[Radiographic assessment of vertebral artery injury in anterior cervical surgery in healthy adults].

Objectives: To study the relationship between the anatomical parameters of transverse foramen and intervertebral discs in the cross-section of the cervical spine in healthy adults, and to evaluate the risk of vertebral artery injury in the anterior cervical spine surgery. Methods: There were 24 healthy adults(12 male, 12 female) underwent neck CT angiography with clear vertebral artery and the adjacent structure imaging from June to December 2014 in Huashan Hospital, Fudan University. The anatomical parameters of vertebral artery V2 segment with lower cervical vertebrae and intervertebral discs were measured by cross-sectional images of C(3-6). The corresponding parameters of different sex and both sides of the same segment were analyzed by independent samples t-test and paired t test, respectively. The least significant difference(LSD) t test was used to compare the corresponding data between different segments. Results: The vertebral artery was not walking in the middle of the transverse foramen in healthy individual, but partial medial, partial front walking. Transverse diameter of transverse foramen in male and female were 6.62-6.89 mm and 6.21-6.45 mm, and sagittal diameter was 5.41-6.48 mm and 5.40-6.10 mm, respectively.The transverse foramen were slightly oval. The distance between vertebral artery and midline in male and female were 14.23-16.12 mm and 13.60-15.04 mm, respectively, which was much larger than the width of cervical vertebral corpectomy. Compared with C(3-4), intervertebral disc, the transverse distance between the vertebral artery and the uncovertebral joint of C(4-5), C(5-6) was smaller, and the distance from the vertebral artery to the posterior margin of the uncovertebral joint was relatively small, the difference was statistically significant (t=2.449, P=0.022). The distance from vertebral artery to the posterior margin of uncinate process was 1/5-2/5 of the distance between the anterior and posterior edge of the corresponding segmental vertebra. Conclusion: Based on this anatomical study, the risk of vertebral artery injury in conventional anterior cervical decompression is small, and the risk of vertebral artery injury in different segments is slightly different.目的：探讨健康成人C(3～6)节段横突孔及椎间盘层面横断面各解剖参数的关系，并评估颈椎前路术中发生椎动脉损伤的风险。 方法：选取2014年6—12月于复旦大学附属华山医院行颈部CT血管造影检查且椎动脉与相应毗邻结构成像清晰的24例健康成人资料，男性12例，女性12例。选取C(3～6)不同节段横突孔及椎间盘层面横断面CT血管造影图像，测量椎动脉V2段与下颈椎各椎体及椎间盘之间的解剖学参数。对不同性别和同节段左右两侧参数测量结果分别进行成组和配对t检验；不同节段之间对应数据的比较采用最小显著差异(LSD)t检验。 结果：健康成人椎动脉并非走行于横突孔中央，而是偏内、偏前走行。男性和女性横突孔横径分别为6.62～6.89 mm和6.21～6.45 mm；矢状径分别为5.41～6.48 mm和5.40～6.10 mm，呈椭圆形。健康男性椎动脉在C(3～6)横突孔层面中线旁开距离为14.23～16.12 mm，女性为13.60～15.04 mm，大于椎体次全切除的减压宽度。与C(3～4)相比，C(4～5)、C(5～6)椎间盘层面椎动脉距钩椎关节的横向距离相对较小，且椎动脉至钩椎关节后缘的距离亦相对较小，差异有统计学意义(t＝2.449，P＝0.022)。椎动脉距钩突后缘的距离为相应节段椎体前后缘距离的1/5～2/5。 结论：根据健康成人解剖学研究结果显示，常规颈椎前路术中发生椎动脉损伤的总体风险较小，不同节段发生椎动脉损伤风险略有差别。.