颅颈交界畸形寰枢侧方关节与寰枢稳定性的关系  

The lateral atlantoaxial articulation in congenital anomaly of the craniovertebral junction and the atlantoaxial stability

作　　者：余新光[1] 尹一恒[1] 周定标[1] 许百男[1] 张远征[1] 刘策[2] 

机构地区：[1]解放军总医院神经外科,北京100853 [2]解放军第309医院神经外科

出　　处：《中华神经外科杂志》2011年第10期1029-1033,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金（30973032）

摘　　要：目的分析先天性颅颈交界区畸形的寰枢侧方关节的形态学变化及与寰枢稳定性的关系。方法回顾性分析98例行薄层CT扫描的患者和20例正常对照者。数据导入MIMICS三维成像软件，以Frankfort平面作为新的轴位进行重新分割，分别在重建的矢状面和冠状面上测量寰枢侧方关节面的倾斜角度；对寰枢侧方关节的三维构型进行分析，依据其脱位程度和关节面的倾斜方向进行分型。结果与正常的形态对比，发现有4种畸形的寰枢侧方关节。Ⅰ型特点是上下关节面向前轻度倾斜，但二者接触良好无滑脱；Ⅱ型的特点是上下关节面间有部分滑脱，整个侧方关节结构呈明显的前倾；Ⅲ型以两关节面的完全滑脱或完全分离为特征；Ⅳ型特点是寰枢侧方关节面向后方倾斜。61例至少有一侧关节面前倾（Ⅰ、Ⅱ或Ⅲ型），其中57例有寰枢脱位；33例双侧关节面后倾（Ⅳ型），均无脱位。结论寰枢侧方关节的前倾及骨性异常可能是先天性颅颈交界区畸形中寰枢间不稳定的直接因素，且寰枢间不稳定性随着寰枢侧方关节面倾斜角度的增大而加重。通过分析寰枢侧方关节的三维形态可能对诊断先天性颅颈交界区畸形的稳定性提供一个新的方法，并对手术策略的合理选择提供帮助。Objective To establish the morphological changes of the lateral atlantoaxial articulations （LAA） in congenital anomaly of the craniovertebral junction （CACVJ） and its relationship with the atlantoaxial stability. Methods A series of 98 cases of CACVJ and 20 control subjects who had underwent thin - slice CT scanning were retrospectively reviewed. CT data were imported into the MIMICS software and Frankfort horizontal plane was chosen as the new basal plane of the axial plane. The obliquity of the atlantoaxial articular facets was measured in reconstructed sagittal and coronal planes, respectively. The three - dimensional configurations of LAA were analyzed and categorized based on the degree of olisthy and inclination orientation of the articular facets. Results Compared to the normal configuration of LAA in control subjects, four types of malformed configuration of LAA in CACVJ were found. Type I, characterized by slight anteversion of LAA without olisthy of the inferior and superior facets; Type II , characterized by partial olisthy of the two facets and evident anteversion of LAA; Type III, defined by the separation or complete olisthy of the two facets ; Type IV, wherein the articular facets sloped dorsally. 57 of 61 cases in the former three types wherein AAF sloped ventrally had atlantoaxial dislocation （AAD）. All 33 type lVcases wherein AAF sloped dorsally had no AAD. Conclusion Atlantoaxial instability in CACVJ is likely a direct result of the anteversion of LAA and bony malformation of this region and it aggravates with the increasing obliquity of anteversion of the atlantoaxial articular facets. Demonstiating 3D morphological changes of LAA may provide a new means to diagnosis instability in atlantoaxial articular facets and a basis for rational surgical treatment.

关 键 词：先天性畸形 颅颈交界区 寰枢侧方关节 寰枢稳定性 

分 类 号：R687.3[医药卫生—骨科学]