目的探讨儿童寰枢椎椎弓根形态特征及其螺钉内固定置入方式。方法收集4~12岁儿童颈椎CT扫描资料60例,按年龄分为3组,每组20例。将原始数据导入Mimics软件行三维重建,在3D模型上测量寰枢椎椎弓根宽(Pw)、椎弓根高(PH)、椎弓根骨通道全长(POCL)、外偏角(e角)、尾偏角(f角)及两侧入钉点间距(BB’间距)并计算Pw/PH(I值),按年龄组及节段行统计分析。通过椎弓根轴线投影确定不同年龄组寰枢椎入钉点范围。结果寰枢椎的PW、PH及POCL总体随年龄增长呈递增趋势。寰椎A组PW(6.10±1.19)与B组(7.33±0.73)、C组(8-04±0.99)差异均有统计学意义(P〈O-05),枢椎C组PW(5.95±1-04)与A组(4.23±0.63)、B组(4.62±0.30)差异均有统计学意义(P〈0-05)。寰椎A组PH(4.18±0.74)与C组(4.98±0.67)差异有统计学意义(P〈0-05)。枢椎C组PH(6.88±0.92)与A组(5.15±0.69)、B组(5.99±0.44)的差异均有统计学意义(P〈0-05)。寰椎A组POCL(23-05±2.67)与B组(25.68±1.93)和C组(26.51±1.88)差异有统计学意义(P〈0-05),枢椎A组POCL(25.27±2.85)与B组(26.57±1.41)和C组(26.68±1.98)差异也有统计学意义(P〈0-05)。寰椎A组f角(5.06±3.12)与C组(8.51±2.67)差异有统计学意义(P〈0-05),寰椎BB’间距值在三组间(A组35-04±2.97;B组39.06±2.70;C组42.41±2.90)差异均有统计学意义(P〈O-05)。枢椎A组BB’间距值(31.72±2.76)与B组(35.25±2.32)、C组(36.15±2.71)间差异均有统计学意义(P〈O-05)。结论4~12岁儿寰枢椎椎弓根均具有置入3.5mm螺钉的可行性。不同年龄组形态发育规律性明显,且置钉参数存在差异,置钉方式亦有所不同。应用数字化技术可实现对儿童寰枢椎椎弓根三维立体观测及其?
Objective To explore the vertebral pedicle characteristics and pedicle screw internal fixations of atlas and axis in children. Methods A total of 60 healthy children aged 4- 12 years with computed tomography (CT) data of cervical spine were divided into three groups (n = 20 each). The original data were entered into the Mimics software for 3D image reconstruction. The values of pedicle width (PW), pedicle height (PH), entire length of pedicle osseous channel (POCL), external deflection angle (e angle), tail deflection angle (f angle) and BB spacing of atlas & axis were measured. Then PW/PH (I value) was calculated. Statistical analyses were performed by age group and segment. For different age groups, atlantoaxial vertebral axis point range was determined through pedicle nailing projection. Results PW, PH and POCL of atlantoaxial generally showed a rising trend with advancing age. Statistically significant difference existed in PW of atlas between groups A, B and C [-(6. 10 ±1.19), (7. 33 ±0. 73), (8. 04 ± 0. 99), P〈0. 05);PW of axis between groups C, A and B [(5. 95± 1-04), (4. 23 ± 0. 63), (4. 62 ± 0. 30), P〈0. 05); PH of atlas between groups A and C [(4. 18 ± 0. 74), (4. 98 ± 0. 67), P〈0. 05) PH of axis between groups C and A, B [-(6. 88 ± 0. 92),(5.15 ± 0. 69), (5.99 ± 0. 44), P〈0. 05) atlantoaxial POCL between groups A, B and C [-(23. 05 ± 2. 67), (25.68 ± 1.93), (26. 51± 1.88), P〈0. 05) of angle of atlas between groups A and C E(5.06±3.12), (8. 51 ± 2. 67), P〈0. 05) BB spacing of atlas between groups A, B and C [-(35, 04± 2.97), (39.06 ± 2. 70), (42. 41±2. 90), P〈0. 05) BB spacing of axis between groups A, B and C [-(31.72±2.76), (35.25±2.32), (36. 15±2.71), P〈0-053. Conclusions It is feasible to insert a pedicle screw with a diameter of 3.5 mm into atlas and axis pedicles of children aged 4-12 years. Morphological development varies g