4-6岁儿童下颈椎关节突关节的三维数字化形态特征
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摘要
背景:颈椎关节突关节又称椎间小关节,与全身各种大关节一样属于滑膜关节。近年来解剖学和生物力学研究表明,颈椎关节突关节损伤、退变是引起慢性颈痛的最常见原因之一,现有研究主要集中于青少年和成人。目的:测量儿童下颈椎关节突关节的相关形态参数,探讨其发育规律和形态特征,为临床经关节螺钉固定提供解剖学参数。方法:选择4-6岁儿童32例,行下颈椎螺旋CT扫描后三维重建,要求无骨质破坏、肿瘤、畸形、骨折等,椎骨形态结构未发生改变,既往无脊柱相关手术,监护人对试验方案知情同意,且得到医院伦理委员会批准。进行C_3-C_7关节突关节相关形态测量及统计分析。结果与结论:(1)儿童颈椎关节突关节面无论高度还是宽度,在相邻两椎骨之间总是下关节面较上关节面小,由此推断出关节面的大小总是上关节面大于下关节面,根据高宽比例得出4-6岁儿童下颈椎上关节突关节面从C_3-C_7皆接近椭圆形,下关节突关节面从C_3-C_7皆接近圆形,还未形成从圆形到椭圆形的过渡改变;(2)关节突关节内高变化趋势从C_2-C_7在C4节段出现最低点,总体呈先降后升趋势;(3)关节突间距先升后降,上关节突间距与下关节突间距除在C_5节段之间差异无显著性意义且达最大值,在C_3和C_4节段上关节突间距均小于下关节突间距,在C_6和C_7节段上关节突间距明显大于下关节突间距,这可能与重力传递和颈椎活动有关。
BACKGROUND: Zygapophysial joints of cervical vertebra is also called intervertebral facet joint. It is a synovial joint like the large joints of the body. In recent years, anatomical and biomechanical studies have shown that zygapophysial joints injuries and degeneration is one of the most common causes of chronic neck pain. Existing studies on this joint have focused on adolescents and adults.OBJECTIVE: The morphological parameters of children's inferior cervical zygapophysial joints were measured to explore their developmental rules and morphological characteristics, and finally to provide anatomical parameters for clinical zygapophysial joint screw fixation.METHODS: Totally 32 cases of children aged 4-6 years old with no changes in vertebral bone structure such as bone destruction, tumor,deformity or fracture in the inferior cervical spine and no previous spine related surgery were selected for three-dimensional reconstruction after cervical spiral CT scanning. Guardian signed the informed consent. This study was approved by the Hospital Ethics Committee.Morphological measurement and statistical analysis of C_3-C_7 zygapophysial joints were conducted.RESULTS AND CONCLUSION:(1) For children cervical zygapophysial joint articular surfaces in both height and width, between the adjacent two vertebrae, the lower articular surface was smaller than the upper articular surface, so it can be inferred that the size of the upper articular surface was always larger than that of the lower articular surface. According to the height to width ratio, the articular surface of the superior facet of the lower cervical spine in children aged 4-6 years was nearly elliptic from C_3-C_7; the articular surface of the inferior facet from C_3-C_7 was nearly circular. The transition from circular to elliptic shape had not yet been formed.(2) The trend of high change in facet joint was from the lowest point of C_2-C_7 in the C_4 segment, and the overall trend was first down and then up.(3) The zygapophysial joints first rose and then fell, and there was no significant difference between the upper supraspinal spacing and the lower one except in the C_5 segment, and the maximum value was reached. In C_3 and C_4 segments, the supraspinal spacing was less than the inferior one, and in C_6 and C_7 segments, the supraspinal spacing was remarkably greater than the inferior one, which may be related to the gravity transfer and cervical s pine activities.
