C2 椎弓根峡部结构的形态学分析及安全置钉的可行性：多层螺旋 CT 重建与传统 X 线方法的比较。
Morphology analysis of the C2 pediculoisthmic component and feasibility of safe C2 pedicle screw placement: comparison of multiplanar reconstruction versus traditional radiographic methods.
机构信息
The Spine Department, Orthopaedic Center, Guangdong Second Provincial General Hospital, Guang Zhou, Guangdong Province, China.
The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China.
出版信息
J Orthop Surg Res. 2023 Mar 28;18(1):252. doi: 10.1186/s13018-023-03727-3.
BACKGROUND
Preoperatively evaluating the feasibility of safe C2 pedicle screw placement is the key to avoiding iatrogenic vertebral artery injury. However, it has not been verified whether the conventional CT measurements of C2 pediculoisthmic component (PIC) are reliable and accurate, and the results may lack validity. The purpose of this study is to analyze the evaluative performance of conventional CT measurements and to create an accurate predictor of morphometrics of C2 PIC.
METHODS
A total of 304 C2 PICs were measured in 152 consecutive patients who underwent CT examination of the cervical spine between April 2020 and December 2020. We obtained the morphometric parameters of C2 PIC by measuring minimum PIC diameter (MPD) in CT multiplanar reconstruction versus conventional measurements of transverse PIC width (TPW), oblique PIC width (OPW) and definition of high-riding vertebral artery (HRVA). The outer diameter measured less than 4 mm in MPD was regarded as the standard of precluding safe C2 pedicle screw insertion. The evaluative performance of the conventional CT measurements was assessed, and the correlation between conventional CT measurements and measurements in CT multiplanar reconstruction was calculated.
RESULTS
The parameters in OPW and MPD were measured significantly larger than those in TPW, and the preclusion of C2 pedicle screw placement evaluated from TPW and HRVA was significantly higher than that evaluated from OPW and MPD. The sensitivity of TPW was 93.09%, and the specificity was 79.31%. The sensitivity and specificity of OPW were 97.82% and 82.76%. The sensitivity of HRVA was 88.36%, and the specificity was 96.55%. Strong agreement with the highest correlation coefficient (0.879) and determination coefficient (0.7720) suggested that the outer diameter of OPW could be useful for the precise prediction of MPD.
CONCLUSIONS
CT MPR allows accurate measurement of the narrowest section of the C2 PIC. The outer diameter of OPW could be simply measured and be useful for precise prediction of MPD, which makes C2 pedicle screw placement more safely than the conventional measurement of TPW and HRVA.
背景
术前评估 C2 椎弓根螺钉置入的安全性至关重要，可避免医源性椎动脉损伤。然而，目前尚未验证 C2 椎弓根峡部（PIC）的常规 CT 测量是否可靠和准确，且结果可能缺乏有效性。本研究旨在分析常规 CT 测量的评估性能，并创建 C2 PIC 形态学的准确预测器。
方法
共纳入 2020 年 4 月至 2020 年 12 月期间连续 152 例行颈椎 CT 检查的患者，对其 304 个 C2 PIC 进行测量。通过 CT 多平面重建测量最小 PIC 直径（MPD）获得 C2 PIC 的形态学参数，与常规测量的横突 PIC 宽度（TPW）、斜 PIC 宽度（OPW）和高位椎动脉（HRVA）定义进行比较。将 MPD 测量值小于 4mm 的外径定义为排除安全 C2 椎弓根螺钉置入的标准。评估常规 CT 测量的评估性能，并计算常规 CT 测量与 CT 多平面重建测量之间的相关性。
结果
OPW 和 MPD 中的参数明显大于 TPW，且根据 TPW 和 HRVA 评估的 C2 椎弓根螺钉置入排除率明显高于 OPW 和 MPD。TPW 的灵敏度为 93.09%，特异度为 79.31%。OPW 的灵敏度和特异度分别为 97.82%和 82.76%。HRVA 的灵敏度为 88.36%，特异度为 96.55%。与最高相关系数（0.879）和确定系数（0.7720）具有强烈一致性表明，OPW 的外径可用于准确预测 MPD。
结论
CT MPR 可准确测量 C2 PIC 的最窄部分。OPW 的外径易于测量，可用于准确预测 MPD，这使得 C2 椎弓根螺钉置入比常规的 TPW 和 HRVA 测量更安全。
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