颈部三维CT血管成像在寰椎后路固定术中的应用

背景:寰枢椎后路内固定融合是治疗上颈椎病变的常用手术方式,此处解剖结构复杂多变,损伤椎动脉的案例时有报道。目的:观察正常人上颈椎三维CT血管图像,研究寰椎后弓的解剖结构及伴行椎动脉的走形特点,为寰椎后路置钉提供解剖学依据。方法:纳入椎动脉显影良好且寰枢椎无明显病变者400例,利用原始资料进行容积重建,同时配合分离、融合、透明和伪彩等图像处理技术,在三维图像上观察椎动脉寰枕段的走行及变异,测量寰椎与后路置钉相关的解剖数据。结果与结论:400例头颈部三维CT血管图像清晰,满足要求。椎动脉寰枕段的行程弯曲,走形典型者385例,变异15例,共18侧。固定第一阶段动脉11侧,窗式椎动脉6侧,异常起源的小脑后下动脉1侧;椎动脉沟环48例,其中10例为双侧,共58侧。椎动脉沟底的后弓是钉道最薄弱部分,左右侧比较差异无显著性意义(P>0.05)。说明寰椎后弓及其伴行椎动脉常存在变异,给寰椎后路置钉带来不确定因素,三维CT血管图像可以清楚地显示两者的解剖结构,置入前充分了解这些数据,可以制定准确的手术方案,提高手术的安全性。

Application of three-dimensional CT angiography of cervical part in posterior atlas fixation

BACKGROUND:Posterior atlantoaxial fusion with internal fixation is a common treatment method for the treatment of upper cervical lesions.Some cases of vertebral artery injuries have been reported since complex and variable anatomical structure here.OBJECTIVE:To observe normal three-dimensional CT angiograph images of the upper cervical spine and to study the anatomy of atlantal posterior arch and the accompanying vertebral artery journey in order to provide the basis of microvascular anatomy for clinical treatment.METHODS:Four hundred cases without pathological lesions of atlantoaxial joint were selected.All the three-dimensional CT images were formed with volume rendering together with the techniques of separating,fusing,opacifying and false-coloring,On the three-dimensional CT images,the courses and variations of vertebral artery were observed,and the posterior screw-related data of the atlantal posterior arch were measured.RESULTS AND CONCLUSION:All the three-dimensional CT angiography images of head and neck were in high quality and up to our requirements.The courses of vertebral artery accompanied with the atlas were curved.There were 385 cases with typical itinerary.Variations were found in 15 cases,a total of 18 sides.There were 11 sides of persistent first intersegmental artery,6 sides of fenestrated vertebral artery,1 side of abnormal posterior inferior cerebellar artery respectively.48 cases of posterior ponticulus were found,and 10 cases were bilateral,a total of 58 sides.The bottom of the vertebral artery’s groove was the weakest part of the posterior arch,and there was no significant difference between left and right(P > 0.05).The shape of the atlantal posterior arch and the vicinal vertebral artery are polytropic which bright the uncertain factors for the atlas posterior screw.Therefore,the three-dimensional CT angiography image clearly shows the anatomical structures.Full understanding of these data before operation can help to identify the precise surgical programs in order to improve the security of the operation.