Imaging measurement of anterior internal fixation for the cervicothoracic junction and its clinical significance / 中国骨伤

<p><b>OBJECTIVE</b>To measure important parameters of anterior internal fixation for the cervicothoracic junction by us-ing imaging measurement, and provide reference for cervicothoracic junction surgery and design of steel plate screw internal fixation.</p><p><b>METHODS</b>From June to November 2012, 120 health people's median sagittal plane MRI of cervical spine were ran-domly collected. Of the 120 cases, there were 58 males and 62 females with an average age of 48.3 +/- 13.7, ranging the age of 20 to 78 years old. The anterior,middle and posterior height of vertebral, anterior, upper, medium and lower sagittal diameter, an-terior height of different segments and Cobb angle were measured by measuring machine in the PACS system.</p><p><b>RESULTS</b>The an-terior, middle and posterior height of vertebral, medium and lower sagittal diameter gradually increased from cranial to caudal of cervicothoracic junction (P < 0.01). For single vertebral,posterior> anterior>middle height (P < 0.01), lower > upper>medium sagittal diameter (P < 0.01). The lower sagittal diameter of upper vertebral body was close to upper sagittal diameter of lower vertebral body. Cobb angle of male was (7.61 +/- 3.85) degrees, while female's was (5.58 +/- 2.59) degrees .</p><p><b>CONCLUSION</b>During the anterior in-ternal fixation of cervicothoracic junction, it is suggested that the entry points of upper vertebral body should locate on the lower and middle 1/3 of vertebral body, and screws could slightly incline towards cranial,the entry points of lower vertebral body should locate on the upper and middle 1/3 of vertebral body, while screws could slightly incline towards caudal, also can be prebent according to Cobb angle of health.</p>

Study on the three-dimensional reconstruction and visualization of the anatomical structures of the anterior approach to the upper thoracic spine / 中国骨伤

<p><b>OBJECTIVE</b>To establish the three-dimensional (3D) visible models of the anatomical structures of the anterior approach to the upper thoracic spine (UTS) for anatomic study and preoperative planning of the UTS.</p><p><b>METHODS</b>Sectional images from the superior margin of the first thoracic vertebral body to the inferior margin of the fifth thoracic vertebral body were acquired through the Chinese Visible Human Female (VCHF) database which was collected by the Third Military Medical University. These images were imported into Photoshop CS, cut automatically and converted into a JPEG format. Surface and volume reconstruction were performed by 3D Doctor 3.5 and Amira 4.0 software programs on an ordinary personal computer respectively.</p><p><b>RESULTS</b>The surface reconstruction model could be rotated at any angle and observed from any direction. And the reconstructed structures of the anterior approach to the UTS could be displayed individually or as a composite with any other selected structure. The volume reconstruction displayed abundant internal details of the reconstructed images in transverse, coronal, sagittal, and random oblique sections.</p><p><b>CONCLUSION</b>Three-dimensional visible models of the anatomical structures of the anterior approach to the UTS based on the sectional images of VCHF can clearly display the morphology, spatial orientation and adjacent relationship of every structure. These models are very helpful to the anatomy study and preoperative planning of this complex anatomic region.</p>

CT imaging study of anterior approaches to the upper thoracic spine / 中国骨伤

<p><b>OBJECTIVE</b>There are small smount of literatures on the study of the anterior surgical approaches to the upper thoracic spine (UTS). Moreover, there are many differences among the results of these studies. This study is to investigate the exposure ranges of different anterior surgical approaches to the UTS for making the preoperative plan by means of CT images analysis.</p><p><b>METHODS</b>From October to December in 2008, 120 CT images of normal chests were chosen. These subjects (58 males, 62 females) ranged in age from 16 to 75 years (mean 40.3 +/- 12.3 years). By using the X-ray positioning images of these CT images,following indexes were studied: the location of the superior margin of the left brachiocephalic vein on the sagittal plane, the confluence of the bilateral brachiocephalic veins, and the vertebrae level of the tracheal bifurcation. The caudal access of E1 (the interval between the tracheo esophageal sheath and the bilateral carotid sheath), E2 (the interval between the right brachiocephalic vein and the brachiocephalic artery), and E3 (the interval between the ascending aorta and superior caval vein) were respectively defined as the above mentioned three points.</p><p><b>RESULTS</b>Among the 120 studies, 105 T2 vertebral bodies could be exposed through E1 (87.5%), 82 T3 vertebral bodies could be exposed through E2 (68.3%), and 89 T4 vertebral bodies could be exposed through E3 (74.2%).</p><p><b>CONCLUSION</b>The exposure ranges of three different anterior surgical approaches to the upper thoracic spine are different. Proper surgical approaches could be selected according to the chest CT images of the patients.</p>