寰枢关节相关解剖变异及其影像学诊断  

Anatomic variation related to atlanto-axial joint and their imaging diagnosis

作　　者：钟福华[1] 赵文俊[2] 段少银[3] 

机构地区：[1]福建省龙岩监狱医院 [2]福建医科大学协和临床医学院,福州350001 [3]厦门大学附属中山医院影像科

出　　处：《福建医药杂志》2017年第3期26-30,共5页Fujian Medical Journal

基　　金：国家自然科学基金(30870690);厦门市科技计划项目(3502Z20144025)

摘　　要：目的统计患者影像学数据,显示寰枢关节相关解剖变异,明确变异的发生与表现,提高相关变异的影像学诊疗水平。方法 1)利用我院影像归档和通讯系统(PACS)资料,查找2010年1月至2015年10月寰枢关节相关解剖变异病例共590例;2)分析寰枢关节相关解剖变异的影像学表现,进行解剖变异分型;3)利用三维重建技术,进行寰枢关节相关解剖变异的三维重建成像与分析;4)比较影像学检查方法。结果 1)寰枢关节相关解剖变异590例,其中男性293例(49.66%),女性297例(50.34%),男女间差异无统计学意义。解剖变异包括4类:第1类,寰椎椎动脉沟环变异419例(71.02%);第2类,骨性融合或缺如113例(19.15%),其中寰枕融合10例,寰枢融合9例,C2-3融合84例,齿突变异5例,寰椎椎弓发育不全5例;第3类,椎动脉变异26例(4.41%),其中椎动脉走形异常5例,椎动脉发育异常4例,椎动脉纤细14例,椎动脉缺如3例;第4类,颅底畸形32例(5.42%),其中Chiari畸形20例,扁平颅底5例,颅底凹陷7例。2)影像检查与诊断:X线、CT、MRI分别发现第1类变异357例(60.51%)、93例(15.76%)、0例(0.00%);发现第2类变异4例(0.68%)、65例(11.02%)、15例(2.54%);第3类变异20例(3.39%)、6例(1.02%)、0例(0.00%);第4类变异17例(2.88%)、6例(1.02%)、24例(4.07%)。接受2种以上影像学检查15例,其中结论不一致11例,均发生于第2类变异;三维重建技术诊断准确率达100%。结论寰枢关节相关解剖变异发现率为7.13%,男女无显著差别。第1类变异椎动脉沟环最多,都是经X线检查或CT诊断;第3类椎动脉变异由三维CT诊断最多;第4类Chiari畸形由MRI诊断最多。影像学检查诊断不一致均为第2类变异骨性融合或缺如,三维CT的应用有利于提高其诊断准确率。Objective To show anatomic variation related to atlanto-axial joint in order to improve the level of clinical diagnosis and treatment on the anatomic variations by analyzing incidence of patients and application of imaging exam. Methods 1） A total of 590 patients with anatomic variation related to atlanto-axial joint were achieved from the PACS in our hospital from January 2010 to October 2015. 2） Imaging and clinical manifestations of anatomic variation related to atlanto-axial joint were analyzed, as well as the type of variation on the characteristics of structural variation. 3） 3D imaging was used and anatomic variation related to atlanto-axial joint was analyzed. 4） Imaging examination methods were compared. Results 1） All the 590 patients with anatomic variation related to atlanto-axial joint included 293 cases in male （49.66%） and 297 cases in female （50.34%）, there was no statistical difference between male and female cases. Anatomic variations were divided into Type 1 of variation in 419 cases （71, 02%） ; Type 2 of 113 cases （19.15%）, including 10 cases of atlanto-occipital fusion, 9 cases of atlanto-axial fusion, 84 cases of C2-3 fusion, 5 cases of odontoid variation and 5 cases of hypoplasia of posterior arch of atlas; Type 3 of anomalous vertebral artery in 26 cases （4.41%）, including 5 cases of vertebral artery course variation, 4 cases of developmental anomalies of the vertebral artery, 14 cases of delicate vertebral artery, 3 cases of vertebral artery absence; Type 4 of 32 cases （5.42%）, including 20 cases of Chiari malformation, 5 cases of platybasia and 7 cases of basilar invagination. 2） Imaging examination and diagnosis： Type 1 variations discovered by X-ray, CT and MRI were 357 cases （60.51%）, 93 cases （15.76%） and 0 case （0.00%） respectively; type 2 variations discovered by X-ray, CT and MRI were 4 cases （0.68%）, 65 cases （11.02%）, 15 cases （2.54%） respectively; type 3 variations discovered by X-ray, CT and MRI were 20 cases （3.3

关 键 词：寰枢关节 解剖 变异 影像学诊断 

分 类 号：R684[医药卫生—骨科学] R445[医药卫生—外科学]