| Objective：To explore the application of multi-slice CTangiography(MSCTA) and screw pathway design in theevaluation of posterior approach of upper cervical vertebrae; toobserve the variation of the vertebra artery in the craniocervicalarea, the relationship between the vertebra artery and adjacentstructure; to provide reference for clinical screw placement bydetermining the basic parameters of screw pathway of posteriorapproach of upper cervical vertebrae; to study the consistency ofdifferent measurement of screw pathway and summarize the bestway; to judge the success rate in anatomy by observing the screwplacement by CTA after surgery, compared with the postoperativesymptom as well. MSCTA and screw pathway design are used inthis study to provide accurate imaging accordance before operation toreduce the bleeding and pressure of spinal canal during the operation,improve surgery accuracy and safety and provide reference forpostoperative clinical treatment. Material and methods: Collect51patients suspected or conformed upper cervical disease, which performcervical CTA, of which23patients with internal fixation surgery ofposterior upper cervical, and reviewed by3DCT/CTA.Collect thepostoperative symptom of the23cases. The scan equipment is thelight-speed64slices VCT of America GE company, scan parameter: theslice thickness and slice gap is0.625mm, the pith ratio is0.984:1, therotation time of the tube is0.6s/circle, the tube voltage is120KV, autotube electric current is100-400mA（noisy index is8-10）, standard function reconstruction, SFOV：Head，DFOV：22cm，the matrix is512×512，and the high pressure injector is Ulrich medical XD2051. Thescan distance is from the skull base to the cervical root. Scan the2phases(plain phase and artery phase) primary data，choose the artery phase datato perform reconstruction at GE-AW4.4， including ordinary CTangiography（CTA）,subtraction CT angiography（SCTA）,MaximumIntensity Projection(MIP) and Multi-planar Reformation(MPR) toshow the courser and anatomy variation of vertebra artery, theshape of vertebrae, the relationship between the vertebra arteryand adjacent structure. Determine the variability rate, includingadvantage artery, vertebra artery dysplasia and courser variationof vertebra artery. Measure the screw channel data of C1,C2,C3and occipital in MPR images, including pedicle/massa lateralisatlantis length(PL),width(PW),height(PH),pedicle median angle(PMA), pedicle superior angle (PSA), occipital thickness of1cm,2cm,3cm plane from skull base which be the point around middleoccipital left/right1cm and transverse sinus interchange to skullbase, PAH-distance from point of pedicle axis projection tohorizontal reference, PAV-distance from point of pedicle axisprojection to vertical reference. Measure the screw data of C2andC3in MIP and MPR image-PL, PW, PH, PMA and PSA. The screwplacement was performed by VR, MIP, MPR and subtraction VR, andpostoperative symptom was statisticsed follow up. Excel-2003andSPSS-19.0statistical packages for data entry and statistical analysis:variability rate of advantage artery, vertebra artery dysplasia,courser variation of vertebra artery; mean statistical analysis forPL,PW,PH,PMA,PSA,PAH,PAV and screw channel data of occipital, pair sample t-test statistical analysis for the difference of leftand right side; the pedicle diameter of less than4mm, the diameterof one artery30%being larger than the other side was defined asadvantage artery, analysis the relationship between tiny pedicleand advantage artery; pair sample t-test statistical analysis for theconsistency of C2and C3data by VR,MIP and MPR; percentage ratestatistical analysis for screw placement, including perforation of