的三维CT测量

Three-dimensional CT measurement of anatomical parameters related to posterior cervical endoscopic surgery

中文关键词:  颈椎  内镜下手术  解剖学  三维CT

英文关键词:Cervical vertebrae  Endoscopic surgery  Anatomy  Three-dimensional CT

中文摘要:

  【摘要】　目的：测量颈椎后柱骨性结构相关三维CT解剖学参数，为后路内镜下手术提供参考数据。方法：选取2025年6月在我院行颈椎三维CT检查的214例患者，其中男性113例，年龄52.1±8.9岁，体质指数（body mass index，BMI）为21.2±5.8kg/m2；女性101例，年龄49.7±9.0岁，BMI为22.4±4.7kg/m2。男女间年龄、BMI无统计学差异（P＞0.05）。在影像系统中行颈椎CT三维重建和测量。将颈椎C3~C6各节段后部结构分割为棘突、椎板、侧块三部分，测量棘突长度、倾斜方向、倾斜角度、高度和宽度；测量椎板长度、厚度、高度；测量侧块宽度、高度、厚度。以单因素方差分析法比较各节段测量结果的差异。结果：所测量指标均无性别、左右侧别差异（P＞0.05）。各节段棘突左倾斜的比例为19%~33%，无明显倾斜的比例为24%~57%，右倾斜的比例为14%~43%，左倾斜与右倾斜的例数无统计学差异（P＞0.05）。各节段棘突长度存在统计学差异（P＜0.05），C7最大（32.5±3.0mm），C3、C4最小（11.4±2.5mm、11.6±1.9mm）；C7棘突倾角（26.4°±8.1°）和C6棘突倾角（27.2°±5.7°）无显著性差异（P＞0.05），且均大于其他节段（P＜0.05）；各节段棘突高度存在统计学差异（P＜0.05），C7棘突高度（10.5±3.1mm）大于其他节段（P＜0.05），C3（7.8±1.9mm）与C4（8.0±2.3mm）明显小于其他节段（P＜0.05）。各节段椎板长度有统计学差异（P＜0.05），C7（13.4±2.8mm）最大，C3（9.7±1.6mm）最小；各节段椎板厚度有统计学差异（P＜0.05），其中C4椎板厚度（2.2±0.6mm）小于其他节段，C7椎板厚度（3.1±0.8mm）大于其他节段；C4（10.4±2.3mm）和C5（11.1±1.9mm）椎板高度无显著性差异（P＞0.05），且二者均小于其他节段（P＜0.05），C7椎板高度（15.8±3.2mm）大于其他节段（P＜0.05）。C7侧块宽度（10.5±3.2mm）最大（P＜0.05），其他节段侧块宽度无显著差异（P＞0.05）；C3（10.3±1.9mm）和C4侧块高度（10.5±1.7mm）无统计学差异（P＞0.05），且二者均小于其他节段（P＜0.05），C7（12.2±1.3mm）大于其他节段（P＜0.05）；C3（9.7±2.1mm）小于其他节段（P＜0.05），C6（12.2±1.1mm）和C7（12.5±0.9mm）无统计学差异，且二者均大于他节段（P＜0.05）。结论：颈椎各节段棘突均存在倾斜；各节段颈椎椎板的厚度有差异，椎板长度由头侧向尾侧递增，行减压术时尾侧需切除更多椎板；各节段侧块宽度差异不显著。

英文摘要:

  【Abstract】 Objectives: To measure three-dimensional CT of the bony structure at posterior cervical spine and provide reference data for posterior endoscopic surgery. Methods: 214 patients who underwent cervical three-dimensional CT examination in our hospital in June 2025 were enrolled, including 113 males(mean age: 52.1±8.9 years, BMI 21.2±5.8kg/m2) and 101 females(age 49.7±9.0 years, BMI 22.4±4.7kg/m2). There were no significant differences in age or BMI between male and female patients(P>0.05). Cervical CT three-dimensional reconstruction and measurements were performed in the imaging system. The posterior structures of C3 to C6 were divided into three parts as the spinous process, lamina and lateral mass. Measurements included spinous process length, tilt direction, tilt angle, height, and width; lamina length, thickness, and height; lateral mass width, height, and thickness. Differences among segments were compared using one-way ANOVA. Results: No significant differences were observed in any measured parameters between sexes or between left and right sides(P>0.05). The proportion of left-tilted spinous processes ranged from 19% to 33%, non-tilted from 24% to 57%, and right-tilted from 14% to 43%; no significant difference was found between the proportions of left- and right-tilted processes(P>0.05). Spinous process length differed significantly among segments(P<0.05), with C7 being the longest(32.5±3.0mm) while C3 and C4 the shortest(11.4±2.5mm and 11.6±1.9mm, respectively). No significant difference in tilt angle was observed between C7(26.4°±8.1°) and C6(27.2°±5.7°)(P>0.05), and both were larger than other segments(P<0.05). Spinous process height also differed significantly among segments(P<0.05); C7 height(10.5±3.1mm) was greater than other segments(P<0.05), while C3(7.8±1.9mm) and C4(8.0±2.3mm) were significantly smaller than others(P<0.05). Lamina length differed significantly among segments(P<0.05), with C7 being the longest(13.4±2.8mm) and C3 the shortest(9.7±1.6mm). Lamina thickness also showed significant differences(P<0.05), with C4 the thinnest(2.2±0.6mm) and C7 the thickest(3.1±0.8mm). No significant difference in lamina height was found between C4(10.4±2.3mm) and C5(11.1±1.9mm)(P>0.05), and both were smaller than other segments(P<0.05); C7 lamina height(15.8±3.2mm) was greater than other segments(P<0.05). Lateral mass width: C7(10.5±3.2mm) was the largest(P<0.05), with no significant differences among other segments(P>0.05). Lateral mass height: no significant difference between C3(10.3±1.9mm) and C4(10.5±1.7mm)(P>0.05), both smaller than others(P<0.05); C7(12.2±1.3mm) was larger than others(P<0.05). Lateral mass thickness: C3(9.7±2.1mm) was smaller than other segments(P<0.05); no significant difference between C6(12.2±1.1mm) and C7(12.5±0.9mm)(P>0.05), and both were larger than other segments(P<0.05). Conclusions: Spinous processes may exhibit tilt in each cervical segment, and lamina thickness varies across segments. Lamina length increases from cephalad to caudad, therefore, more caudal lamina resection is required during decompression surgery. There is no significant difference in lateral mass width among segments.