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学术背景:临床诊断寰枢关节不全脱位的标准不明确,可疑诊断多,探讨新的诊断方法及诊断依据有利于提高诊断准确率,是目前该领域的研究热点。目的:利用CT三维成像观察正常人寰枢关节功能位解剖及位置关系,为诊断寰枢关节不全脱位提供解剖学基础。设计:单样本自身对比。单位:厦门大学附属中山医院影像科。对象:实验于2003-06/2004-11在厦门大学附属中山医院影像科CT室进行。随机选取正常志愿者53例,男27例,女26例,年龄4.5～75岁,平均31.2岁,无颈部外伤或颈部疾患史。受试者或监护人对实验知情同意。方法:应用德国西门子Plus4型螺旋CT机,SUN magic veiw 1000工作站及配备的三维重建软件,对志愿者进行中立位寰枢关节CT螺旋扫描及三维重建成像。其中21例加作右、左旋转位。主要观察指标:①错位寰枢外侧关节面吻合情况。②齿突侧距对称情况。③寰齿关节间隙。④左、右旋转位寰枢外侧关节面移位最大经线。⑤左、右旋转位的最大旋转角度。结果:①53例中立位三维重建图像显示寰枢外侧关节上、下关节面对齐,寰齿关节间隙为1.0～3.3mm;齿突侧距不对称24例,占45.28%。②21例旋转位显示寰枢外侧关节上、下关节面呈旋转性关节面移位,关节面吻合面积缩小约1/2～2/3,移位关节面宽度为5.76～8.18mm;齿突侧距中立位对称时齿突向旋转侧偏移,不对称时齿突偏移程度减轻或无改变;寰齿关节间隙无变化。结论:CT三维成像能清楚显示寰枢关节功能位解剖结构及其位置变化规律,为临床诊断及治疗寰枢关节不全脱位提供理论依据。
Academic Background: The clinical diagnosis of atlantoaxial total dislocation of the standard is not clear, more suspicious diagnosis, to explore new diagnostic methods and diagnostic basis is conducive to improve the diagnostic accuracy, is currently the research hotspot in this field. OBJECTIVE: To observe the anatomic and positional relationships of atlantoaxial joint function in normal human by CT three-dimensional imaging and provide anatomical basis for the diagnosis of atlantoaxial joint dislocation. Design: a single sample of their own contrast. Unit: Zhongshan Hospital Affiliated to Xiamen University Imaging. Subjects: The experiment was performed at CT department of Zhongshan Medical Imaging Center, Xiamen University from June 2003 to November 2004. 53 normal volunteers were randomly selected, including 27 males and 26 females, aged from 4.5 to 75 years (mean, 31.2 years) with no history of neck trauma or neck disease. Informed consent of the subject or guardian to the experiment. Methods: The volunteers were treated with atlanto-axial computed tomography (CT) helical scan and three-dimensional reconstruction using the German Siemens Plus4 spiral CT scanner, the SUN magic veiw 1000 workstation and the three-dimensional reconstruction software. 21 cases plus right and left rotation position. MAIN OUTCOME MEASURES: ① Anastomosis of the lateral atlantoaxial articular surface. ② odontoid lateral symmetry. ③ atlantoacral joint space. ④ Left and right rotation atlantolateral articular surface shift maximum warp. ⑤ left and right rotary position of the maximum rotation angle. Results: (1) 53 cases of neutral three-dimensional reconstruction showed that the upper and lower articular surfaces of atlantoaxial joint were aligned with a gap of 1.0-3.3 mm; lateral asymmetry of the odontoid was 24 cases (45.28%). ② The rotational position of 21 cases showed that the upper and lower articular surfaces of the atlantoaxial joint presented a rotational articular surface shift, the anastomosis area of the articular surface was reduced by about 1/2 ~ 2/3, the width of the displaced articular surface was 5.76 ~ 8.18mm; When the distance from the neutral position is shifted to the rotation side, the degree of deviation of the dentition is reduced or not changed when the asymmetry is asymmetrical. There is no change in the atlantoarticular joint space. Conclusion: CT three-dimensional imaging can clearly show the anatomical structure and location of atlantoaxial joint anatomy and provide a theoretical basis for clinical diagnosis and treatment of atlantoaxial joint dislocation.