BACKGROUND: Zygapophysial joints of cervical vertebra is also called intervertebral facet joint. It is a synovial joint like the large joints of the body. In recent years, anatomical and biomechanical studies have shown that zygapophysial joints injuries and degeneration is one of the most common causes of chronic neck pain. Existing studies on this joint have focused on adolescents and adults.OBJECTIVE: The morphological parameters of children's inferior cervical zygapophysial joints were measured to explore their developmental rules and morphological characteristics, and finally to provide anatomical parameters for clinical zygapophysial joint screw fixation.METHODS: Totally 32 cases of children aged 4-6 years old with no changes in vertebral bone structure such as bone destruction, tumor,deformity or fracture in the inferior cervical spine and no previous spine related surgery were selected for three-dimensional reconstruction after cervical spiral CT scanning. Guardian signed the informed consent. This study was approved by the Hospital Ethics Committee.Morphological measurement and statistical analysis of C_3-C_7 zygapophysial joints were conducted.RESULTS AND CONCLUSION:(1) For children cervical zygapophysial joint articular surfaces in both height and width, between the adjacent two vertebrae, the lower articular surface was smaller than the upper articular surface, so it can be inferred that the size of the upper articular surface was always larger than that of the lower articular surface. According to the height to width ratio, the articular surface of the superior facet of the lower cervical spine in children aged 4-6 years was nearly elliptic from C_3-C_7; the articular surface of the inferior facet from C_3-C_7 was nearly circular. The transition from circular to elliptic shape had not yet been formed.(2) The trend of high change in facet joint was from the lowest point of C_2-C_7 in the C_4 segment, and the overall trend was first down and then up.(3) The zygapophysial joints first rose and then fell, and there was no significant difference between the upper supraspinal spacing and the lower one except in the C_5 segment, and the maximum value was reached. In C_3 and C_4 segments, the supraspinal spacing was less than the inferior one, and in C_6 and C_7 segments, the supraspinal spacing was remarkably greater than the inferior one, which may be related to the gravity transfer and cervical s pine activities.
引文
[1]Bogduk N,Marsland A.The cervical zygapophysial Joints as a source of neck pain.Spine.1988;13(6):610-617.
[2]Barnsley L,Lord S,Bogduk N.Comparative local anaesthetic blocks in the diagnosis of cervical zygapophysial joint pain.Pain.1993;55(1):99-106.
[3]Winkelstein BA.Nightingale RW,Richardson WJ,et al.The cervical facet capsule and its role in whiplash injury:a biomechanical investigation.Spine.2000;25(10):1238-1246.
[4]Barnsley L,Lord SM,Wallis BJ,et al.The prevalence of chronic cervical zygapophysial joint pain after whiplash.Spine.1995;20(1):20-25.
[5]Bogduk N.On cervical zygapophysial joint pain after whiplash.Spine.2011;36(25):194-199.
[6]Lord SM,Barnsley L,Wallis BJ,et al.Chronic cervical zygapophysial joint pain after whiplash.A placebo-controlled prevalence study.Spine,1996;21(15):1737-1744.
[7]Gao X,Yang Y,Liu H,et al.Cervical disc arthroplasty with PrestigeLP for the treatment of contiguous 2-level cervical degenerative disc disease.Medicine,2018;97(4):1-6.
[8]王星,史君,张少杰,等.三维图像测量青少年颈椎钩突的形态特征[J].中国组织工程研究与临床康复,2011,15(30):5587-5590.
[9]Knapik DM,Abola MV,Gordon ZL,et al.Differences in cross-sectional intervertebral foraminal area from c3 to c7.Global Spine J.2018;8(6):600-606.
[10]Jaumard NV,Welch WC,Winkelstein BA.Spinal Facet Joint Biomechanics and Mechanotransduction in Normal,Injury and Degenerative Conditions.J Biomech Eng.2011;133(7):1-31.
[11]Wang Q,Wang XT,Zhu L,et al.Thoracic inlet parameters for degenerative cervical spondylolisthesis imaging measurement.Med Sci Monit.2018;24:2025-2030.
[12]Raniga SB,Menon V,Al Muzahmi KS,et al.MDCTof acute subaxial cervical spine trauma:a mechanism-based approach.Insights Imaging.2014;5(3):321-338.
[13]Rong X,Liu Z,Wang B,et al.Relationship between facet tropism and facet joint degeneration in the sub-axial cervical spine.BMCMusculoskelet Disord.2017;18:86-93.
[14]Kunkel ME,Schmidt H,Wilke HJ.Prediction of the human thoracic and lumbar articular facet joint morphometry from radiographic images.J Anat.2011;218(2):191-201.
[15]Tan SH,Teo EC,Chua HC.Quantitative three-dimensional anatomy of cervical,thoracic and lumbar vertebrae of Chinese Singaporeans.Eur Spine J.2004;13(2):137-146.
