颈胸段前路椎弓根螺钉固定技术的影像学研究

Radiological studies on anterior cervicothoracic transpedicular screw fixation

中文关键词:  颈胸段  前路椎弓根螺钉  影像学

英文关键词:Cervicothoracic junction  Anterior transpedicular screw  Radiology

中文摘要:

  【摘要】 目的：研究颈胸段前路椎弓根螺钉置入的进钉位置及进钉方向，并探讨颈胸段前路椎弓根置钉的可行性。方法：选取50例2014年1月~2014年6月行颈胸段螺旋CT扫描无生理曲度异常、骨质破坏患者的影像学资料，其中男性29例，女性21例，年龄22～60岁，平均36.4岁。应用Advantage Workstation 4.2对原始连续横断面图像进行多平面重建，测量C6～T2椎弓根轴线的外倾角和头/尾倾角、横向进针点距离、矢状面进针点距离和椎弓根轴线长度，记录C6～T2椎弓根轴线在胸骨柄上区（A区）、胸骨柄区（B区）及胸骨柄下区（C区）的分布情况，并进行比较分析。结果：C6～T2外倾角、尾倾角在性别差异上无统计学意义，合并两性数据示C6～T2外倾角逐渐减小（46.77°～20.02°）；椎弓根轴线在矢状位上均尾倾，C6～T1尾倾角逐渐减小（18.10°～14.54°），而T2尾倾角最大（20.62°±5.04°）；C6～T2外倾角、尾倾角在不同椎节的差异有统计学意义（P＜0.05）。C6～T2横向进针点距离、矢状面进针点距离、椎弓根轴线长度两性差异有统计学意义（P＜0.05）。C6～T2横向进针点距离逐渐增大（-0.34～4.75mm）；C6矢状面进针点距离最小（5.18±1.02mm），T2矢状面进针点距离最大（9.82±2.28mm）。C6～T2椎弓根轴线长度为31.01～34.21mm。相同性别的横向进针点距离、矢状面进针点距离在不同椎节的差异有统计学意义（P＜0.05）。C6、C7椎弓根轴线穿经A区；T1椎弓根轴线主要穿经A区和B区，在位于A区者中仅3例穿经两侧胸骨锁骨端上缘连线之上；T2椎弓根轴线穿经B区和C区。A、B、C分区结果在性别差异上无统计学意义（P＞0.05）。结论：理论上前方入路可完成C6、C7前路椎弓根螺钉置入，而绝大部分T1、T2因受限于其前方骨性结构的阻挡，无法经下颈椎前方入路完成前路椎弓根螺钉的置入。

英文摘要:

  【abstract】 Objectives: To explore the entry point and trajectory of anterior transpedicular screws(ATPS) in the cervicothoracic junction, and to investigate its feasibility by radiological method. Methods: From January 2014 to June 2014, 50 patients with no signs of cervicothoracic misalignment and bone destruction were scanned by spiral CT on the cervical and upper thoracic spine, there were 29 males and 21 females with the age ranging from 22 to 60 years(average 36.4 years). Sequential raw cervicothoracic transaxial CT image data of each segment were processed by multiplanar reformation(MPR) in Advantage Workstation 4.2. The data of transverse pedicle angle(TPA), sagittal pedicle angle(SPA) and distance transverse intersection point(DTIP), distance sagittal intersection point(DSIP) and pedicle axis length(PAL) of each pedicle were measured. The cervicothoracic junction was devided into three different regions by two lines, and the distribution of the trajectory of sagittal pedicle axis in three regions was recorded. All the above data were processed by the software SPSS 13.0. Results: There was no statistical difference in gender regarding to the value of TPA and SPA, so the data of male and female patients were merged for analysis. From C6 to T2, the TPA decreased from 46.77° to 20.02°. The sagittal pedicle axis all tilted caudally. From C6 to T1, the SPA decreased from 18.10° to 14.54°. However, the SPA of T2(20.62°±5.04°) was the largest. The difference in different segments showed statistical significance(P＜0.05). The gender differences regarding to the DTIP, DSIP and PAL showed statistical significance(P＜0.05). From C6 to T2, the DTIP increased from -0.34 to 4.75mm. The DSIP of C6(5.18±1.02mm) was the minimum, and the maximal DSIP was at the level of T2(9.82±2.28mm). The PAL changed irregularly, from 31.01 to 34.21mm. The difference of the DTIP and DSIP under the same sex in different segments showed statistical significance(P＜0.05). The sagittal pedicle axis of C6 and C7 all located superior to the manubrium. The sagittal pedicle axis of T1 was mainly in manubrium region, but only 3 of them located over the line connecting the superior margin of both sternal ends of clavicle above the manubrium. The sagittal pedicle axis of T2 mainly located in manubrium region followed by the region below the manubrium. There was no statistical significance regarding to the regional distribution between sexes. Conclusions: The ATPS techniques at the level C6, C7 and few T1 is feasible through the anterior cervical approach, but unavailable for most T1 and T2 due to their bony obstacle.