CT图像和重组技术在骶椎临床影像解剖学研究中的应用

doi:10.13418/j.issn.1001-165x.2022.4.07

摘要/Abstract

摘要： 目的观察骶椎的解剖形态及其与耻骨联合的位置关系，为骶椎正位X线摄影体位的优化设计提供解剖学依据。方法回顾性随机收集1000例患者骨盆腔CT影像，借助CT图像重组技术观测骶椎的解剖形态及其与耻骨联合的相对位置关系。结果骶椎均为前面凹陷、底朝上、尖向下后方走行，骶椎上下端中点连线M与人躯体长轴之间的夹角A均为锐角，耻骨联合位于骶椎的前正中偏下位置，其与骶椎下缘的连线N和躯体长轴垂线间夹角B>0 °（即耻骨联合上缘低于骶椎下缘的位置）占89.7%（897/1000)；青少年组（14~45岁）角A为（35.86±6.88）°，明显低于中年组（46~69岁）（37.82±6.34）°和老年组（>69岁）（37.60±6.65）°（P<0.05），青少年组角B为（10.27±7.02）°，明显高于中年组（8.88±7.23）°和老年组（7.83±6.93）°（P<0.05），而中年组和老年组间差异均无统计学意义；男性角A（36.12±0.27）°和角B（6.27±0.25）°，均明显低于女性（38.03±0.33）°和（12.79±0.33）°（P<0.05）。结论 CT图像重组技术可用于观察和分析骶椎的解剖形态及其与耻骨联合的位置关系，不同年龄段和不同性别者骶椎与耻骨联合的相对位置情况差异显著，可为骶椎正位X线摄影检查体位的优化设计提供可靠的解剖学依据。

关键词: CT图像重组技术, , , 骶椎, , , 正位, , , X线, , , 年龄, , , , 性别

Abstract: Objective To observe the anatomical morphology of the sacral vertebra and the position relationship between the sacral vertebra and the pubic symphysis, which provides anatomic basis for the optimal design of the anteroposterior radiography position of the sacral vertebra. Methods Pelvic CT images of existing patients were collected randomly. The anatomical morphology of sacral vertebra and its relative positionship with pubic symphysis were observed and analyzed by CT image reconstruction technique. Results The sacral vertebra was concave in front, the bottom was upward and the tip was backward and downward. The angle A, between the long axis of the human body and the line M formed by connecting the midpoint of the upper and lower edges of the sacral vertebra, was acute angle. The pubic symphysis was located at the lower position of the anterior middle of the sacral vertebra. The angle B, between the vertical line of the long axis of the human body and the line N formed by connecting the upper edge of the pubic symphysis and the lower edge of the lower sacral vertebra, was positive (that was, the position of the upper edge of the pubic symphysis was lower than the lower edge of the sacral vertebra) accounting for 89.7% of cases (897/1000). The measurement value of angle A in the adolescent group (14~45 years old) was (35.86±6.88)°, which was significantly lower than that in the middle-aged group (46~69 years old) (37.82±6.34)° and the elderly group (>69 years old) (37.60±6.65)° （P<0.05）. The value of angle B in the adolescent group was (10.27±7.02)°, which was significantly higher than that in the middle-age group (8.88±7.23)° and the elderly group (7.83±6.93)° (P<0.05), and there was no significant difference between the middle-age group and the elderly group. The value of angle A (36.12±0.27)° and angle B (6.27±0.25)° in males were significantly lower than those in females (38.03±0.33)° and (12.79±0.33)° (P<0.05). Conclusions The CT image reconstruction technique can be used to observe and analyze the anatomical morphology of the sacral vertebra and its relative position with the pubic symphysis. The positional relationship of the sacral vertebra and pubic symphysis were significantly different in different ages and genders, which can provide a reliable anatomic basis for the optimal design of the radiography position of anteroposterior sacral vertebra.

Key words: CT image recombination technique, , , Sacral vertebra, , , Anteroposterior, , , Radiography, Age differences, , , Gender differences

中图分类号:

R322.71

王诗鸣, 肖智博, 陆云峰, 廖军义, 金瑞, 李巧琳, 何谐. CT图像和重组技术在骶椎临床影像解剖学研究中的应用[J]. 中国临床解剖学杂志, 2022, 40(4): 410-413.

Wang Shiming, Xiao Zhibo, Lu Yunfeng, Liao Junyi, Jin Rui, Li Qiaolin, He Xie. Application of CT image and reconstruction technique in clinical imaging anatomy of sacral vertebra [J]. Chinese Journal of Clinical Anatomy, 2022, 40(4): 410-413.

