颈椎钩椎关节发育特征的基础与临床应用解剖学研究

Because of its special structure and the adjacent vessels and nerves, the adjacent vertebral joint has a complex relationship with the stability of the cervical vertebra and its mobility. In recent years, scholars believe that the uncovertebral joint is one of the main pathogenesis of cervical spondylosis, but the joint Has been a controversial joint, early studies on the spine of children aged 1-17 years also found that the uncovertebral joint is not inherently formed, but later gradually formed according to cervical mechanics needs, with age And cervical activity increased, uncinate process in degenerative joint degeneration, such as hyperplasia, osteophytes, etc. can be pressed vertebral artery, spinal nerve caused by the corresponding cervical spondylosis. However, there is no accurate conclusion about the formation of this joint at present, whether it is a real "synovial joint" or not, and the formation and degeneration of "joint" occurred mostly in what age stage, whether there is correlation between synovial membrane and degeneration, Select the surgical approach, the scope of removal of uncinate process and the stability of vertebra and cervical spine and healing recovery lack of finite element and biomechanical comparative study. The existing researches mostly focus on adults and are mostly single studies. Therefore, from the perspective of aging changes, we use theories of development, mechanics, biomechanics and histology to study the prevention and treatment of clinical cervical spondylosis in accordance with.

钩椎关节由于其特殊的结构及与周围血管、神经毗邻关系复杂，并与颈椎的稳定性和活动度密切相关，近年来学者认为钩椎关节是颈椎病的主要发病部位之一，但该关节一直是颇有争议的关节，在前期对1-17岁儿童青少年群体脊柱进行相关研究时也发现，钩椎关节并不是先天形成的，而是后期根据颈椎力学需要逐渐形成的，随着年龄增长和颈部活动度的增大，钩椎关节中的钩突会发生退行性病变，如增生、骨赘等均可压迫椎动脉、脊神经等而引起相应的颈椎病。但目前就这一关节的发育形成没有准确定论，是否为真正的“滑膜关节”、“关节”的形成与退变多发生在在何年龄段、滑膜与退变是否存在相关性以及后期选择手术入路、钩突切除范围及椎骨与颈椎稳定性及愈后功能的恢复缺乏有限元与生物力学的对比研究。现有的研究多集中于成人，而且多是单一的研究，因此，从增龄变化角度出发，利用发育学、力学与生物力学、组织学等技术进行研究为临床颈椎病的预防与治疗提供理论依据。

钩椎关节作为颈椎所特有的关节，是一个动态发育的过程，经历了关节形成期、发育成熟期和关节退变期的三个过程。这一过程也是从“正能量”到“负能量”的变化过程，即从限制颈椎体的侧向运动对颈椎的活动度和稳定性起作用到逐渐演变为因退行性改变而压迫神经根或椎动脉导致颈椎病的病理变化过程。本课题通过形态学、组织学、影像学、力学等研究等发现：1.钩椎关节中钩突的长、高、宽随椎序递增和增龄总体呈缓慢递增趋势，符合脊柱重力发育规律；双侧钩突、钩突前脚、后脚间距随椎序递增呈缓慢递增趋势，三者间变化不很显著；钩突-横突孔间距随椎序递增呈缓慢递增趋势，但增龄变化不显著；钩突夹角、钩突矢状角随椎序递增和增龄总体呈波浪状，钩突夹角约130°与颈椎的稳定性密切相关，而钩突矢状角平均15°，有限制颈椎过度旋转作用；但钩突宽与椎间孔面积密切相关，是神经根型颈椎病致病的重要因素之一；椎间隙前、后高随椎序增加呈缓慢递增，随增龄而呈下降趋势，这与脊柱生长发育规律相符，随年龄增长、脊柱过度运动等因素致颈椎间盘发生退行性改变引起椎间隙高度降低，从而引起相应颈椎病症状。2.钩突与椎动脉间距是评估椎动脉型颈椎病的重要评价指标，椎弓根横倾角范围可作为临床椎弓根置钉角度参考值，椎弓根宽是确保椎弓根螺钉准确置入椎弓根的保证。3. Micro-CT可清晰地观测颈椎钩突内骨小梁分布特征、计量和形态学参数，钩突内骨小梁在侧别间、椎序间差异不显著，为钩突骨质疏松及颈椎病及相关疾病的预防、诊疗等提供了实验理论依据。4.钩突应力和位移值随椎序增加呈递增趋势，最大值位于远离重力线的C5，切除钩突范围越大越影响颈椎的稳定性；钩椎关节中的关节突应力和位移值在正常颈椎中其应力集中区位于C6，但切除不同范围钩突后其应力和位移值则集中于C5；颈椎间盘应力和位移值不论在何种情况下均集中于C5/6，其受力不因钩突的切除而受影响。通过上述研究为临床颈椎病的早期诊断、治疗及预防提供了理论依据。