Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China.
Spine Surgery, The Second Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China.
Orthop Surg. 2024 Oct;16(10):2428-2435. doi: 10.1111/os.14164. Epub 2024 Jul 26.
The C4 is the transition point between the upper and lower cervical vertebrae and plays a pivotal role in the middle of the cervical spine. Currently, there are limited reports on large-scale sample studies regarding C4 anatomy in children, and a scarcity of experience exists in pediatric cervical spine surgery. The current study addresses the dearth of anatomical measurements of the C4 vertebral arch and lateral mass in a substantial sample of children. This study aims to measure the imaging anatomy of the C4 vertebral arch and lateral mass in children under 14 years of age across various age groups, investigate the growth and development of these structures.
We measured 12 indicators, including the size (D1, D2, D3, D4, D5, D6, D7, and D8) and angle (A, C, D, and E) of the C4 vertebral arch and lateral mass, in 513 children who underwent cervical CT examinations at our hospital. We employed the aggregate function for statistical analysis, conducted t-tests for difference statistics, and utilized the least squares method for regression analysis.
Overall, as age increased, there was a gradual increase in the size of the vertebral arch and lateral mass. Additionally, the medial inclination angle of the vertebral arch decreased, and the lateral mass flattened gradually. The rate of change decreased gradually with age. The mean value of D1 increased from 2.31 mm to 3.88 mm, of D2 from 16.75 mm to 29.2 mm, of D3 from 2.21 mm to 4.92 mm, and of D4 from 7.34 mm to 11.84 mm. Meanwhile, the mean value of D5 increased from 5.2 mm to 9.71 mm, of D6 from 10.19 mm to 16.16 mm, of D7 from 2.53 mm to 5.67 mm, and of D8 from 6.11 mm to 11.45 mm. Angle A ranged from 49.12° to 54.97°, angle C from 15.28° to 19.83°, angle D from 39.91° to 53.7°, and angle E from 18.63° to 28.08°.
Prior to cervical spine surgery in children, meticulous CT imaging anatomical measurements is essential. The imaging data serves as a reference for posterior C4 internal fixation, aids in designing posterior cervical screws for pediatric patients, and offer morphological anatomical references for posterior cervical spine surgery and screw design in pediatric patients.
C4 是颈椎上下两部分的过渡点，在颈椎中段起着关键作用。目前，关于儿童 C4 解剖结构的大规模样本研究报告有限，小儿颈椎外科经验也较少。本研究旨在对大量儿童的 C4 椎弓根和横突进行解剖测量。本研究旨在测量 14 岁以下不同年龄组儿童 C4 椎弓根和横突的影像学解剖结构，研究这些结构的生长发育情况。
我们对在我院行颈椎 CT 检查的 513 例儿童的 12 项指标（D1、D2、D3、D4、D5、D6、D7 和 D8 椎弓根和横突的大小和 A、C、D 和 E 角）进行了测量。我们采用了汇总函数进行统计分析，进行了差异统计的 t 检验，并采用最小二乘法进行了回归分析。
总的来说，随着年龄的增长，椎弓根和横突的大小逐渐增加。此外，椎弓根的内倾角度减小，横突逐渐变平。随着年龄的增长，变化率逐渐减小。D1 的平均值从 2.31mm 增加到 3.88mm，D2 从 16.75mm 增加到 29.2mm，D3 从 2.21mm 增加到 4.92mm，D4 从 7.34mm 增加到 11.84mm。同时，D5 的平均值从 5.2mm 增加到 9.71mm，D6 从 10.19mm 增加到 16.16mm，D7 从 2.53mm 增加到 5.67mm，D8 从 6.11mm 增加到 11.45mm。A 角范围为 49.12°至 54.97°，C 角范围为 15.28°至 19.83°，D 角范围为 39.91°至 53.7°，E 角范围为 18.63°至 28.08°。
在儿童进行颈椎手术前，需要对 CT 影像学解剖结构进行仔细测量。影像学数据为后路 C4 内固定提供参考，有助于设计儿童后路颈椎螺钉，并为儿童后路颈椎手术和螺钉设计提供形态解剖学参考。