参考文献 24

[1]	苏佳灿, 张春才. 骨盆骨折及其康复的研究进展[J]. 中国临床康复, 2004, 8(2): 312-313. DOI: 10.3321/j.issn:1673-8225.2004.02.071.
[2]	夏海红, 高杨, 肖扬锐, 等. 第三代Force双能量CT对骶骨翼骨挫伤及隐匿性骨折的临床诊断价值[J]. 温州医科大学学报, 2021, 51(1): 30-34. DOI: 10.3969/j.issn.2095-9400.2021.01.006.
[3]	李韧, 陈德纯, 来津, 等. 不稳定骶骨骨折伴马尾神经损伤早期后路手术疗效分析[J]. 中国骨与关节损伤杂志, 2019, 34(4): 365-367. CNKI: SUN:GGJS.0.2019-04-008.
[4]	王楚铭, 邓秋萍, 胡岗, 等. 骨盆骨折DR摄影与CT检查的临床应用价值[J]. 医学新知杂志, 2013, 23(5): 346-347. DOI: 1004-5511(2013)05-0346-02.
[5]	高等发, 贾红, 张爱莲, 等. 直接数字X线摄影诊断骶尾骨外伤的价值[J].中国医学影像学杂志, 2005, 13(6): 434-436. DOI: 10.3969/j.issn.1005-5185.2005.06.012.
[6]	蒋廷宠, 毛小明, 林坚, 等. 骶骨隐匿性骨折的CT诊断价值[J]. 影像诊断与介入放射学, 2007, 16(2): 90-91. DOI: 10.3969/j.issn.1005-8001.2007.02.014.
[7]	余建明, 曾勇明. 医学影像检查技术学[M]. 北京: 人民卫生出版社, 2016: 42-43.
[8]	安胜军, 李恩. 人类椎间盘退变与年龄的关系[J]. 中国矫形外科杂志, 2000, 7(4): 379-381. DOI: 10.3969/j.issn.1005-8478.2000.04.023.
[9]	苏慧, 付孟莉, 孙芬, 等. 腰椎间盘退行性改变与年龄的相关性研究[J]. 社区医学杂志, 2015, 13(9): 8-11. DOI: 1672-4208(2015)09-0008-04.
[10]	杨振国. 腰骶角的大小与退行性腰椎滑脱的相关性研究[D]. 济南: 山东中医药大学, 2007. DOI: 110.7666/d.Y1144039.
[11]	王燕芬. 腰骶椎解剖形态与退行性腰椎滑脱的相关性研究[D]. 石家庄: 河北医科大学, 2016.
[12]	Can P, Izzet D, Esra MK, et al. Body height estimation based on dimensions of sacral and coccygeal vertebrae[J]. J Forensic Sci, 2005, 50(2): 1-4. PMID: 15813539.
[13]	刘玉新, 金合, 李金松. 腰骶角及其测量的若干方法和意义[J]. 中医正骨,2004,16(10): 25-26. DOI: 10.3969/j.issn.1001-6015.2 004.10. 012.
[14]	师宁宁, 沈国权, 何水勇, 等. 骶髂关节紊乱与腰椎间盘退变之间相关性的流行病学研究与生物力学分析[J]. 中医骨伤, 2014, 27(7): 560-564. DOI: 10.3969/j.issn.1003-0034.2014.07.007。
[15]	Slipman CW, Whyte WS 2nd, Chow DW, et al. Sacroiliac joint syndrome[J]. Pain Physician, 2001, 4(2): 143-152. PMID: 16902687.
[16]	李阳, 刘燕, 孙超, 等. 基于三维重建技术的腰骶椎轴向融合术入路的相关解剖学测量[J]. 中国临床解剖学杂志, 2014, 32(3): 280-283. DOI: 10.13418/j.issn.1001-165x.2014.03.010.
[17]	师宁宁, 沈国权, 郭汝宝, 等. 骶骨倾斜移位与L5S1椎间盘退变之间的相关性生物力学分析[J]. 中国骨伤, 2017, 30(3): 217-221. DOI: 10.3969/j.issn.1003-0034.2017.03.006.
[18]	Alagu ARB, Karthik GM. Morphological and morphometrical analysis of the sacroiliac joint with respect to sacral hiatus[J]. Drug Invent Today, 2019, 11(10): 2462-2465.
[19]	张原诚, 鲍虹达, 舒诗斌, 等. 青春期骨盆解剖形态变化与骨盆入射角的关系[J]. 中华骨科杂志, 2019, 39(4): 226-233. DOI: 10.3760/cma.j.issn.0253-2352.2019.04.005.
[20]	王智伟, 刘臻, 王渭君, 等. 正常汉族青少年骨盆矢状面形态的影像学研究[J]. 中国脊柱脊髓杂志, 2012, 22(10): 919-924. DOI: 10.3969/j.issn.1004-406X.2012.10.13.
[21]	王德明, 尤剑达, 刘珠耀. 根据成人的耻骨缘枝角和耻骨联合部宽高指数鉴定性别[J]. 中国法医学杂志, 1987, 2(3): 143-145.
[22]	Tom PCS, Michiel MAJ, Tomaž V, et al. Evolution of the ischio-iliac lordosis during natural growth and its relation with the pelvic incidence[J]. Eur Spine J, 2014, 23(7): 1433-1441. DOI: 10.1007/s00586-014-3358-z.
[23]	马振超, 何文武, 樊中川, 等. 弓状线位置的应用解剖[J]. 四川解剖学杂志, 2008, 16(3): 18-19. DOI: 10.3969/j.issn.1005-1457.2008.03.006.
[24]	刘尚清, 李良育, 蔡容, 等. 耻骨联合的应用解剖学研究[J]. 四川解剖学杂志, 2009, 17(4): 7-11. DOI: 10.3969/j.issn.1005-1457.2009.04.003.