中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (21): 4545-4551.doi: 10.12307/2025.171

• 骨与关节图像与影像Bone and joint imaging • 上一篇    下一篇

基于CT影像儿童枢椎正常发育与变异的解剖特征

吕绍茂1,2,蓝佐珍3,吴文雪2,池金澄2,段少银2   

  1. 1福建医科大学临床医学部,福建省福州市   350004;2厦门大学附属中山医院影像科,福建省厦门市   361004;3厦门市儿童医院(复旦大学附属儿童医院厦门医院)放射科,福建省厦门市   361006
  • 收稿日期:2024-01-18 接受日期:2024-04-11 出版日期:2025-07-28 发布日期:2024-12-06
  • 通讯作者: 蓝佐珍,硕士,主治医师,厦门市儿童医院(复旦大学附属儿童医院厦门医院)放射科,福建省厦门市 361006 段少银,博士,教授,主任医师,厦门大学附属中山医院影像科,福建省厦门市 361004
  • 作者简介:吕绍茂,男,1981年生,汉族,2007年昆明医科大学毕业,硕士,副主任医师,主要从事影像解剖及应用研究。
  • 基金资助:
    国家自然科学基金面上项目(30870690),课题名称:寰枢外侧关节面错位的影像解剖及有限元建模,项目负责人:段少银

Anatomical characteristics of normal development and variation of axis in children based on CT images

Lyu Shaomao1, 2, Lan Zuozhen3, Wu Wenxue2, Chi Jincheng2, Duan Shaoyin2   

  1. 1School of Clinical Medicine, Fujian Medical University, Fuzhou 350004, Fujian Province, China; 2Department of Medical Imaging, Zhongshan Hospital of Xiamen University, Xiamen 361004, Fujian Province, China; 3Department of Radiology, Xiamen Children’s Hospital (Xiamen Hospital, Affiliated Children's Hospital, Fudan Unversity), Xiamen 361006, Fujian Province, China
  • Received:2024-01-18 Accepted:2024-04-11 Online:2025-07-28 Published:2024-12-06
  • Contact: Lan Zuozhen, MS, Attending physician, Department of Radiology, Xiamen Children’s Hospital (Xiamen Hospital, Affiliated Children's Hospital, Fudan Unversity), Xiamen 361006, Fujian Province, China Duan Shaoyin, MD, Professor, Chief physician, Department of Medical Imaging, Zhongshan Hospital of Xiamen University, Xiamen 361004, Fujian Province, China
  • About author:Lyu Shaomao, MS, Associate chief physician, School of Clinical Medicine, Fujian Medical University, Fuzhou 350004, Fujian Province, China; Department of Medical Imaging, Zhongshan Hospital of Xiamen University, Xiamen 361004, Fujian Province, China
  • Supported by:
    National Natural Science Foundation of China (General Project), No. 30870690 (to DSY) 

摘要:

文题释义:

骨化中心:骨化不是在骨的所有部分同时进行的,首先是在1个乃至几个地方开始骨化,再逐次向周边扩展,把这些最初发生骨化的部位称为骨化中心或骨化点。典型的长骨一般骨化中心是在骨干和两个骨骺这3个地方,骨化中心出现可反映长骨的生长成熟程度。用X射线片测定不同年龄儿童长骨干骺端骨化中心的出现时间、数目、形态的变化,并将其标准化,即为骨龄。骨龄测定的方法通常可分为以下4种:图谱法、骨骺出现与闭合年龄法、骨化中心计数法、计分法。
骨骺闭合:骨骺是儿童出生后在不同的时间内出现的二次骨化中心。骨骺和骺板都是未成熟的四肢长骨的生长区域,骨骺损伤后可引起肢体的生长障碍,导致肢体短缩或关节畸形。骨骺闭合是指长骨的两头骨骺线消失的现象,实际意义是指机体已经失去了自然长高的潜力。骨骺闭合时间因性别、个体不同而各异。

