基于CT三維重建技術(shù)的頸椎鉤突及周圍結(jié)構(gòu)解剖學(xué)研究
發(fā)布時間：2018-08-19 19:19
【摘要】：目的 觀察多層螺旋CT掃描和三維重建技術(shù)評估頸椎鉤突及毗鄰結(jié)構(gòu)的解剖學(xué)關(guān)系，探討頸椎鉤突骨性結(jié)構(gòu)的特點(diǎn)和鉤突與周圍結(jié)構(gòu)的相關(guān)性及臨床意義。 方法 對36名無神經(jīng)根性癥狀的成人，21名保守治療無效而進(jìn)行了手術(shù)治療的神經(jīng)根型頸椎病患者（C6神經(jīng)根）和20名保守治療有效的神經(jīng)根型頸椎病患者（C6神經(jīng)根）的下頸椎（頸3-7）多層螺旋CT掃描和三維重建影像學(xué)檢查圖像進(jìn)行分析。以頸椎鉤突為研究對象，重點(diǎn)在三維重建圖形基礎(chǔ)上，分別對鉤突、椎體、椎間孔和橫突孔等解剖學(xué)結(jié)構(gòu)、實(shí)際長度、面積和立體空間相互之間的關(guān)系進(jìn)行數(shù)據(jù)測量，然后進(jìn)行統(tǒng)計分析及評價。 結(jié)果 1.在正常人群中，鉤突高度從C3～C6逐漸增加，平均值5.51±1.05mm；C7最低，左側(cè)5.34±1.21mm，右側(cè)5.14±1.35mm；C6最高，左側(cè)6.16±1.44mm，右側(cè)5.70±1.58mm。鉤突寬度從C3～C7逐漸增寬，平均值5.09±1.32mm，但增幅不大；鉤突長基本一致，平均值11.12±1.72mm。鉤突傾角平均值為48.88°±15.68°。鉤突前角間距從C3～C7逐漸變長，平均值18.24±2.75mm；鉤突側(cè)緣間距從C3～C6基本一致，平均值28.13±2.14mm，其中C7最長，平均值29.98±1.63mm；后角間距從C3～C7逐漸縮小，平均值10.06±3.11mm。 2.在無癥狀組中，C3～C6橫突孔橫徑縱徑變化不大，但左側(cè)略大于右側(cè)，左側(cè)橫突孔橫徑平均值5.65±1.10mm，右側(cè)橫突孔橫徑平均值5.25±0.97mm，左側(cè)橫突孔縱徑4.98±0.98mm，右側(cè)橫突孔縱徑4.65±0.96mm。左右椎間孔大小基本一致，左側(cè)椎間孔長徑平均值9.54±1.34mm，右側(cè)椎間孔長徑9.54±1.42mm，左側(cè)椎間孔最短徑平均值5.52±1.46mm，右側(cè)椎間孔最短徑5.37±1.34mm。橫突孔前緣至椎體前方水平線的垂直距離從C3～C6逐漸縮小，左側(cè)平均值9.06±1.82mm，右側(cè)平均值8.58±2.01mm，C7最長；橫突孔間距從C3～C7逐漸增寬，平均值27.72±2.46mm，C7最寬，平均值32.42±2.60mm。 3.手術(shù)治療組的C6椎體鉤突基底長平均值為13.36±2.36mm，C6椎體鉤突基底寬平均值為5.96±1.46，鉤突側(cè)緣間距平均值為29.91±2.26mm，橫突孔間距平均值為30.10±1.73mm，以上各值均比正常人增加，且P0.05，有顯著性意義。 4.無癥狀組椎間孔最短徑左側(cè)4.87±1.83mm，右側(cè)4.65±1.83mm，手術(shù)治療組椎間孔最短徑左側(cè)3.54±1.84mm，右側(cè)3.64±1.34mm，兩者比較，手術(shù)治療組明顯更短，且P0.05，有顯著性意義。無癥狀組左側(cè)椎間孔面積36.20±29.40mm2，右側(cè)椎間孔椎間孔面積33.68±17.75mm2，手術(shù)治療組面積左側(cè)為22.17±8.23mm2，右側(cè)為19.48±6.89mm2，兩者相比，手術(shù)治療組面積更小，且P0.05，具有統(tǒng)計學(xué)意義。 5.保守治療組左側(cè)椎間孔短徑4.03±1.69mm，，右側(cè)椎間孔短徑4.20±1.12mm，左側(cè)面積27.55±7.65mm2，右側(cè)面積24.69±7.17mm2，與無癥狀組比較，雖然從數(shù)據(jù)上兩側(cè)椎間孔的最短徑較無癥狀組有所減少，但P0.05,不具有統(tǒng)計學(xué)意義，但是椎間孔面積也較無癥狀組減少，且P0.05,具有統(tǒng)計學(xué)意義。 6.