枕颈角与后枕颈角影像学参数的数字化测量及其临床意义

曲星月; 张少杰; 王星

doi:10.16098/j.issn.0529-1356.2021.01.015

PDF(2110 KB)

解剖学报 ›› 2021, Vol. 52 ›› Issue (1) : 98-102. DOI: 10.16098/j.issn.0529-1356.2021.01.015

解剖学

枕颈角与后枕颈角影像学参数的数字化测量及其临床意义

曲星月¹卜佳琪² 史君³ 段瑾东² 周雯卉²李志军⁴ 王星^4* 张少杰^4*

作者信息 +

Digital measurement and clinical significance of imaging parameters of occipital-C2 angle and posterior occipitocervical angle

QU Xing-yue¹ BU Jia-qi² SHI Jun³ DUAN Jin-dong² ZHOU Wen-hui² LI Zhi-jun⁴ WANG Xing^4* ZHANG Shao-jie^4*

Author information +

文章历史 +

摘要

目的探讨影像学参数枕颈角（OC2A）和后枕颈角（POCA）在性别、年龄之间变化规律及相关性，为枕颈融合术中固定头颈位置的角度提供参考。方法收集473例（男性339例、女性134例）影像学资料，以性别分2组，每组又以年龄分为≤29岁、30～39岁、40～49岁、50～59岁、60～69岁和≥70岁各6组。将扫描的颈椎断层影像原始数据以DICOM格式存贮，并导入Mimics16.0软件中测量OC2A与POCA，对两者值随性别、年龄的变化行统计学分析。结果 OC2A和POCA在性别间差异无显著性（P>0.05）。OC2A男性组中30~39岁除与≤29岁男性组外，其余组间差异均存在显著性（P<0.05），而女性组各年龄组间差异均无显著性（P>0.05）； POCA男性30～39岁组中除与≤29岁以下组外，与其余组间差异显著（P<0.05），而40～49岁组则与每组间差异均存在显著性（P<0.05），女性组中则≤29岁组与各年龄组间差异存在显著性（P<0.05），其余各组间差异不显著（P>0.05）；Pearson相关分析显示，OC2A与POCA即两者间不存在相关性 (r=0.038，P>0.05)。结论 OC2A和POCA值在性别间无差异；男性OC2A和POCA值各年龄段间存在差异，提示临床注意考虑男性年龄差异；而女性OC2A值各年龄段间无差异，POCA却在各年龄段间有差异，OC2A和POCA值在不同年龄段和性别间的变化规律，为枕颈融合术中固定头颈解剖复位角度提供参数依据。

Abstract

Objective To explore the differences and correlation of imaging parameters of occipital-C2 angle (OC2A) and posterior occipitocervical angle (POCA) between sex and age, so as to provide theoretical reference for fixing the position of head and neck in occipitocervical fusion. Methods The imaging data of 473 cases (339 males and 134 females) were collected and divided into 2 groups according to sex. Each group was subdivided into 6 groups according to age: ≤29 year-old, 30-39 year-old, 40-49 year-old, 50-59 year-old, 60-69 year-old and ≥70 year-old. OC2A and POCA were measured in Mimics software, and their differences with sex and age were statistically analyzed. Results There was no significant difference in OC2A and POCA between sexes (P>0.05). In the OC2A male group, except for the male group aged 30-39 year-old and ≤29 year-old, there were significant differences among the other groups (P<0.05), but there was no significant difference among all age groups in the female group (P>0.05); There were significant differences in POCA between the male group of 30-39 year-old and ≤29 year-old (P<0.05), but between the group of 40-49 year-old and each group (P<0.05). In the female group, there was significant difference between the group of ≤29 year-old and all age groups(P<0.05), but there was no significant difference among the other groups (P>0.05). Pearson correlation analysis showed that there was a positive correlation between OC2A and POCA (r=0.038, P>0.05), that is, there was no correlation between them. ConclusionThere is no difference in OC2A and POCA values between sexes; there are differences in OC2A and POCA values in males among different age groups, suggesting that clinical attention should be paid to the age differences in males, while there is no difference in OC2A values in females, but POCA is different in different age groups. The changes of OC2A and POCA values in different age groups and sex provide a parameter basis for fixing the anatomical reduction angle of head and neck in occipitocervical fusion.

导出引用

曲星月卜佳琪史君段瑾东周雯卉李志军王星张少杰. 枕颈角与后枕颈角影像学参数的数字化测量及其临床意义[J]. 解剖学报. 2021, 52(1): 98-102 https://doi.org/10.16098/j.issn.0529-1356.2021.01.015

QU Xing-yue BU Jia-qi SHI Jun DUAN Jin-dong ZHOU Wen-hui LI Zhi-jun WANG Xing ZHANG Shao-jie. Digital measurement and clinical significance of imaging parameters of occipital-C2 angle and posterior occipitocervical angle[J]. Acta Anatomica Sinica. 2021, 52(1): 98-102 https://doi.org/10.16098/j.issn.0529-1356.2021.01.015

