慢性寰枢关节旋转固定或脱位复位前后寰枕关节影像学变化

Retrospective radiographic study of Occipito-atlantal joint for the patients with chronic atlanto-axial rotatory fixation or dislocation

中文关键词:  寰枢旋转固定  寰枢旋转半脱位  Grisel综合征  寰枕关节脱位

英文关键词:Atlantoaxial  Rotatory fixation  Rotatory subluxation  Grisel′s syndrome  Occipitoatlantal dislocation

中文摘要:

  【摘要】 目的：总结慢性寰枢关节旋转固定或脱位患者的寰枕关节在寰枢旋转或脱位复位前后的影像学改变。方法：回顾性分析2004年9月~2019年6月间因寰枢关节旋转固定或脱位在我院诊治的患者40例，男19例，女21例，年龄5~17岁，平均11.2±2.8岁，病程2~36个月，平均6.0±5.7个月，随访时间3~18个月，平均5.7±3.1个月。其中A类（3例），寰枢关节旋转固定；B类（36例），寰枢关节旋转固定性脱位（其中B1类10例，一侧寰椎侧块前脱位，另一侧原位；B2类21例，一侧寰椎侧块前脱位，另一侧后脱位；B3类5例，双侧寰椎侧块不对称前脱位）；C类（1例），寰枢关节旋转固定性脱位合并寰枕关节反向脱位。A类病例中1例牵引治愈、2例做了Halovest外固定下寰枢间植骨融合术；36例B类和1例C类患者都做了寰枢复位内固定植骨术。利用CT轴位、矢状位和冠状位影像，观察治疗前后寰枕关节面对合情况和关节间隙的变化。结果：大部分寰枢关节旋转固定或脱位患者寰枕关节出现不同程度的反向旋转移位、对合异常的现象，不同分类间其旋转程度有差异，寰枢关节旋转复位后，寰枕关节的旋转和关节面的对合关系也有不同程度改善。复位前、后都有寰枕关节自发骨性融合的现象。本次治疗前寰枕关节的情况：（1）除1例A类、3例B1类和5例B3类病例的寰枕关节对合正常外；其余病例的寰枕关节都有不同程度的旋转移位，对合不正常；1例C类双侧寰枕关节脱位；（2）2例出现寰枕关节自发融合，B1类和B3类各有1例。剩余38例经过治疗寰枢关节旋转矫正后寰枕关节的情况：（1）22例寰枕关节正常（包括A类3例，B1类6例，B2类10例和B3类3例）；（2）寰枕关节自发骨性融合8例（包括B1类1例，B2类6例和B3类1例）；（3）寰枕关节残留旋转移位、对合不正常4例（包括B2类3例，C类1例）；（4）寰枕关节间隙变窄、模糊4例（包括B1类和B2类各2例）。结论：大部分A类和B1类患者以及全部B2类患者在治疗前出现寰枕关节反向旋转移位，其中个别B类患者在治疗前有寰枕关节自发融合的现象。复位后A类、B1类和B3类患者的寰枕关节恢复正常对合关系，但B类患者中有近一半出现寰枕关节对合不正常、关节间隙狭窄模糊、关节自发融合等不良问题，多见于B2类病例。

英文摘要:

  【Abstract】 Objectives: To investigate the radiographic changes of the occipito-atlantal joint for the patients with chronic atlanto-axial rotatory fixation or dislocation(AARF/D) before and after our treatment. Methods: A series of 40 cases were diagnosed and treated in our hospital from September 2004 to June 2019, including 19 males and 21 females, with the mean age of 11.2±2.8 years. The mean duration of symptoms was 6.0±5.7months(2-36 months), and the mean follow-up period was 5.7±3.1 months(3-18 months). According to author′s classification, there were three types of radiographic characteristic findings on the X ray films and CT scan: the first was atlantoaxial rotatory fixation(AARF); the second was atlantoaxial rotatory dislocation(AARD); the third was occipito-atlanto-axial rotatory dislocation(OAARD). There were 3 cases with type A(AARF); 36 cases with type B(AARD), among that, 10 cases with type B1, 21 cases with type B2, and 5 cases with type B3; and 1 cases with type C(OAARFD). One case with type A was reduced by traction and the other 2 cases with type A were reduced by skull traction and surgical atlantoaxial fusion under Halovest stablization. 36 cases with type B and one case with type C were treated by surgical atlantoaxial reduction and fusion. The imaging changes of the occipito-atlantal joint on CT scan before and after treatment were observed. Results: The occipito-atlantal rotatory displacement occurred in most cases with AARF/D before treatment and reduced after treatment. Spontaneous bony fusion took place in a few cases either before or after treatment. Before the treatment, except 1 case with type A and 3 cases with type B1 and 5 cases with type B3, occipito-atlantal rotatory displacement took place among all other cases in different size, 1 case with type C was occipito-atlantal dislocation. The occipito-atlantal joint developed to spontaneous bony fusion before our treatment in 2 case(1 case was with type B1 and 1 case with type B3). After the treatment, (1)the occipitoatlantal joint was normal in 22 cases(including 3 cases with type A, 19 cases with type B); (2)the joint developed to spontaneous bony fusion in 8 cases(including 6 cases with type B2,1 case with type B1 and 1 case with type B3); (3)the joint was partially reduced in 4 cases (including 3 cases with type B2 and 1 case with type C); (4)the joint space became narrow and indistinct in 4 cases (including 2 cases with type B1 and 2 cases with type B2). Conclusions: For most cases with type A and type B1 and all cases with type B2, the occipitoatlantal rotatory displacement occurred, and a few cases with type B developed spontaneous bony fusion before treatment. After treatment, the occipito-atlantal rotatory displacement reduced to normal alignment for all cases with type A and type B1, but in nearly half of cases with type B, occipito-atlantal joint developed to failed reduction and the joint space narrowed even spontaneous bony fusion developed after atlantoaxial rotatory alignment was reduced. One case with type C had left occipito-atlantal rotated displacement.