手術(shù)治療組椎間孔最短徑左側(cè)3.54±1.84mm，右側(cè)3.64±1.34mm，保守治療組左側(cè)椎間孔短徑4.03±1.69mm，右側(cè)椎間孔短徑4.20±1.12mm，手術(shù)組椎間孔短徑雖較保守治療組有所減小，但P0.05，無統(tǒng)計學(xué)意義。手術(shù)治療組面積左側(cè)為22.17±8.23mm2，右側(cè)為19.48±6.89mm2，保守治療組左側(cè)面積27.55±7.65mm2，右側(cè)面積24.69±7.17mm2，手術(shù)組左右椎間孔面積明顯小于保守治療組，且P0.05，具有有統(tǒng)計學(xué)意義。 7.無癥狀組只有約9%的病人出現(xiàn)椎間孔狹窄；而保守治療組的狹窄部位出現(xiàn)在椎間孔上部和中部的比例分別為25%、50%，并且保守治療有10%的病例未出現(xiàn)椎間孔狹窄；而手術(shù)治療組全部出現(xiàn)不同程度的狹窄，且在椎間孔上部狹窄的例數(shù)較前兩組明顯增多，達(dá)到47.6%。 結(jié)論 1.多層螺旋CT掃描和三維重建技術(shù)能從多角度、立體觀察頸椎椎骨結(jié)構(gòu)的立體空間位置、距離和解剖學(xué)標(biāo)示，為臨床提供了極其重要依據(jù)和有價值的信息。 2.不同節(jié)段的鉤突，其空間體積、間距具有一定規(guī)律，但仍存在較大差異。 3.構(gòu)成頸椎間孔前壁的鉤突異常增生是造成頸椎間孔狹窄的主要因素。且狹窄的部位可分為上、中、下三部分，上部和中部的狹窄是引起神經(jīng)根型頸椎病疼痛的主要原因；發(fā)生了上部椎間孔狹窄的患者手術(shù)可能性明顯增加。 4.椎間孔的最短徑和椎間孔面積均可作為手術(shù)指征的參考指標(biāo)之一，但因存在狹窄部位的影響，椎間孔面積的特異性更高，故椎間孔面積大小更能成為神經(jīng)根型頸椎病患者手術(shù)適應(yīng)癥的客觀指標(biāo)。
[Abstract]:objective
Objective To observe the anatomical relationship between the uncinate process and adjacent structures of the cervical spine by multi-slice spiral CT scanning and three-dimensional reconstruction, and to explore the characteristics of the osseous structure of the uncinate process of the cervical spine and the correlation between the uncinate process and the surrounding structures and its clinical significance.
Method
Thirty-six adults without radicular symptoms, 21 patients with Radicular Cervical Spondylosis (C6 nerve roots) who underwent surgical treatment but failed conservative treatment, and 20 patients with Radicular Cervical Spondylosis (C6 nerve roots) who underwent conservative treatment were examined by multi-slice spiral CT and three-dimensional reconstruction imaging. Based on the three-dimensional reconstructed images, the anatomical structures of uncinate process, vertebral body, intervertebral foramen and transverse foramen, the actual length, area and the relationship between the three-dimensional space were measured and analyzed.
