Applied anatomy research of the uncovertebral joint for design of uncovertebral joint fusion cage_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Yi ,  LIU Hao , WU Tingkui , HU Lingyun , CHEN Lin , RONG Xin , MA Litai , MENG Yang

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding?author：

LIU Hao, Email: liuhao6304@163.com

Keywords：

Uncovertebral joint; cage; anatomical measurement; CT three-dimensional reconstruction; cervical spine

DOI：

10.7507/1002-1892.201904073

Video：

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Objective To measure anatomical parameters related to cervical uncovertebral joint and provide data support for the design of uncovertebral joint fusion cage.Methods According to the inclusion and exclusion criteria, raw DICOM data of cervical CT scan in 60 patients (30 males and 30 females, aged 39-60 years) were obtained, then the three-dimensional cervical spine model was reconstructed for anatomical measurement by using the Mimics19.0 software. The height of the uncinate process, the length of the uncinate process, the width of the uncinate process, and the length of the uncovertebral joint in the intervertebral foramen region were measured bilaterally from C₃ to C₇. The anterior and posterior distances between the uncinate processes were measured from C₃ to C₇. The height of the uncovertebral joint space, the central height of the intervertebral disc space, and the depth of the intervertebral disc space were also measured from C_{2, 3} to C_{6, 7}. The mean, standard deviation, maximum, and minimum were calculated by using the SPSS22.0 statistical software for the design of uncovertebral joint fusion cage.Results The height of the uncinate process, the length of the uncinate process, the width of the uncinate process, and the length of the uncovertebral joint in the intervertebral foramen region of C₃-C₇ and the height of the uncovertebral joint space of C_{2, 3}-C_{6, 7} showed no significant difference between two sides (P>0.05). The height of the uncovertebral joint space also had no significant difference between females and males (P>0.05). The anterior distances between the uncinate processes of C₃-C₇ were significantly larger than the posterior distances between the uncinate processes (P<0.05), the uncovertebral joint presented a posterior cohesive shape. The central height of the intervertebral disc space in male group was slightly higher than that in female group, and the differences were significant (P<0.05) at C_{2, 3} and C_{5, 6}; the depth of the intervertebral disc space in male group was significantly higher than that in female group (P<0.05). The central height of the intervertebral disc space was (4.94±0.49) mm (range, 3.81-5.90 mm), the depth of the intervertebral disc space was (15.78±1.23) mm (range, 12.94-18.85 mm), the anterior and posterior distances between the uncinate processes were (17.19±2.39) mm (range, 13.39-24.63 mm) and (10.84±2.12) mm (range, 7.19-16.64 mm), respectively. According to the results of the anatomical research, the height of the uncovertebral joint fusion cage was designed as 5, 6, 7, and 8 mm; the depth of the uncovertebral joint fusion cage was designed as 12, 13, 14, 15, and 16 mm; the width of the uncovertebral joint fusion cage was designed as 14-18 mm; and the two wings are designed as arc-shape with 2 and 3 mm in width.Conclusion There are certain differences in the anatomical parameters of the uncovertebral joint between different segments. The uncovertebral joint fusion cage that designed based on the results of anatomical research is suitable for most patients.

Citation： YANG Yi, LIU Hao, WU Tingkui, HU Lingyun, CHEN Lin, RONG Xin, MA Litai, MENG Yang. Applied anatomy research of the uncovertebral joint for design of uncovertebral joint fusion cage. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(12): 1491-1497. doi: 10.7507/1002-1892.201904073 Copy

