Bapuraj Jayapalli Rajiv, Bruzek Amy K, Tarpeh Jamaal K, Pelissier Lindsey, Garton Hugh J L, Anderson Richard C E, Nan Bin, Ma Tianwen, Maher Cormac O
Departments of1Radiology and.
2Neurosurgery, University of Michigan, Ann Arbor, Michigan.
J Neurosurg Pediatr. 2019 Jun 21;24(3):227-235. doi: 10.3171/2019.4.PEDS1968. Print 2019 Sep 1.
Current understanding of how the pediatric craniocervical junction develops remains incomplete. Measurements of anatomical relationships at the craniocervical junction can influence clinical and surgical decision-making. The purpose of this analysis was to quantitatively define clinically relevant craniocervical junction measurements in a population of children with CT scans that show normal anatomy.
A total of 1458 eligible patients were identified from children between 1 and 18 years of age who underwent cervical spine CT scanning at a single institution. Patients were separated by both sex and age in years into 34 groups. Following this, patients within each group were randomly selected for inclusion until a target of 15 patients in each group had been reached. Each patient underwent measurement of the occipital condyle-C1 interval (CCI), pB-C2, atlantodental interval (ADI), basion-dens interval (BDI), basion-opisthion diameter (BOD), basion-axial interval (BAI), dens angulation, and canal diameter at C1. Mean values were calculated in each group. Each measurement was performed by two teams and compared for intraclass correlation coefficient (ICC).
The data showed that CCI, ADI, BDI, and dens angulation decrease in magnitude throughout childhood, while pB-C2, PADI, BAI, and BOD increase throughout childhood, with an ICC of fair to good (range 0.413-0.912). Notably, CCI decreases continuously on coronal CT scans, whereas on parasagittal CT scans, CCI does not decrease until after age 9, when it shows a continuous decline similar to measurements on coronal CT scans.
These morphometric analyses establish parameters for normal pediatric craniocervical spine growth for each year of life up to 18 years. The data should be considered when evaluating children for potential surgical intervention.
目前对于小儿颅颈交界区如何发育的理解仍不完整。颅颈交界区解剖关系的测量会影响临床和手术决策。本分析的目的是在CT扫描显示解剖结构正常的儿童群体中，定量确定临床上相关的颅颈交界区测量值。
从1至18岁在单一机构接受颈椎CT扫描的儿童中，共识别出1458例符合条件的患者。患者按性别和年龄（以岁计）分为34组。在此之后，每组内随机选择患者纳入，直至每组达到15例患者的目标。对每位患者进行枕髁-C1间隙（CCI）、pB-C2、寰齿间隙（ADI）、颅底-齿突间隙（BDI）、颅底-枕大孔直径（BOD）、颅底-枢椎间隙（BAI）、齿突角度以及C1处椎管直径的测量。计算每组的平均值。每项测量由两个团队进行，并比较组内相关系数（ICC）。
数据显示，整个儿童期CCI、ADI、BDI和齿突角度的数值减小，而pB-C2、PADI、BAI和BOD在整个儿童期增大，ICC为中等至良好（范围0.413 - 0.912）。值得注意的是，在冠状位CT扫描上CCI持续减小，而在矢状旁位CT扫描上，CCI直到9岁后才减小，此时它呈现出与冠状位CT扫描测量结果类似的持续下降趋势。
这些形态学分析确定了18岁以下各年龄段小儿正常颅颈脊柱生长的参数。在评估儿童是否需要进行潜在手术干预时应考虑这些数据。