[16]席新华,吴强,唐华军,等.成人下颈椎椎体与关节突关节倾角的X射线测量数据[J].中国组织工程研究与临床康复,2009,13(4):662-666.
[17]刘观燚,徐荣明,马维虎,等.下颈椎关节突关节的解剖学测量与经关节螺钉固定的关系[J].中国脊柱脊髓杂志,2007,17(2):140-144.
[18]曾辉,邹德威,吴继功,等.下颈椎关节突关节的影像学观测及其临床意义[J].中国脊柱脊髓杂志,2012,22(1):59-64.
[19]Denis F.The three columnspine and its significance in the classification of acate thoracolumbar spine injure.Spine.1983;8(8):817-831.
[20]郭马超,鲁世保,孔超,等.关节突关节角度和不对称性在退变性腰椎疾病中的角色[J].中国骨与关节杂志,2018,7(10):772-777.
[21]王大林,吴小涛,王黎明.腰椎关节突关节不对称与青少年腰椎间盘突出症[J].中国脊柱脊髓杂志,2005,15(6):341-344.
[22]Gellhorn AC,Katz JN,Suri P.Osteoarthritis of the spine:the facet joints.Nat Rev Rheumatol.2013;9(4):216-224.
[23]Manchikanti L,Hirsch JA,Falco FJ,et al.Management of lumbar zygapophysial(facet)joint pain.World J Orthop.2016;7(5):315-337.
[24]Tian Gao,Qi Lai,Song Zhou,et al.Correlation between facet tropism and lumbar degenerative disease:a retrospective analysis.BMC Musculoskelet Disord.2017;18:483-489.
[25]郭功亮,奇兵,曲阳,等.关节突关节切除范围对下颈椎稳定性影响的生物力学研究[J].生物医学工程研究,2010,29(4):259-262.
[26]王立,刘少喻,黄春明,等.儿童脊柱畸形矫形手术技巧[M].1版.北京:人民军医出版社,2014:17-18.
[27]An SJ,Seo MS,Choi SI,et al.Facet joint hypertrophy is a misnomer A retrospective study.Medicine.2018;97(24):1-4.
[28]Perolat R,Kastler A,Nicot B,et al.Facet joint syndrome:from diagnosis to interventional management.Insights Imaging.2018;9(5):773-789.
[29]Ko S,Vaccaro AR,Lee S,et al.The prevalence of lumbar spine facet joint steoarthritis and its association with low back pain in selected Korean populations.Clin Orthop Surg.2014;6(4):385-391.
[30]Jin IIS,Bae JY,In CB,et al.Epiduroscopic removal of a lumbar facet Joint cyst.Korean J Pain.2015,28(4):275-279.
[31]黄袁迟,邹德威,吴继功,等.颈椎小关节三维螺旋CT测量在数字骨科中的应用[J].中国矫形外科杂志,2012,20(15):1405-1408.
[32]刘路.7-12岁儿童颈椎关节突关节数字化三维形态研究及其有限元分析[D].呼和浩特:内蒙古医科大学,2016.
[2]Barnsley L,Lord S,Bogduk N.Comparative local anaesthetic blocks in the diagnosis of cervical zygapophysial joint pain.Pain.1993;55(1):99-106.
[3]Winkelstein BA.Nightingale RW,Richardson WJ,et al.The cervical facet capsule and its role in whiplash injury:a biomechanical investigation.Spine.2000;25(10):1238-1246.
[4]Barnsley L,Lord SM,Wallis BJ,et al.The prevalence of chronic cervical zygapophysial joint pain after whiplash.Spine.1995;20(1):20-25.
[5]Bogduk N.On cervical zygapophysial joint pain after whiplash.Spine.2011;36(25):194-199.
[6]Lord SM,Barnsley L,Wallis BJ,et al.Chronic cervical zygapophysial joint pain after whiplash.A placebo-controlled prevalence study.Spine,1996;21(15):1737-1744.
[7]Gao X,Yang Y,Liu H,et al.Cervical disc arthroplasty with PrestigeLP for the treatment of contiguous 2-level cervical degenerative disc disease.Medicine,2018;97(4):1-6.
[8]王星,史君,张少杰,等.三维图像测量青少年颈椎钩突的形态特征[J].中国组织工程研究与临床康复,2011,15(30):5587-5590.
[9]Knapik DM,Abola MV,Gordon ZL,et al.Differences in cross-sectional intervertebral foraminal area from c3 to c7.Global Spine J.2018;8(6):600-606.
