CAJ | 학술논문

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Plus 4 型螺旋CT机,SUN magic veiw1000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1.0～3.3 mm;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5.76～8.18 mm;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.
학술배경:림상진단환추관절불전탈위적표준불명학,가의진단다,탐토신적진단방법급진단의거유리우제고진단준학솔,시목전해영역적연구열점.목적:이용CT삼유성상관찰정상인환추관절공능위해부급위치관계,위진단환추관절불전탈위제공해부학기출.설계:단양본자신대비.단위:하문대학부속중산의원영상과.대상:실험우2003-06/2004-11재하문대학부속중산의원영상과CT실진행.수궤선취정상지원자53례,남 27 례,녀26 례,년령4.5～75세,평균31.2세,무경부외상혹경부질환사.수시자혹감호인대실험지정동의.방법:응용덕국서문자Plus 4 형라선CT궤,SUN magic veiw1000공작참급배비적삼유중건연건,대지원자진행중립위환추관절CT라선소묘급삼유중건성상.기중21례가작우、좌선전위.주요관찰지표:①착위환추외측관절면문합정황.②치돌측거대칭정황.③환치관절간극.④좌、우선전위환추외측관절면이위최대경선.⑤좌、우선전위적최대선전각도. 결과:①53례중립위삼유중건도상현시환추외측관절상、하관절면대제,환치관절간극위1.0～3.3 mm;치돌측거불대칭24 례,점45.28%.②21례선전위현시환추외측관절상、하관절면정선전성관절면이위,관절면문합면적축소약1/2～2/3,이위관절면관도위5.76～8.18 mm;치돌측거중립위대칭시치돌향선전측편이,불대칭시치돌편이정도감경혹무개변;환치관절간극무변화. 결론:CT삼유성상능청초현시환추관절공능위해부결구급기위치변화규률,위림상진단급치료환추관절불전탈위제공이론의거.
BACKGROUND: Clinical diagnosis criteria for rotary subluxation of atlanto-axial joint have not been identified. Many clinical diagnoses are suspicious. Therefore, investigating a new diagnostic method and diagnostic evidence is beneficial to enhancing diagnosis accuracy, and is a study hotspot in the current field.OBJECTIVE: This study aimed to observe the relationship between anatomy of normal human atlanto-axial joint and functional positions, and to provide anatomical basis for the diagnosis of atlanto-axial rotary subluxation.DESIGN: Single sample self-control study.SETTING: Department of Imageology, Zhongshan Hospital Affiliated to Xiamen University.PARTICIPANTS: This study was carried out in the CT Room, Department of Imageology, Zhongshan Hospital Affiliated to Xiamen University between June 2003 and November 2004. Fifty-three volunteers, 27 males and 26 females, with an average age of 31.2 years (range 4.5-75 years), without cervical trauma or history of cervical diseases, were randomly recruited in to this study. Written informed consents were obtained from each subject or their guardians.METHODS: CT helical scanning and three-dimensional reconstruction imaging of atlanto-axial joint in the neutral position were performed in all the volunteers and were supplemented in the right and left rotary position in 21 subjects on a helical CT scanner (somatom plus 4, Siemens, Germany), SUN magic view 1000 workstation and three-dimensional reconstruction software.MAIN OUTCOME MEASURES: ① Lateral atlanto-axial articular facet contraposition. ② Lateral atlanto dental space③ Atlanto dental interval. ④ The largest extent of articular facets dislocation in the right and left rotary positions. ⑤ Head's rotary maximal angle in the right and left rotary positions.RESULTS: ① Three-dimensional images with atlanto-axial joint in the functional position of 53 patients showed that the articular surfaces of lateral atlanto-axial joint had basic contraposition, the width of atlanto-dental interval ranged from 1.0 to 3.3 mm, and the lateral atlanto-dental distance devirated in 24 patients (45.28%). ②Three-dimensional images with atlanto-axial joint in the rotary position of 21 patients showed that the width of atlanto dental interval had no change, the articular facets of lateral atlanto-axial joint had rotary displacement with the width ranging from 5.76 to 8.18 mm, and anastomotic area of articular facet was decreased by 1/2 to 2/3. The condyles had deflected to the rotary direction in the patients with symmetrical lateral atlanto dental space, and for 15 patients with asymmetrical lateral atlanto dental space, the condyle deflected slightly or had no changes.CONCLUSION: CT-three dimensional imaging can clearly show the anatomical structure of atlanto-axial joint in functional position and the changing rule of atlanto-axial joint movement, providing theoretical evidence for the clinical diagnosis and the treatment of atlanto-axial subluxation.