寰枢关节不全脱位50例临床分析  

Clinical study and discussion about atlantoaxial subluxation

作　　者：隋桐[1] 陈雍君[2] 赵慧毅[2] 林清池[1] 段少银[1] 

机构地区：[1]厦门大学附属中山医院影像科,福建厦门361004 [2]厦门大学附属中山医院骨科

出　　处：《中国中医骨伤科杂志》2012年第3期9-12,共4页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：国家自然科学基金面上项目(30870690)

摘　　要：目的:探讨寰枢关节不全脱位的临床诊断与治疗。方法:回顾性分析我院2006年1月～2011年6月住院治疗的寰枢关节不全脱位患者的临床资料50例,其中37例为非手术治疗,13例接受手术治疗。分析其临床特征、影像学表现,讨论其治疗方法及效果。结果:寰枢关节不全脱位患者临床表现以枕颈部疼痛、颈部旋转活动受限为多,发生率分别为84%、78%。影像检查阳性率X线侧位与齿突张口位平片为81.8%,常规CT为94%,CT三维成像阳性率100%、MR检查阳性率25%。出现寰枢外侧关节面错位100%、寰齿间隙增宽24%、齿突侧距偏移90%及左右寰枢外侧关节间隙不对称60%。37例非手术治疗患者中临床治愈13例,显效17例,改善7例;13例手术治疗患者中临床治愈7例,显效3例,改善3例。寰枢外侧关节面错位为2.0～4.0mm患者29例,并发症率51.7%(15/29),选择手术治疗13.8%(4/29),治疗显效率为93.1%(27/29);错位4.1mm以上患者21例,并发症率52.4%(11/21),选择手术治疗42.9%(9/21),治疗显效率为61.9%(13/21);其中选择手术治疗、治疗显效率比较差异有统计学意义(P<0.05)。结论:影像学检查中CT三维成像诊断寰枢关节不全脱位具有重要价值,诊断结合临床症状、体征是非常必要的。寰枢外侧关节面错位程度与治疗方法选择、临床疗效有直接关系。Objective：To discuss the clinical diagnosis and treatment on atlantoaxial subluxation.Methods：50 patients（37 cases without operation,13 cases with operation） with atlantoaxial subluxation were retrospectively analyzed,from January 2006 to June 2011.The clinical features,imaging findings and treatment method were analyzed,and the clinical effects were observed.Results： Clinical manifestations of patients with atlantoaxial subluxation are mostly the neck pain with the incidence of 84%,and the rotation limitation with the incidence of 78%.The diagnosis positive rate of X-ray plain film was 81.8%,which of CT was 94%,three-dimensional CT was100.0%,MR was 25.0%.The sign of dislocated joint face was showed with 100% in medical imaging,atlanto-odontoid gap widened with 24%,odontoid process deviated with 90% and asymmetry joint space between left and right lateral atlantoaxial with 60%.13 cases were obtained clinical cure,17 cases were effective,7 cases were improved in all the 37 cases without operation;7 cases were cured,3 cases were effective,3 cases were improved in all the 13 cases with operation.The complication rate was 51.7%（15 / 29）,the operation rate was 13.8%（4 / 29） and the treatment effective rate was 93.1%（27 / 29） in all 29 patients with the width of dislocated joint face was 2.0~4.0mm.The complication rate was 52.4%（11 / 21）,the operation rate was 42.9%（9 / 21） and the treatment effective rate was 61.9%（13 / 21） in all 21 patients with the width of dislocated joint face was over 4.1mm.There were significant differences in the rate of operation,treatment efficiency between the two groups（2.0-4.0mm and up to 4.0mm）（P0.05）.Conclusion：Three-dimensional CT has important value to diagnosis on the atlantoaxial subluxation,and it is very necessary to combination with the clinical symptoms and physical signs,in order to make the correct diagnosis.The width of dislocated joint face has a direct relationship with the choice of treatment method and clinical effect.

关 键 词：寰枢关节 脱位 影像学诊断 治疗方法 

分 类 号：R684.7[医药卫生—骨科学]