Result
1. In the normal population, the height of uncinate process increased gradually from C3 to C6, with an average of 5.51 (+ 1.05 mm); C7 was the lowest, 5.34 (+ 1.21 mm) on the left and 5.14 (+ 1.35 mm) on the right; C6 was the highest, 6.16 (+ 1.44 mm) on the left and 5.70 (+ 1.58 mm) on the right. The width of uncinate process increased gradually from C3 to C7, with an average of 5.09 (+ 1.32 mm), but the increase was not significant; the length of uncinate process was basically the same, with an average of 11.12 (+ 1.72 mm). The average dip angle of the uncinate process was 48.88 [15.68]. The distance between the anterior angles of the uncinate process increased gradually from C3 to C7 with an average of 18.24 [2.75 mm]. The distance between the lateral edges of the uncinate process was basically the same from C3 to C6 with an average of 28.13 [2.14 mm], of which C7 was the longest with an average of 29.98 [1.63 mm]. The distance between the posterior angles was gradually reduced from C3 to C7 with an average of 10.06 [3.11 mm
2. In the asymptomatic group, the transverse diameter and longitudinal diameter of the foramen C3-C6 did not change much, but the left side was slightly larger than the right side. The mean transverse diameter of the left transverse foramen, the right transverse foramen, the left transverse foramen, the left transverse foramen, the left transverse foramen, the left transverse foramen, the right transverse foramen and the left intervertebral foramen were 5.65 (+1.10 mm), 5.25 (+0.97 mm), 4.98 (+0.98 mm) and 4. The mean length of the right intervertebral foramen was 9.54 (+ 1.34 mm), the mean shortest diameter of the left intervertebral foramen was 5.52 (+ 1.46 mm) and the shortest diameter of the right intervertebral foramen was 5.37 (+ 1.34 mm). 3 ~ C7 gradually widened, the average value was 27.72 + 2.46mm, the C7 was the widest, and the average value was 32.42 + 2.60mm.
3. The average length of the base of the uncinate process of the C6 vertebral body was 13.36 (+ 2.36 mm), the average width of the base of the uncinate process of the C6 vertebral body was 5.96 (+ 1.46), the average distance of the lateral margin of the uncinate process was 29.91 (+ 2.26 mm) and the average distance of the transverse foramen was 30.10 (+ 1.73 mm) in the operation group. All the above values were higher than those of the normal people, and P 0.05 was significant.
4. The shortest diameter of the intervertebral foramen in asymptomatic group was 4.87 (+ 1.83 mm) on the left side and 4.65 (+ 1.83 mm) on the right side. The shortest diameter of the intervertebral foramen in surgical group was 3.54 (+ 1.84 mm) on the left side and 3.64 (+ 1.34 mm) on the right side. The area of 75 mm2 was 22.17 (+ 8.23) mm2 on the left side and 19.48 (+ 6.89) mm2 on the right side in the operation group. Compared with the two groups, the area of the operation group was smaller, and the difference was statistically significant (P 0.05).
5. Compared with the asymptomatic group, the shortest diameter of the left intervertebral foramen, the right intervertebral foramen, the right intervertebral foramen, the left foramen, the left foramen, the left foramen, the left foramen and the right foramen were 4.03 (+ 1.69) mm, 4.20 (+ 1.12) mm, 27.55 (+ 7.65) mm 2, 24.69 (+ 7.17) mm 2, respectively. The symptom group decreased, and P0.05 had statistical significance.
6. The shortest diameter of the intervertebral foramen in the operation group was 3.54 (+ 1.84 mm) on the left side, 3.64 (+ 1.34 mm) on the right side, 4.03 (+ 1.69 mm) on the left side and 4.20 (+ 1.12 mm) on the right side in the conservative group. Although the shortest diameter of the intervertebral foramen in the operation group was smaller than that in the conservative group, the difference was not statistically significant (P 0.05). The area of left side and right side were 27.55 and 7.65 mm 2 respectively in conservative treatment group and 24.69 and 7.17 mm 2 respectively. The area of left and right intervertebral foramen in operation group was significantly smaller than that in conservative treatment group, and P 0.05 was statistically significant.
7. Only about 9% of the asymptomatic group had stenosis of the intervertebral foramen, while 25% and 50% of the patients in the conservative treatment group had stenosis in the upper and middle foramen respectively, and 10% of the patients in the conservative treatment group had no stenosis of the intervertebral foramen, while the number of patients in the surgical treatment group had stenosis of varying degrees and stenosis in the upper foramen. Significantly increased compared with the first two groups, reaching 47.6%.
conclusion
1. Multi-slice spiral CT scanning and three-dimensional reconstruction technology can observe the three-dimensional space position, distance and anatomical indication of the vertebral structure of the cervical spine from multi-angle and provide extremely important basis and valuable information for clinical practice.