theanterior wall, the inner wall, the outer wall, the upper wall, the interiorwall and the inner wall of occipital, specifically for the relationshipbetween screw and vertebra artery, screw and spinal cord;compare the correlation of screw placement and postoperativesymptom. Result: Both of MIP and VR can observe courser and nearbyspace relationship of cervical artery. The display of cervical artery:number of advantage artery is25, equilibration26, development variation13, course variation4.The screw channel data wasanalyzed by mean±standard deviation, the records were as follow:C1-PL(R/L)24.95±2.03mm/25.05±2.09mm, C1-PW(R/L)9.66±1.78mm/9.19±2.13mm, C1-PH(R/L)4.49±0.7mm/4.45±0.73, C1-PMA(R/L)12.23±4.40mm/15.24±17.96mm, C1-PSA(R/L)16.85±5.01mm/18.66±5.52mm, C2-PL(R/L)25.66±3.79mm/26.57±3.76mm, C2-PW(R/L)5.43±1.62mm/5.43±1.53mm, C2-PH(R/L)9.18±2.20mm/9.08±2.34mm,C2-PMA(R/L)31.14±10.2mm/32.69±10.57mm,C2-PSA(R/L)31.79±9.57mm/32.13±9.96mm, C2-PAH(R/L)3.61±0.90mm/3.75±0.87mm, C2-PAV(R/L)5.10±0.71mm/5.27±0.76mm, C3-PL(R/L)28.13±2.24mm/28.29±3.73mm, C3-PW(R/L)4.99±0.91mm/4.66±1.39mm, C3-PH(R/L)6.67±1.40mm/6.60±1.42mm，C3-PMA(R/L)46.25±7.17mm/45.37±6.66mm, C3-PSA(R/L)21.54±8.65mm/ 20.85±7.11m m, C3-P A H (R/L)9.86±2.30m m/10.11±2.30mm,C3-PAV(R/L)2.59±0.79mm/2.50±0.79mm,the occipitalthickness of1cm,2cm,3cm plane and transverse sinus interchanget o s k u l l b a s e:4.47±1.35mm/4.47±1.41mm，3.48±1.47mm/3.52±1.61mm，4.52±1.40mm/4.55±1.41mm，8.40±2.27mm/8.77±1.97mm，45.13±4.85mm. Pair sample t-test statistical analysis forthe difference of left and right side: there was marked difference onlybetween two sides of C3-PH. Number of Small pedicle was16,including ipsilateral advantage artery9cases. The data of three methodswere: for VR， C2-PL(R/L)28.28±3.93mm/28.40±3.76mm,C2-PW(R/L)6.82±1.75mm/6.52±1.92mm,C2-PH(R/L)9.64±1.73mm/9.33±2.13mm，C2-PMA(R/L)34.00±11.28mm/36.43±11.90mm,C2-PSA(R/L)31.82±8.81mm/29.12±2.33mm, C3-P L (R/L)29.12±2.33mm/29.07±2.02mm,C3-PW(R/L)5.84±0.92mm/5.69±1.20mm,C3-PH(R/L)7.79±1.60mm/7.61±1.71m m， C3-P M A(R/L)46.11±6.49mm/46.30±7.32mm,C3-PSA(R/L)21.07±8.76mm/20.34±7.23mm;(2) for MIP,C2-P L (R/L)28.59±3.76m m/28.95±3.79m m, C2-P W (R/L)6.04±1.62mm/6.11±1.66mm,C2-PH(R/L)9.52±2.13mm/9.19±2.10mm，C2-PMA(R/L)35.78±11.84mm/35.68±12.30mm,C2-PSA(R/L)28.73±11.00mm/29.88±2.82mm,C3-PL(R/L)29.88±2.82mm/30.17±2.34mm,C3-PW(R/L)5.55±1.06mm/5.33±0.98mm,C3-PH(R/L)7.62±1.48m m/7.18±1.59m m， C3-P M A (R/L)45.80±6.51m m/445.82±6.81mm,C3-PSA(R/L)19.94±9.02mm/19.01±8.11mm,with pairsample t-test statistical analysis, most of data had significant deviation,which means there was significant difference between three methods.Analysis for23postoperative data: the total screw103, accurate screwplacement83，C1-20,C2-36,C3-15, perforation of the anterior wall2, the inner wall1, the outer wall7, the upper wall2, the interior wall1， theinner wall of occipital17,close to vertebra artery3, close to spinalcord1. Postoperative status of the23patients was well, comparedwith screw placement, there was no difference. Conclusion：CTAcan reflect the morphology of cervical vertebral, the spatial relationshipbetween cervical vertebral and surrounding structure. Pedicle andoccipital screw channel design combined with CTA can provide anaccurate reference for clinical screw placement and improve the accuracyand success of surgery. The postoperative CTA, which has greatreference for the evaluation of clinical success rate of surgery andpostoperative functional recovery, for the guidance of post-surgerytreatment as well, can accurately show screw placement, show therelationship between screw and vertebra artery, screwand spinal cord. |
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