基于CT三维重建技术的颈椎钩突及周围结构解剖学研究
发布时间：2018-08-19 19:19
【摘要】：目的 观察多层螺旋CT扫描和三维重建技术评估颈椎钩突及毗邻结构的解剖学关系，探讨颈椎钩突骨性结构的特点和钩突与周围结构的相关性及临床意义。 方法 对36名无神经根性症状的成人，21名保守治疗无效而进行了手术治疗的神经根型颈椎病患者（C6神经根）和20名保守治疗有效的神经根型颈椎病患者（C6神经根）的下颈椎（颈3-7）多层螺旋CT扫描和三维重建影像学检查图像进行分析。以颈椎钩突为研究对象，重点在三维重建图形基础上，分别对钩突、椎体、椎间孔和横突孔等解剖学结构、实际长度、面积和立体空间相互之间的关系进行数据测量，然后进行统计分析及评价。 结果 1.在正常人群中，钩突高度从C3～C6逐渐增加，平均值5.51±1.05mm；C7最低，左侧5.34±1.21mm，右侧5.14±1.35mm；C6最高，左侧6.16±1.44mm，右侧5.70±1.58mm。钩突宽度从C3～C7逐渐增宽，平均值5.09±1.32mm，但增幅不大；钩突长基本一致，平均值11.12±1.72mm。钩突倾角平均值为48.88°±15.68°。钩突前角间距从C3～C7逐渐变长，平均值18.24±2.75mm；钩突侧缘间距从C3～C6基本一致，平均值28.13±2.14mm，其中C7最长，平均值29.98±1.63mm；后角间距从C3～C7逐渐缩小，平均值10.06±3.11mm。 2.在无症状组中，C3～C6横突孔横径纵径变化不大，但左侧略大于右侧，左侧横突孔横径平均值5.65±1.10mm，右侧横突孔横径平均值5.25±0.97mm，左侧横突孔纵径4.98±0.98mm，右侧横突孔纵径4.65±0.96mm。左右椎间孔大小基本一致，左侧椎间孔长径平均值9.54±1.34mm，右侧椎间孔长径9.54±1.42mm，左侧椎间孔最短径平均值5.52±1.46mm，右侧椎间孔最短径5.37±1.34mm。横突孔前缘至椎体前方水平线的垂直距离从C3～C6逐渐缩小，左侧平均值9.06±1.82mm，右侧平均值8.58±2.01mm，C7最长；横突孔间距从C3～C7逐渐增宽，平均值27.72±2.46mm，C7最宽，平均值32.42±2.60mm。 3.手术治疗组的C6椎体钩突基底长平均值为13.36±2.36mm，C6椎体钩突基底宽平均值为5.96±1.46，钩突侧缘间距平均值为29.91±2.26mm，横突孔间距平均值为30.10±1.73mm，以上各值均比正常人增加，且P0.05，有显著性意义。 4.无症状组椎间孔最短径左侧4.87±1.83mm，右侧4.65±1.83mm，手术治疗组椎间孔最短径左侧3.54±1.84mm，右侧3.64±1.34mm，两者比较，手术治疗组明显更短，且P0.05，有显著性意义。无症状组左侧椎间孔面积36.20±29.40mm2，右侧椎间孔椎间孔面积33.68±17.75mm2，手术治疗组面积左侧为22.17±8.23mm2，右侧为19.48±6.89mm2，两者相比，手术治疗组面积更小，且P0.05，具有统计学意义。 5.保守治疗组左侧椎间孔短径4.03±1.69mm，，右侧椎间孔短径4.20±1.12mm，左侧面积27.55±7.65mm2，右侧面积24.69±7.17mm2，与无症状组比较，虽然从数据上两侧椎间孔的最短径较无症状组有所减少，但P0.05,不具有统计学意义，但是椎间孔面积也较无症状组减少，且P0.05,具有统计学意义。 6.手术治疗组椎间孔最短径左侧3.54±1.84mm，右侧3.64±1.34mm，保守治疗组左侧椎间孔短径4.03±1.69mm，右侧椎间孔短径4.20±1.12mm，手术组椎间孔短径虽较保守治疗组有所减小，但P0.05，无统计学意义。手术治疗组面积左侧为22.17±8.23mm2，右侧为19.48±6.89mm2，保守治疗组左侧面积27.55±7.65mm2，右侧面积24.69±7.17mm2，手术组左右椎间孔面积明显小于保守治疗组，且P0.05，具有有统计学意义。 7.无症状组只有约9%的病人出现椎间孔狭窄；而保守治疗组的狭窄部位出现在椎间孔上部和中部的比例分别为25%、50%，并且保守治疗有10%的病例未出现椎间孔狭窄；而手术治疗组全部出现不同程度的狭窄，且在椎间孔上部狭窄的例数较前两组明显增多，达到47.6%。 结论 1.多层螺旋CT扫描和三维重建技术能从多角度、立体观察颈椎椎骨结构的立体空间位置、距离和解剖学标示，为临床提供了极其重要依据和有价值的信息。 2.不同节段的钩突，其空间体积、间距具有一定规律，但仍存在较大差异。 3.构成颈椎间孔前壁的钩突异常增生是造成颈椎间孔狭窄的主要因素。且狭窄的部位可分为上、中、下三部分，上部和中部的狭窄是引起神经根型颈椎病疼痛的主要原因；发生了上部椎间孔狭窄的患者手术可能性明显增加。 4.椎间孔的最短径和椎间孔面积均可作为手术指征的参考指标之一，但因存在狭窄部位的影响，椎间孔面积的特异性更高，故椎间孔面积大小更能成为神经根型颈椎病患者手术适应症的客观指标。
[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.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.8
本文编号：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.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.8
【共引文献】
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