目的 分析伴有优势椎动脉C2椎弓根线性和角度的三维影像学特征。 方法 回顾2022年3月~2023年2月186例患者的颈椎CT血管成像（CT angiography，CTA）资料，双侧椎动脉在C2横突孔横截面直径差值大于0.8 mm定义为优势椎动脉（vertebral artery dominance，VAD），伴VAD患者为VAD组，非VAD为对照组。通过RadiAnt DICOM Viewer软件进行多平面重建，测量C2椎弓根宽度（pedicle outer width，POW）、椎弓根横向角度（pedicle transverse angle，PTA）和峡部-椎弓根矢状位角度（isthmic-pedicle sagittal angle，IPSA），记录两组患者狭窄椎弓根（POW<4.0 mm）的占比，分析VAD对C2椎弓根形态学的影响。 结果 入组患者中49.5%（92/186）伴有VAD，左侧占67.4%（62/92）；女性VAD发生率高于男性（P<0.05）。组内比较显示：VAD组C2优势侧POW（4.2±1.3）mm，IPSA（32.6±4.9）°，小于非优势侧（5.8±1.4）mm和36.4±5.5）°，P<0.001，优势侧PTA（36.7±6.4）°，大于非优势侧（30.6±7.1）°，P<0.001；对照组C2左右侧POW、PTA及IPSA无统计学差异。VAD组狭窄椎弓根总体占比（26.6%）高于对照组（10.6%），P<0.001；VAD组的优势侧狭窄椎弓根占比（44.6%）高于非优势侧（8.7%），P<0.001。多因素Logistic回归分析显示VAD是狭窄椎弓根的独立危险因素，Odds Ratio（OR）：7.076，95% CI：3.176~15.764，P<0.001。 结论 VAD与C2椎弓根形态改变存在相关性，优势侧的椎弓根细小、内倾较大、尾倾较小，以上形态学特征对C2椎弓根安全置钉具有指导意义。
Abstract
Objective To analyze the three-dimensional imaging characteristics of the linear and angular parameters of the C2 pedicle in patients with dominant vertebral artery. Methods The cervical computed tomography angiography (CTA) imaging data of 186 patients from March 2022 to February 2023 were retrospectively reviewed. Vertebral artery dominance (VAD) was defined as a difference in the cross-sectional diameter of the bilateral vertebral arteries at the C2 transverse foramen greater than 0.8 mm. Patients with VAD were classified as the VAD group, and those without VAD were the normal control group. Multi-planar reconstruction (MPR) was performed using the RadiAnt DICOM Viewer software. The pedicle outer width (POW), pedicle transverse angle (PTA), and isthmic-pedicle sagittal angle (IPSA) of C2 were measured. The proportion of narrow pedicles (POW<4.0 mm) in both groups was recorded. The influence of VAD on the morphology of the C2 pedicle was analyzed. Results Among the 186 patients, 49.5% (92/186) were accompanied by VAD, with the left side accounting for 67.4% (62/92); the incidence of VAD in females was higher than that in males (P<0.05). Intra-group comparison showed that in the VAD group, the POW (4.2± 1.3) mm and IPSA (32.6±4.9)° on the dominant side of C2 were smaller than those on the non-dominant side [(5.8±1.4) mm and （36.4±5.5）°, P<0.001], but the PTA (36.7±6.4)° on the dominant side was greater than that on the non-dominant side [(30.6±7.1)°, P<0.001]. There was no statistical difference in POW, PTA and IPSA on the left and right sides of C2 in the control group (P>0.05). The overall proportion of narrow pedicles in the VAD group (26.6%) was higher than that in the control group (10.6%, P<0.001); the proportion of narrow pedicles on the dominant side in the VAD group was higher than that on the non-dominant side (44.6% vs. 8.7%, P<0.001). Multivariate Logistic regression analysis showed that VAD was an independent risk factor for narrow pedicles (Odds Ratio [OR]: 7.076, 95% CI: 3.176-15.764, P<0.001). Conclusions There is a correlation between VAD and the morphological changes of the C2 pedicle. The pedicle on the dominant side is thinner, has a greater medial inclination and a smaller caudal inclination. The above morphological characteristics have guiding significance for the safe screw placement of the C2 pedicle.
关键词
优势椎动脉； /
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枢椎椎弓根； /
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影像学观察； /
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狭窄椎弓根； /
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相关性
Key words
Dominant vertebral artery; /
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Axis pedicle /
Imaging observation; /
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Narrowed pedicle /
Association
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