1.	王星, 史君, 張少杰, 等. 三維圖像測量青少年頸椎鉤突的形態特征. 中國組織工程研究與臨床康復, 2011, 15(30): 5587-5590.
2.	王曉慧, 劉宇, 廉小偉. 頸前路鉤椎關節切除術的應用解剖. 解剖學研究, 2008, 30(4): 276-278.
3.	凌澤莎. 獼猴椎動脈及橫突孔大水的 CTA 觀察及其 CSA 模型的可行性研究. 重慶: 重慶醫科大學, 2014.
4.	瞿東濱, 金大地, 鐘世鎮. 頸椎鉤突的解剖學測量及臨床意義. 中國矯形外科雜志, 2002, 9(1): 49-51.
5.	鞠曉華, 鞠學紅, 王金平, 等. 頸椎鉤突的解剖觀察及臨床意義. 濰坊醫學院學報, 2001, 23(3): 164-165.
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7.	王星, 史君, 張少杰, 等. 青少年頸椎鉤突與橫突孔的相關性研究及臨床意義. 局解手術學雜志, 2016, 25(10): 728-731.
8.	Kocabiyik N, Ercikti N, Tunali S. Morphometric analysis of the uncinate processes of the cervical vertebrae. Folia Morphol (Warsz), 2017, 76(3): 440-445.
9.	朱建兵, 龔建平, 錢銘輝. 螺旋 CT 研究頸椎鉤突的大小及其相關因素. 頸腰痛雜志, 2006, 27(2): 88-92.
10.	Chong E, Pelletier MH, Mobbs RJ, et al. The design evolution of interbody cages in anterior cervical discectomy and fusion: a systematic review. BMC Musculoskelet Disord, 2015, 16: 99.
11.	Kwon B, Kim DH, Marvin A, et al. Outcomes following anterior cervical discectomy and fusion: the role of interbody disc height, angulation, and spinous process distance. J Spinal Disord Tech, 2005, 18(4): 304-308.
12.	王海波, 王元, 孫璟川, 等. 頸椎前路椎間盤切除融合術術中恢復椎間隙自然高度對術后療效的影響. 脊柱外科雜志, 2018, 16(5): 284-288.
13.	孫超. 單節段 ACDF 的椎間高度矯正程度對鄰近節段間盤生物力學影響的研究. 天津: 天津醫科大學, 2016.
14.	Lu J, Ebraheim NA, Yang H, et al. Anatomic bases for anterior spinal surgery: surgical anatomy of the cervical vertebral body and disc space. Surg Radiol Anat, 1999, 21(4): 235-239.
15.	Panjabi MM, Duranceau J, Goel V, et al. Cervical human vertebrae. Quantitative three-dimensional anatomy of the middle and lower regions. Spine (Phila Pa 1976), 1991, 16(8): 861-869.
16.	Wilke HJ, Kettler A, Goetz C, et al. Subsidence resulting from simulated postoperative neck movements: an in vitro investigation with a new cervical fusion cage. Spine (Phila Pa 1976), 2000, 25(21): 2762-2770.
17.	Ebraheim NA, Lu J, Biyani A, et al. Anatomic considerations for uncovertebral involvement in cervical spondylosis. Clin Orthop Relat Res, 1997, (334): 200-206.
18.	袁健東, 陳鑫, 劉彩龍, 等. 頸前路術中鉤椎關節切除減壓治療神經根型頸椎病的療效分析. 中國骨傷, 2012, 25(9): 721-725.
19.	韓偉峰, 林欣, 李小光, 等. 頸椎病前路手術減壓范圍標志的解剖學研究. 中國臨床解剖學雜志, 2009, 27(4): 375-378.
20.	Lu J, Ebraheim NA, Georgiadis GM, et al. Anatomic considerations of the vertebral artery: implications for anterior decompression of the cervical spine. J Spinal Disord, 1998, 11(3): 233-236.
21.	蔣富貴, 瞿東濱, 朱志剛, 等. 頸椎前路減壓及內固定的解剖學問題. 中國臨床解剖學雜志, 2000, 18(4): 310-311.
22.	林永綏, 王萬明, 張發惠, 等. 頸椎前路減壓手術解剖標志定位測量及其臨床意義. 中國臨床解剖學雜志, 2014, 32(5): 523-528.
23.	楊敏杰, 朱曉白, 劉淼, 等. 經前路切除鉤椎關節治療頸椎病. 西安交通大學學報 (醫學版), 1995, 16(2): 192-193.
24.	孟慶玲, 施宇云, 譚小翠, 等. Mimics 軟件測量頸椎后縱韌帶骨化容積. 中國矯形外科雜志, 2018, 26(5): 453-457.
25.	孫振輝, 趙成禮, 陳亦飛, 等. 載距突螺釘固定跟骨骨折恒定骨折塊的植入方法研究. 中國修復重建外科雜志, 2018, 32(5): 581-586.
26.	Loisel F, Chapuy S, Rey PB, et al. Dimensions of the trapezium bone: a cadaver and CT study. Surg Radiol Anat, 2015, 37(7): 787-792.

