摘要
目的基于颈椎CT血管造影(CT angiography,CTA)和MRI测量颈椎钩椎关节“拐点”解剖学参数,为颈椎前路减压手术提供安全、有效的定位标志。方法回顾性分析2020年1月—2024年1月符合选择标准的正常成人颈椎CTA和MRI影像学资料。其中颈椎CTA数据326例,男200例,女126例;年龄22~55岁,平均46.7岁。MRI数据300例,男200例,女100例;年龄18~55岁,平均43.7岁。基于CTA数据构建C_(3)~C_(7)三维模型,上面观测量左、右侧钩椎关节“拐点”至椎动脉内侧壁距离(uncinate process“inflection point”to vertebral artery distance,UIVD)、钩突顶点至椎动脉内侧壁距离(uncinate process tip to vertebral artery distance,UTVD),双侧钩椎关节“拐点”间距(uncinate process“inflection point”to“inflection point”distance,UID),以及左、右侧钩椎关节长轴与矢状面夹角(uncinate process long-axis to sagittal angle,ULSA)、经钩椎关节“拐点”横突孔后内侧壁切线与矢状面夹角(uncinate process“inflection point”to transverse foramen-sagittal angle,UITSA);前面观测量左、右侧椎体前方钩椎关节与矢状面夹角(anterior uncinate process to sagittal angle,AUSA);后面观测量左、右侧椎体后方钩椎关节与矢状面夹角(posterior uncinate process to sagittal angle,PUSA)。基于MRI测量左、右侧钩椎关节“拐点”至同侧硬膜囊外侧缘距离(uncinate process“inflection point”to dural sac distance,UIDD)以及硬膜囊宽度(dural sac width,DSW)。观察C_(3)~C_(7)测量参数变化趋势,比较不同性别和同节段左、右侧间测量参数差异,以及同节段UID、DSW差异。结果CTA各测量参数从C_(3)~C_(7)节段均呈总体逐渐增大趋势,同节段左、右侧差异均无统计学意义(P>0.05)。男性同节段UIVD、UTVD、UID均大于女性,其中C_(3)、C_(6)节段UIVD、UTVD以及C_(3)、C_(6)、C_(7)节段UID差异有统计学意义(P<0.05)。MRI测量的DSW从C_(3)~C_(7)节段总体呈逐渐增大趋势,且女性C_(6)节段DSW大于男性,差异有统计学意义(P<0.05)。UIDD则呈总体逐渐减小趋势,但C_(6)节段最小。同节段不同性别间以及左、右侧差异均无统计学意义(P>0.05)。C_(3)~C_(7)节段UID均大于DSW,差异有统计学意义(P<0.05)。结论钩椎关节“拐点”是颈椎前方一个恒定解剖结构,位于钩突顶点前内侧、硬膜囊外侧,与椎动脉之间有一定安全距离,将其作为颈椎前路减压手术的减压定位标志,既可以保障手术安全,又可以保证减压彻底。
Objective To explore the anatomical parameters of the cervical uncinate process“inflection point”through cervical CT angiography(CTA)and MRI measurements,offering a reliable and safe anatomical landmark for anterior cervical decompression surgery.Methods A retrospective analysis was conducted on the cervical CTA and MRI imaging data of normal adults who met the selection criteria between January 2020 and January 2024.The CTA dataset included 326 cases,with 200 males and 126 females,aged 22-55 years(mean,46.7 years).The MRI dataset included 300 cases,with 200 males and 100 females,aged 18-55 years(mean,43.7 years).Based on the CTA data,three-dimensional models of C_(3)-C_(7) were constructed,and the following measurements were obtained from the superior view:uncinate process“inflection point”to vertebral artery distance(UIVD),uncinate process tip to vertebral artery distance(UTVD),uncinate process“inflection point”to“inflection point”distance(UID),uncinate process long-axis to sagittal angle(ULSA),and uncinate process“inflection point”to transverse foramen-sagittal angle(UITSA).From the anterior view,the anterior uncinate process to sagittal angle(AUSA)was measured.From the posterior view,the posterior uncinate process to sagittal angle(PUSA)was measured.Based on the MRI data,uncinate process“inflection point”to dural sac distance(UIDD)and dural sac width(DSW)were measured.The trends in measurement parameters of C_(3)-C_(7) were observed,and the differences in measurement parameters between genders and between the left and right sides of the same segment were compared,as well as the difference in UID and DSW within the same segment was compared.Results The measurement parameters from C_(3) to C_(7) in the CTA data showed a general increasing trend,with no significant difference between the left and right sides within the same segment(P>0.05).The UIVD,UTVD,and UID were greater in males than in females,with significant differences observed in the UIVD and UTVD at C_(3) and C_(6) and UID at C_(3),C_(6),and C_(7)(P<0.05).The MRI measured DSW showed a general increasing trend from C_(3) to C_(7),and the DSW at C_(6) was greater in females than in males,with a significant difference(P<0.05).The UIDD showed a gradual decreasing trend,with the smallest value at C_(6).There was no significant difference between males and females or between the left and right sides within the same segment(P>0.05).The UID was greater than the DSW at C_(3)-C_(7),and the differences were significant(P<0.05).Conclusion The uncinate process“inflection point”is a constant anatomical structure located at the anteromedial aspect of the uncinate process tip and laterally to the dural sac.It maintains a certain safe distance from the vertebral artery.As a decompression landmark in anterior cervical spine surgery,it not only ensures surgical safety but also guarantees complete decompression.
作者
江剑峰
马俊
杨茂宇
韩尧政
苏林涛
雷昌宇
葛晨光
康辉
JIANG Jianfeng;MA Jun;YANG Maoyu;HAN Yaozheng;SU Lintao;LEI Changyu;GE Chenguang;KANG Hui(Medical College,Wuhan University of Science and Technology,Wuhan Hubei,430065,P.R.China;Department of Orthopedics,General Hospital of Central Theater Command of Chinese PLA,Wuhan Hubei,430070,P.R.China)
出处
《中国修复重建外科杂志》
北大核心
2025年第3期332-340,共9页
Chinese Journal of Reparative and Reconstructive Surgery
基金
湖北省医学青年拔尖人才项目[鄂卫通(2019)48号]
湖北省卫生健康委员会面上科研项目(WJ2023M091)
中部战区总医院“三英一队”人才工程项目(1685)。
关键词
钩椎关节“拐点”
颈椎前路减压手术
定位标志
解剖测量
影像学研究
Uncinate process“inflection point”
anterior cervical decompression surgery
localization landmark
anatomical measurement
radiographic study
