螺旋CT对寰枢椎损伤的诊断价值  

Diagnostic Value of Spiral CT for Atlantoaxial Injury

作　　者：沈明华[1] 叶进湖[1] 

机构地区：[1]厦门大学附属第一医院放射科,福建厦门361003

出　　处：《医学综述》2012年第2期303-304,共2页Medical Recapitulate

摘　　要：目的探讨X线平片和螺旋CT及其后图像处理技术在寰枢椎损伤中的应用价值。方法回顾性分析37例患者通过X线平片和多层螺旋CT证实寰枢关节脱位,齿状突骨拆,寰枢侧块及椎弓骨折的一般资料。利用三维重建、二维重建、容积再现和表面遮盖法后处理技术显示骨折、脱位,并进行比较。结果 37例患者中X线平片诊断正确25例,可疑和误诊2例。螺旋CT均明确诊断,其中C1爆裂性骨折7例,其中2例合并C1、C2脱位失稳。C2齿状突骨折17例,其中X线平片漏诊2例。C2椎弓骨折(Hang-man骨折)9例。单纯C1、C2椎间失稳2例,其中X线平片漏诊1例。枢椎椎体骨折,本组中2例为椎体纵行骨折,骨折无明显移位。在37例寰枢椎骨折病例中,螺旋CT全部正确,X线平片诊断正确25例,正确率67.5%,其中9例未能作出诊断,3例将寰枢椎骨折误诊为关节脱位。结论应用X线平片诊断寰枢椎损伤有很大局限性,易发生漏检。螺旋CT轴位和多种重建技术各具特色,结合使用可提高寰枢椎损伤的诊断价值。Objective To study the application value of X-ray radiography and spiral CT and digital image processing technology in the vertebral injury between atlas.Methods A retrospective analysis of 37 cases of atlantoaxial dislocation,odontoid bone removed,atlantoaxial lateral mass and pedicle fracture confirmed by X-ray and spiral CT was done.Three-dimensional reconstruction,two-dimensional reconstruction,volume rendering and surface shaded display post-processing techniques were used to display the fractures,dislocations,and comparison was done.Results Among 37 patients,X-ray diagnosis was correct in 25 cases,2 cases were suspicious and misdiagnosed.All were clearly diagnosed by spiral CT,of which the column C1 burst fracture in 7 cases,including 2 patients with C1,C2 dislocation instability.C2 dens fractures in 17 patients,including X-ray missed in 2 cases.C2 pedicle fracture（Hangman fracture）in 9 cases.Pure C1,C2 intervertebral instability in 2 cases,in which X-ray missed 1 case.Atlantoaxial vertebral fractures in this group,2 cases of longitudinal fracture of vertebral fractures without significant displacement.In 37 cases of atlantoaxial fracture cases,spiral CT diagnosis were all correct;X-ray diagnosis were correct in 25 cases,the correct rate of 67.5%,failure of diagnosis in 9 cases,atlantoaxial fracture misdiagnosed as dislocation in 3 cases.Conclusion The application of X-ray radiography to diagnose atlantoaxial injury has a lot of limitation,where failure of detection may easily occur.Spiral CT shaft and a variety of reconstruction techniques have different features,combinaton use of which can improve the diagnostic value for atlantoaxial injury.

关 键 词：寰枢椎损伤 X线平片 断层摄影 X线计算机 重建 

分 类 号：R814.42[医药卫生—影像医学与核医学] R814.4[医药卫生—放射医学]