摘要
背景:枢椎发育演变过程复杂,研究报道较少。CT成像可以显示枢椎的正常发育过程、解剖结构、发育变异与畸形,明确枢椎骨化中心出现与骺板闭合时间及其演变过程和规律具有重要的临床价值。
目的:基于CT影像展示儿童枢椎正常发育与变异的解剖结构。
方法:回顾性分析2016年6月至2019年11月行颈部扫描的732例0-15岁儿童CT图像。观察指标包括枢椎齿状突、双侧椎弓、椎体骨化中心,齿突尖部二次骨化中心,椎弓、齿突基底部及后正中骺板,以及枢椎发育变异或畸形。分析与比较各项指标在不同年龄下的变化情况,并利用SPSS 17.0统计学软件包进行数据分类处理及统计学分析。
结果与结论:①732例研究对象包括枢椎正常发育718例(98.1%),畸形或发育异常14例(1.9%);②枢椎5个骨化中心,其中双侧椎弓及齿突、椎体骨化中心在出生时已出现;齿突尖部二次骨化中心出现的中位年龄是5.7岁,年龄四分位差(IQR)是4.1-7岁,最早出现的为8个月22 d,最迟未出现的为12岁10个月;③齿突尖骺板融合的中位年龄是6岁,IQR是5-8岁,未融合最大年龄是8岁9个月,融合的最小年龄是4岁3个月;④双侧椎弓骺板闭合的中位年龄约3.8岁,IQR约2.9-4.6岁,闭合的最小年龄是2岁3个月,未闭合的最大年龄是6岁;⑤齿突基底部骺板闭合的中位数5.2岁,IQR为3.5-6.8岁,闭合最小年龄是2岁6个月,最晚未闭合年龄是9岁6个月;⑥后正中骺板闭合年龄中位数为1.5岁,IQR为1.0-2.1岁,最晚未闭合2例分别为2岁5个月、14岁,最早闭合为6个月20 d;⑦枢椎畸形或发育异常,包括出现副骨化中心及副骺板7例、枢椎游离骨化小骨3例、后正中骺板不闭合2例、无齿突尖部二次骨化中心2例及枢椎齿突骨化中心未出现1例;⑧提示多层螺旋CT扫描、结合多平面重组技术可以完整显示枢椎的解剖结构,评估其正常发育变异及畸形。

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程

关键词: 枢椎, 骨化中心, 骺板, 发育与变异, CT影像

Abstract: BACKGROUND: The development and evolution of atlas are complex, and there are a few research reports. CT imaging can show the normal development process, anatomical structure, developmental variation and deformity of the axis. It has important clinical value to clarify the time of occurrence of ossification center of axis and closure of epiphyseal plate and its evolution process and law. 
OBJECTIVE: To present the anatomical structure of the normal development and variation of children’s axis based on CT images.
METHODS: CT images obtained from 732 children aged 0 to 15 years who underwent neck scans between June 2016 and November 2019 were retrospectively analyzed. The observation indicators encompassed the axis odontoid, bilateral pedicle, vertebral ossification center, secondary ossification center at the tip of odontoid, pedicle, base of odontoid, and posterior median epiphyseal plate, as well as any variations or deformities in axis development. The changes in these indicators were analyzed and compared across different age groups. SPSS 17.0 statistical software package was utilized for data classification and statistical analysis. 
RESULTS AND CONCLUSION: (1) A total of 732 subjects were examined, comprising 718 cases (98.1%) with normal development of the axis and 14 cases (1.9%) exhibiting deformity or dysplasia. (2) The axis demonstrated the presence of five ossification centers, including those of the bilateral pedicles, odontoid process, and vertebral body, which were observed at birth. The median age for the secondary ossification center located at the tip of the odontoid process was determined to be 5.7 years, with an interquartile range of 4.1 to 7 years. The earliest recorded occurrence was observed at 8 months and 22 days, while the latest occurrence was noted at 12 years and 10 months. (3) The median age at which fusion took place was 6 years, with an interquartile range of 5-8 years. The maximum age at which non-fusion was observed was 8 years and 9 months, while the minimum age at which fusion occurred was 4 years and 3 months. (4) The median age at which bilateral epiphyseal plate closure occurred was approximately 3.8 years, with an interquartile range of about 2.9-4.6 years. The earliest observed closure was at 2 years and 3 months, while the latest observed unclosure was at 6 years old. (5) The median age at which odontoid base epiphyseal plate closure occurred was 5.2 years, with an interquartile range of 3.5-6.8 years. The minimum age for closure was 2 years and 6 months, and the latest age for non-closure was 9 years and 6 months. (6) The posterior median epiphyseal plate typically closed at a median age of 1.5 years, with an interquartile range of 1.0-2.1 years. However, two cases exhibited delayed closure, occurring at ages 2 years and 5 months, and 14 years, respectively. The earliest closure observed was at 6 months and 20 days. (7) Axis malformation or developmental abnormalities, including 7 cases of accessory ossification center and accessory epiphyseal plate, 3 cases of free ossified small bones in the axis, 2 cases of posterior median epiphyseal plate failure, 2 cases of secondary ossification centers in the absence of the apex of odontosis, and 1 case of absence at ossification center in the odontoid of the armature vertebrae. (8) It is concluded that the utilization of multi-slice spiral CT scanning in conjunction with the multi-plane reconstruction technique enables comprehensive visualization of the anatomical structure of the axis, facilitating precise assessment of both its typical developmental variations and deformities.

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程

Key words: ">axis, ossification center, epiphyseal plate, development and variation, CT image

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