1. 王星, 史君, 張少杰, 等. 三維圖像測量青少年頸椎鉤突的形態特征. 中國組織工程研究與臨床康復, 2011, 15(30): 5587-5590.
2. 王曉慧, 劉宇, 廉小偉. 頸前路鉤椎關節切除術的應用解剖. 解剖學研究, 2008, 30(4): 276-278.
3. 凌澤莎. 獼猴椎動脈及橫突孔大水的 CTA 觀察及其 CSA 模型的可行性研究. 重慶: 重慶醫科大學, 2014.
4. 瞿東濱, 金大地, 鐘世鎮. 頸椎鉤突的解剖學測量及臨床意義. 中國矯形外科雜志, 2002, 9(1): 49-51.
5. 鞠曉華, 鞠學紅, 王金平, 等. 頸椎鉤突的解剖觀察及臨床意義. 濰坊醫學院學報, 2001, 23(3): 164-165.
6. 毛雨. 正常人體頸部鉤椎關節 X 線研究 (附 40 例 X 線測量). 醫學綜述, 2008, 14(19): 3029-3030.
7. 王星, 史君, 張少杰, 等. 青少年頸椎鉤突與橫突孔的相關性研究及臨床意義. 局解手術學雜志, 2016, 25(10): 728-731.
8. Kocabiyik N, Ercikti N, Tunali S. Morphometric analysis of the uncinate processes of the cervical vertebrae. Folia Morphol (Warsz), 2017, 76(3): 440-445.
9. 朱建兵, 龔建平, 錢銘輝. 螺旋 CT 研究頸椎鉤突的大小及其相關因素. 頸腰痛雜志, 2006, 27(2): 88-92.
10. Chong E, Pelletier MH, Mobbs RJ, et al. The design evolution of interbody cages in anterior cervical discectomy and fusion: a systematic review. BMC Musculoskelet Disord, 2015, 16: 99.
11. Kwon B, Kim DH, Marvin A, et al. Outcomes following anterior cervical discectomy and fusion: the role of interbody disc height, angulation, and spinous process distance. J Spinal Disord Tech, 2005, 18(4): 304-308.
12. 王海波, 王元, 孫璟川, 等. 頸椎前路椎間盤切除融合術術中恢復椎間隙自然高度對術后療效的影響. 脊柱外科雜志, 2018, 16(5): 284-288.
13. 孫超. 單節段 ACDF 的椎間高度矯正程度對鄰近節段間盤生物力學影響的研究. 天津: 天津醫科大學, 2016.
14. Lu J, Ebraheim NA, Yang H, et al. Anatomic bases for anterior spinal surgery: surgical anatomy of the cervical vertebral body and disc space. Surg Radiol Anat, 1999, 21(4): 235-239.
15. Panjabi MM, Duranceau J, Goel V, et al. Cervical human vertebrae. Quantitative three-dimensional anatomy of the middle and lower regions. Spine (Phila Pa 1976), 1991, 16(8): 861-869.
16. Wilke HJ, Kettler A, Goetz C, et al. Subsidence resulting from simulated postoperative neck movements: an in vitro investigation with a new cervical fusion cage. Spine (Phila Pa 1976), 2000, 25(21): 2762-2770.
17. Ebraheim NA, Lu J, Biyani A, et al. Anatomic considerations for uncovertebral involvement in cervical spondylosis. Clin Orthop Relat Res, 1997, (334): 200-206.
18. 袁健東, 陳鑫, 劉彩龍, 等. 頸前路術中鉤椎關節切除減壓治療神經根型頸椎病的療效分析. 中國骨傷, 2012, 25(9): 721-725.
19. 韓偉峰, 林欣, 李小光, 等. 頸椎病前路手術減壓范圍標志的解剖學研究. 中國臨床解剖學雜志, 2009, 27(4): 375-378.
20. Lu J, Ebraheim NA, Georgiadis GM, et al. Anatomic considerations of the vertebral artery: implications for anterior decompression of the cervical spine. J Spinal Disord, 1998, 11(3): 233-236.
21. 蔣富貴, 瞿東濱, 朱志剛, 等. 頸椎前路減壓及內固定的解剖學問題. 中國臨床解剖學雜志, 2000, 18(4): 310-311.
22. 林永綏, 王萬明, 張發惠, 等. 頸椎前路減壓手術解剖標志定位測量及其臨床意義. 中國臨床解剖學雜志, 2014, 32(5): 523-528.
23. 楊敏杰, 朱曉白, 劉淼, 等. 經前路切除鉤椎關節治療頸椎病. 西安交通大學學報 (醫學版), 1995, 16(2): 192-193.
24. 孟慶玲, 施宇云, 譚小翠, 等. Mimics 軟件測量頸椎后縱韌帶骨化容積. 中國矯形外科雜志, 2018, 26(5): 453-457.
25. 孫振輝, 趙成禮, 陳亦飛, 等. 載距突螺釘固定跟骨骨折恒定骨折塊的植入方法研究. 中國修復重建外科雜志, 2018, 32(5): 581-586.
26. Loisel F, Chapuy S, Rey PB, et al. Dimensions of the trapezium bone: a cadaver and CT study. Surg Radiol Anat, 2015, 37(7): 787-792.

Chinese Journal of Reparative and Reconstructive Surgery

Applied anatomy research of the uncovertebral joint for design of uncovertebral joint fusion cage

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