2. the spatial volume and spacing of uncinate processes in different segments have certain regularity, but there are still great differences.
3. Anterior wall of cervical foramen uncinate process hyperplasia is the main cause of cervical foramen stenosis, and the stenosis can be divided into upper, middle and lower parts, the upper and middle stenosis is the main cause of pain in cervical spondylotic radiculopathy; the upper foramen stenosis in patients with surgery is significantly increased.
4. The shortest diameter and the area of the intervertebral foramen can be used as one of the indicators of surgery. However, the specificity of the area of the intervertebral foramen is higher because of the influence of the narrow position, so the area of the intervertebral foramen can be more objective indicators of the surgical indications for patients with cervical spondylotic radiculopathy.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R816.8
本文編號：2192581
[Abstract]:objective
Objective To observe the anatomical relationship between the uncinate process and adjacent structures of the cervical spine by multi-slice spiral CT scanning and three-dimensional reconstruction, and to explore the characteristics of the osseous structure of the uncinate process of the cervical spine and the correlation between the uncinate process and the surrounding structures and its clinical significance.
Method
Thirty-six adults without radicular symptoms, 21 patients with Radicular Cervical Spondylosis (C6 nerve roots) who underwent surgical treatment but failed conservative treatment, and 20 patients with Radicular Cervical Spondylosis (C6 nerve roots) who underwent conservative treatment were examined by multi-slice spiral CT and three-dimensional reconstruction imaging. Based on the three-dimensional reconstructed images, the anatomical structures of uncinate process, vertebral body, intervertebral foramen and transverse foramen, the actual length, area and the relationship between the three-dimensional space were measured and analyzed.
Result
1. In the normal population, the height of uncinate process increased gradually from C3 to C6, with an average of 5.51 (+ 1.05 mm); C7 was the lowest, 5.34 (+ 1.21 mm) on the left and 5.14 (+ 1.35 mm) on the right; C6 was the highest, 6.16 (+ 1.44 mm) on the left and 5.70 (+ 1.58 mm) on the right. The width of uncinate process increased gradually from C3 to C7, with an average of 5.09 (+ 1.32 mm), but the increase was not significant; the length of uncinate process was basically the same, with an average of 11.12 (+ 1.72 mm). The average dip angle of the uncinate process was 48.88 [15.68]. The distance between the anterior angles of the uncinate process increased gradually from C3 to C7 with an average of 18.24 [2.75 mm]. The distance between the lateral edges of the uncinate process was basically the same from C3 to C6 with an average of 28.13 [2.14 mm], of which C7 was the longest with an average of 29.98 [1.63 mm]. The distance between the posterior angles was gradually reduced from C3 to C7 with an average of 10.06 [3.11 mm
2. In the asymptomatic group, the transverse diameter and longitudinal diameter of the foramen C3-C6 did not change much, but the left side was slightly larger than the right side. The mean transverse diameter of the left transverse foramen, the right transverse foramen, the left transverse foramen, the left transverse foramen, the left transverse foramen, the left transverse foramen, the right transverse foramen and the left intervertebral foramen were 5.65 (+1.10 mm), 5.25 (+0.97 mm), 4.98 (+0.98 mm) and 4. The mean length of the right intervertebral foramen was 9.54 (+ 1.34 mm), the mean shortest diameter of the left intervertebral foramen was 5.52 (+ 1.46 mm) and the shortest diameter of the right intervertebral foramen was 5.37 (+ 1.34 mm). 3 ~ C7 gradually widened, the average value was 27.72 + 2.46mm, the C7 was the widest, and the average value was 32.42 + 2.60mm.
3. The average length of the base of the uncinate process of the C6 vertebral body was 13.36 (+ 2.36 mm), the average width of the base of the uncinate process of the C6 vertebral body was 5.96 (+ 1.46), the average distance of the lateral margin of the uncinate process was 29.91 (+ 2.26 mm) and the average distance of the transverse foramen was 30.10 (+ 1.73 mm) in the operation group. All the above values were higher than those of the normal people, and P 0.05 was significant.