中图分类号： R323.1

参考文献

［1］ Pan J, Huang D, Hao D, et al. Occipitocervical fusion: fix to C2 or C3［J］? Clin Neurol Neurosurg,2014,127:134-139.
［2］ He B, Yan L, Xu Z, et al. The causes and treatment strategies for the postoperative complications of occipitocervical fusion:a 316 cases retrospective analysis［J］. Eur Spine J,2014,23(8):1720-1724.
［3］ Yoshizumi T, Murata H, Ikenishi Y, et al. Occipitocervical fusion with relief of odontoid invagination: atlantoaxial distraction method using cylindrical titanium cage for basilar invagination—case report［J］.Neurosurg Rev,2014, 37(3):519-525.
［4］ Yoshida M,Neo M, Fujibayashi S, et al. Upper-airway obstruction after short posterior occipitocervical fusion in a flexed position［J］.Spine,2007,32(8): 267-270.
［5］ Matsubayashi Y, Shimizu T, Chikuda H, et al. Correlations of cervical sagittal alignment before and after occipitocervical fusion［J］.Global Spine J，2016,6(4):362-369.
［6］ Liao SX, Wang JH, Zheng YQ, et al. Three-dimensional finite element analysis of a newly developed aliform internal fixation system for occipitocervical fusion［J］. Med Eng Phys，2016,38(12):1392-1398.
［7］ Takami T, Ichinose T, Ishibashi K, et al. Importance of fixation angle in posterior instrumented occipitocervical fusion［J］.Neurol Med-Chir(Tokyo), 2008,48(6):279-282.
［8］ Shoda N, Takeshita K, Seichi A, et al. Measurement of occipitocervical angle［J］. Spine,2004,29(10):E204-208.
［9］ Riel RU, Lee MC, Kirkpatrick JS. Measurement of a posterior occipitocervical fusion angle［J］.Clin Spine Surg,2010,23(1):27-29.
［10］ Yuan T, Jia G, Yang L, et al. Occipitocervical fusion combined with 3-dimensional navigation and 3-dimensional printing technology for the treatment of atlantoaxial dislocation with basilar invagination:a case report［J］.Medicine,2020, 99(5):e18983.
［11］ Wang L, Hu B, Song Y, et al. Predictive abilities of O-C2a and O-EAa for the development of postoperative dysphagia in patients undergoing occipitocervical fusion［J］.Spine J, 2020, 20(5):745-753.
［12］ Miyata M, Neo M, Fujibayashi S, et al. O-C2 angle as a predictor of dyspnea and/or dysphagia after occipitocervical fusion［J］.Spine,2009,34(2):184-188.
［13］ Gonda DD, Huang M, Briceo V, et al. Protecting against postoperative dyspnea and dysphagia after occipitocervical fusion［J］. Oper Neurosurg,2020, 18(3):254-260.
［14］ Yoon SD, Lee CH, Lee J, et al. Occipitocervical inclination: new radiographic parameter of neutral occipitocervical position［J］.Eur Spine J,2017, 26(9):2297-2302.
［15］ Maulucci CM, Ghobrial GM, Sharan AD, et al. Correlation of posterior occipitocervical angle and surgical outcomes for occipitocervical fusion［J］. Evid Based Spine Care J,2014,5(2):163-165.
［16］ Tang C, Li GZ, Liao YH, et al. Importance of the occipitoaxial angle and posterior occipitocervical angle in occipitocervical fusion［J］.Orthop Surg, 2019, 11(6):1054-1063.
［17］ Tang Ch, Li GZh, Liao YH, et al. Measurement and clinical significance of occipito-C2 angle and posterior occipitocervical angle in 150 healthy adults［J］.Chinese Journal of Spine and Spinal Cord,2018,28(3):239-244.（in Chinese）
唐超,李广州,廖烨晖,等.150例健康成人枕颈角和后枕颈角影像参数测量及其临床意义［J］.中国脊柱脊髓杂志,2018,28(3):239-244.
［18］ Inada T, Furuya T, Kamiya K, et al. Postoperative increase in occiput-C2 angle negatively impacts subaxial lordosis after occipito-upper cervical posterior fusion surgery［J］.Asian Spine J,2016,10(4):744-747.
［19］ Cone W, Turner WG. The treatment of fracture-dislocations of the cervical vertebrae by skeletal traction and fusion［J］.J Bone Joint Surg,1937,19(3):584-602.
［20］ Sherekar SK, Yadav YR, Basoor AS, et al. Clinical implications of alignment of upper and lower cervical spine［J］.Neurol India,2006,54(3):264-267.
［21］ Nojiri K, Matsumoto M, Chiba K, et al. Relationship between alignment of upper and lower cervical spine in asymptomatic individuals［J］.J Neurosurg,2003,99(1): 80-83.
［22］ Izeki M, Neo M, Takemoto M, et al. The O-C2 angle established at occipito-cervical fusion dictates the patient’s destiny in terms of postoperative dyspnea and/or dysphagia［J］.Euro Spine J,2014,23(2):328-336.
［23］ Li GZh, Liu H, Ding Ch, et al. A strategy combining with posterior occipitocervical angle and occipital-C2 angle foradjustment of occipitocervical fixation angle in posterior instrumented occipitocervical Fusion［J］. Chinese Journal of Reparative and Reconstructive Surgery,2019,33(1):35-40. (in Chinese)
李广州,刘浩,丁琛,等.联合应用后枕颈角和枕颈角指导后路枕颈融合术中枕颈固定角度调整的临床疗效［J］.中国修复重建外科杂志,2019,33(1):35-40.
［24］ Bauman JA, Hardesty DA, Heuer GG, et al. Use of occipital bone graft in pediatric posterior cervical fusion: an alternative paramedian technique and review of the literature［J］.J Neurosurg Pediatr, 2011,7(5):475-481.
［25］ Klimo Jr P, Ware ML, Gupta N, et al. Cervical spine trauma in the pediatric patient［J］.Neurosurg Clin North Am,2007,18(4):599-620.