Ji Wei, Kong Gang-Gang, Zheng Ming-Hui, Wang Xiang-Yang, Chen Jian-Ting, Zhu Qing-An
*Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China; and †Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical College, Wenzhou, China.
Spine (Phila Pa 1976). 2015 Mar 1;40(5):E259-65. doi: 10.1097/BRS.0000000000000749.
A computed tomography-based morphometric measurement of the pediatric craniovertebral junction for clival screw placement.
To identify morphometric differences of the pediatric clivus at different ages and establish guidelines for pediatric clival screw fixation.
Anterior fixation of the pediatric craniovertebral junction, a viable alternative to posterior occipital-cervical fixation, requires clival screw placement. The morphology of the pediatric clivus may be associated with greater difficulty in adequate purchase because of the spheno-occipital synchondrosis (clival fissure).
Morphometric analysis was conducted on computed tomographic scans of the craniocervical junction in 87 pediatric patients who were assigned into groups based on their ages (2-5 yr, 6-9 yr, 10-13 yr, and 14-16 yr). Measurements were made of the sagittal and axial planes to determine the clival length, widest and narrowest clival diameter, clival fissure distance, clival-cervical angle, and putative screw lengths.
The mean clival length, widest diameter, narrowest diameter, fissure distance, and putative screw lengths were 29.4 mm, 28. 9 mm, 17.3 mm, 21.9 mm, and 9.6 mm, respectively. These measurements were significantly different among the groups and highly correlated to age (P < 0.01). There was no significant difference in clival-cervical angle among the groups, with a mean angle of 129.2°± 6.4°. A clival screw (ø3.5 mm) was accommodated for all children older than 10 years, 89% of children aged 6 to 9 years, and 80% of children aged 2 to 5 years.
A clival screw fixation is feasible in the pediatric craniovertebral junction, particularly in children aged 10 years or older. The dimensions of the clivus were highly dependent on age. We suggest that all pediatric patients should undergo high-resolution, thin-slice computed tomography preoperatively to assess suitability for clival screw fixation.
基于计算机断层扫描的小儿颅颈交界区形态测量，用于斜坡螺钉置入。
确定不同年龄段小儿斜坡的形态测量差异，并建立小儿斜坡螺钉固定的指导原则。
小儿颅颈交界区的前路固定是枕颈后路固定的一种可行替代方法，需要进行斜坡螺钉置入。由于蝶枕软骨结合（斜坡裂隙），小儿斜坡的形态可能导致获得足够的把持力更困难。
对87例小儿患者的颅颈交界区计算机断层扫描进行形态测量分析，这些患者根据年龄分为几组（2 - 5岁、6 - 9岁、10 - 13岁和14 - 16岁）。在矢状面和轴面上进行测量，以确定斜坡长度、斜坡最宽和最窄直径、斜坡裂隙距离、斜坡 - 颈椎角以及假定的螺钉长度。
平均斜坡长度、最宽直径、最窄直径、裂隙距离和假定的螺钉长度分别为29.4 mm、28.9 mm、17.3 mm、21.9 mm和9.6 mm。这些测量值在各组之间有显著差异，且与年龄高度相关（P < 0.01）。各组之间的斜坡 - 颈椎角无显著差异，平均角度为129.2°± 6.4°。10岁以上的所有儿童、89%的6至9岁儿童和80%的2至5岁儿童都可容纳一枚斜坡螺钉（ø3.5 mm）。
斜坡螺钉固定在小儿颅颈交界区是可行的，特别是在10岁及以上的儿童中。斜坡的尺寸高度依赖于年龄。我们建议所有小儿患者术前应进行高分辨率、薄层计算机断层扫描，以评估斜坡螺钉固定的适用性。
3级。