[10]Jaumard NV,Welch WC,Winkelstein BA.Spinal Facet Joint Biomechanics and Mechanotransduction in Normal,Injury and Degenerative Conditions.J Biomech Eng.2011;133(7):1-31.
[11]Wang Q,Wang XT,Zhu L,et al.Thoracic inlet parameters for degenerative cervical spondylolisthesis imaging measurement.Med Sci Monit.2018;24:2025-2030.
[12]Raniga SB,Menon V,Al Muzahmi KS,et al.MDCTof acute subaxial cervical spine trauma:a mechanism-based approach.Insights Imaging.2014;5(3):321-338.
[13]Rong X,Liu Z,Wang B,et al.Relationship between facet tropism and facet joint degeneration in the sub-axial cervical spine.BMCMusculoskelet Disord.2017;18:86-93.
[14]Kunkel ME,Schmidt H,Wilke HJ.Prediction of the human thoracic and lumbar articular facet joint morphometry from radiographic images.J Anat.2011;218(2):191-201.
[15]Tan SH,Teo EC,Chua HC.Quantitative three-dimensional anatomy of cervical,thoracic and lumbar vertebrae of Chinese Singaporeans.Eur Spine J.2004;13(2):137-146.
[16]席新华,吴强,唐华军,等.成人下颈椎椎体与关节突关节倾角的X射线测量数据[J].中国组织工程研究与临床康复,2009,13(4):662-666.
[17]刘观燚,徐荣明,马维虎,等.下颈椎关节突关节的解剖学测量与经关节螺钉固定的关系[J].中国脊柱脊髓杂志,2007,17(2):140-144.
[18]曾辉,邹德威,吴继功,等.下颈椎关节突关节的影像学观测及其临床意义[J].中国脊柱脊髓杂志,2012,22(1):59-64.
[19]Denis F.The three columnspine and its significance in the classification of acate thoracolumbar spine injure.Spine.1983;8(8):817-831.
[20]郭马超,鲁世保,孔超,等.关节突关节角度和不对称性在退变性腰椎疾病中的角色[J].中国骨与关节杂志,2018,7(10):772-777.
[21]王大林,吴小涛,王黎明.腰椎关节突关节不对称与青少年腰椎间盘突出症[J].中国脊柱脊髓杂志,2005,15(6):341-344.
[22]Gellhorn AC,Katz JN,Suri P.Osteoarthritis of the spine:the facet joints.Nat Rev Rheumatol.2013;9(4):216-224.
[23]Manchikanti L,Hirsch JA,Falco FJ,et al.Management of lumbar zygapophysial(facet)joint pain.World J Orthop.2016;7(5):315-337.
[24]Tian Gao,Qi Lai,Song Zhou,et al.Correlation between facet tropism and lumbar degenerative disease:a retrospective analysis.BMC Musculoskelet Disord.2017;18:483-489.
[25]郭功亮,奇兵,曲阳,等.关节突关节切除范围对下颈椎稳定性影响的生物力学研究[J].生物医学工程研究,2010,29(4):259-262.
[26]王立,刘少喻,黄春明,等.儿童脊柱畸形矫形手术技巧[M].1版.北京:人民军医出版社,2014:17-18.
[27]An SJ,Seo MS,Choi SI,et al.Facet joint hypertrophy is a misnomer A retrospective study.Medicine.2018;97(24):1-4.
[28]Perolat R,Kastler A,Nicot B,et al.Facet joint syndrome:from diagnosis to interventional management.Insights Imaging.2018;9(5):773-789.
[29]Ko S,Vaccaro AR,Lee S,et al.The prevalence of lumbar spine facet joint steoarthritis and its association with low back pain in selected Korean populations.Clin Orthop Surg.2014;6(4):385-391.
[30]Jin IIS,Bae JY,In CB,et al.Epiduroscopic removal of a lumbar facet Joint cyst.Korean J Pain.2015,28(4):275-279.
[31]黄袁迟,邹德威,吴继功,等.颈椎小关节三维螺旋CT测量在数字骨科中的应用[J].中国矫形外科杂志,2012,20(15):1405-1408.
[32]刘路.7-12岁儿童颈椎关节突关节数字化三维形态研究及其有限元分析[D].呼和浩特:内蒙古医科大学,2016.