4. The shortest diameter of the intervertebral foramen in asymptomatic group was 4.87 (+ 1.83 mm) on the left side and 4.65 (+ 1.83 mm) on the right side. The shortest diameter of the intervertebral foramen in surgical group was 3.54 (+ 1.84 mm) on the left side and 3.64 (+ 1.34 mm) on the right side. The area of 75 mm2 was 22.17 (+ 8.23) mm2 on the left side and 19.48 (+ 6.89) mm2 on the right side in the operation group. Compared with the two groups, the area of the operation group was smaller, and the difference was statistically significant (P 0.05).
5. Compared with the asymptomatic group, the shortest diameter of the left intervertebral foramen, the right intervertebral foramen, the right intervertebral foramen, the left foramen, the left foramen, the left foramen, the left foramen and the right foramen were 4.03 (+ 1.69) mm, 4.20 (+ 1.12) mm, 27.55 (+ 7.65) mm 2, 24.69 (+ 7.17) mm 2, respectively. The symptom group decreased, and P0.05 had statistical significance.
6. The shortest diameter of the intervertebral foramen in the operation group was 3.54 (+ 1.84 mm) on the left side, 3.64 (+ 1.34 mm) on the right side, 4.03 (+ 1.69 mm) on the left side and 4.20 (+ 1.12 mm) on the right side in the conservative group. Although the shortest diameter of the intervertebral foramen in the operation group was smaller than that in the conservative group, the difference was not statistically significant (P 0.05). The area of left side and right side were 27.55 and 7.65 mm 2 respectively in conservative treatment group and 24.69 and 7.17 mm 2 respectively. The area of left and right intervertebral foramen in operation group was significantly smaller than that in conservative treatment group, and P 0.05 was statistically significant.
7. Only about 9% of the asymptomatic group had stenosis of the intervertebral foramen, while 25% and 50% of the patients in the conservative treatment group had stenosis in the upper and middle foramen respectively, and 10% of the patients in the conservative treatment group had no stenosis of the intervertebral foramen, while the number of patients in the surgical treatment group had stenosis of varying degrees and stenosis in the upper foramen. Significantly increased compared with the first two groups, reaching 47.6%.
conclusion
1. Multi-slice spiral CT scanning and three-dimensional reconstruction technology can observe the three-dimensional space position, distance and anatomical indication of the vertebral structure of the cervical spine from multi-angle and provide extremely important basis and valuable information for clinical practice.
2. the spatial volume and spacing of uncinate processes in different segments have certain regularity, but there are still great differences.
3. Anterior wall of cervical foramen uncinate process hyperplasia is the main cause of cervical foramen stenosis, and the stenosis can be divided into upper, middle and lower parts, the upper and middle stenosis is the main cause of pain in cervical spondylotic radiculopathy; the upper foramen stenosis in patients with surgery is significantly increased.
4. The shortest diameter and the area of the intervertebral foramen can be used as one of the indicators of surgery. However, the specificity of the area of the intervertebral foramen is higher because of the influence of the narrow position, so the area of the intervertebral foramen can be more objective indicators of the surgical indications for patients with cervical spondylotic radiculopathy.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R816.8
【共引文獻(xiàn)】
相關(guān)期刊論文 前1條
1 廖旭昱;楊慶國;華興一;張銀順;韓春;葉楊林;;下頸椎椎動脈孔及其毗鄰的解剖學(xué)和影像學(xué)觀測[J];中國臨床解剖學(xué)雜志;2009年06期
相關(guān)博士學(xué)位論文 前2條
1 曹俊明;Bryan人工頸椎間盤置換術(shù)后頸部運(yùn)動功能的評價及臨床療效的研究[D];河北醫(yī)科大學(xué);2011年
2 程吉勇;單純密網(wǎng)孔支架治療兔動脈瘤的血流動力學(xué)數(shù)值模擬研究[D];第二軍醫(yī)大學(xué);2010年
相關(guān)碩士學(xué)位論文 前2條
1 廖旭昱;下頸椎椎動脈孔及其毗鄰的解剖學(xué)和影像學(xué)觀測[D];安徽醫(yī)科大學(xué);2010年
2 王金應(yīng);頸椎后路單開門椎管擴(kuò)大成形術(shù)與雙開門椎管擴(kuò)大成形術(shù)治療多節(jié)段CSM的對比分析[D];福建醫(yī)科大學(xué);2013年
本文編號：2192581
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