中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (28): 4558-4563.doi: 10.3969/j.issn.2095-4344.1473

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

4-6岁儿童下颈椎关节突关节的三维数字化形态特征

和雨洁1，张少杰1，李志军1，2，李筱贺1，王海燕1，2，王  星1，2，许阳阳1，高明杰1，李  琨1，戴丽娜1
  

  1. 内蒙古医科大学基础医学院，1人体解剖学教研室，2数字医学中心，内蒙古自治区呼和浩特市  010059
  • 出版日期:2019-10-08 发布日期:2019-10-08
  • 通讯作者: 李志军，硕士，教授，内蒙古医科大学基础医学院人体解剖学教研室，数字医学中心，内蒙古自治区呼和浩特市 010059 李筱贺，博士，教授，硕士生导师，内蒙古医科大学基础医学院人体解剖学教研室，内蒙古自治区呼和浩特市 010059
  • 作者简介:和雨洁，女，1988年生，内蒙古自治区包头市人，汉族，内蒙古医科大学在读硕士，讲师，主要从事脊柱数字解剖学研究。 并列第一作者：张少杰，男，2011年内蒙古医学院毕业，硕士，副教授，硕士生导师，内蒙古医科大学基础医学院解剖学教研室，主要从事儿童脊柱方面的研究。
  • 基金资助:

    国家自然科学基金(81560348)，项目负责人：李志军|国家自然科学基金(81660358)，项目负责人：张少杰|国家自然科学基金(81460330)，项目负责人：李志军|内蒙古财政厅科技引导项目(2017)，项目负责人：李筱贺

Three-dimensional digital morphological characteristics of the facet joint of the lower cervical spine in children aged 4-6 years

He Yujie1, Zhang Shaojie1, Li Zhijun1, 2, Li Xiaohe1, Wang Haiyan1, 2, Wang Xing1, 2, Xu Yangyang1, Gao Mingjie1, Li Kun1, Dai Lina1
  

  1. 1Department of Human Anatomy, 2Digital Medical Center, Basic Medical College, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia Autonomous Region, China
  • Online:2019-10-08 Published:2019-10-08
  • Contact: Li Zhijun, Master, Professor, Department of Human Anatomy, and Digital Medical Center, Basic Medical College, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia Autonomous Region, China Li Xiaohe, MD, Professor, Master’s supervisor, Department of Human Anatomy, Basic Medical College, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia Autonomous Region, China
  • About author:He Yujie, Master candidate, Lecturer, Department of Human Anatomy, Basic Medical College, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia Autonomous Region, China Zhang Shaojie, Master, Associate professor, Master’s supervisor, Department of Human Anatomy, Basic Medical College, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia Autonomous Region, China He Yujie and Zhang Shaojie contributed equally to this study.
  • Supported by:

    the National Natural Science Foundation of China, No. 81560348 (to LZJ)| the National Natural Science Foundation of China, No. 81660358 (to ZSJ)| the National Natural Science Foundation of China, No. 81460330 (to LZJ)| the Science and Technology Guidance Project of Inner Mongolia Finance Department (2017) (to LXH)

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摘要：

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文题释义：
儿童下颈椎：颈椎位于脊柱颈段，共7块，不仅支撑头的质量，还有很大的活动范围。C3-C7，因其解剖结构和功能与C1和C2有明显不同，故临床上习惯称为下颈椎。儿童颈部与成人颈部在解剖学、形态学方面存在较大差异，儿童颈部骨骼较纤细，韧带较松弛，关节面趋于水平，这些差异将导致儿童颈部相对成人更易受到损伤。
颈椎关节突关节的应用解剖：相邻椎骨的上、下关节突构成关节突关节，属于滑膜关节。颈椎关节突关节囊富含感受器，可感受生理刺激的强度，而且过度牵拉可产生疼痛感。关节突关节的面积、形态与关节的稳定有密切关系，成人C3的关节突关节面形态呈圆形，C4、C5逐渐改变为横椭圆形，C7、T1呈长横形，这种改变可能与适应颈椎生理运动关联，其大小、坡度上、下相适应，随脊柱节段不同而变化，以利于脊柱运动。
 
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C3-C7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C3-C7皆接近椭圆形，下关节突关节面从C3-C7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C2-C7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C5节段之间差异无显著性意义且达最大值，在C3和C4节段上关节突间距均小于下关节突间距，在C6和C7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。

ORCID: 0000-0002-1977-3180(和雨洁)

关键词: 下颈椎, 关节突关节, 发育特征, 儿童, 螺钉, 固定, 螺旋CT, 颈椎活动, 国家自然科学基金

Abstract:

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 C3-C7 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 C3-C7; the articular surface of the inferior facet from C3-C7 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 C2-C7 in the C4 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 C5 segment, and the maximum value was reached. In C3 and C4 segments, the supraspinal spacing was less than the inferior one, and in C6 and C7 segments, the supraspinal spacing was remarkably greater than the inferior one, which may be related to the gravity transfer and cervical spine activities.

Key words: inferior cervical, zygapophysial joints, developmental characteristics, children, screw, fixation, spiral CT, cervical vertebral movement, National Natural Science Foundation of China

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