左右侧屈张口位X线片在寰枢关节不稳诊治中的意义和临床应用

The Clinical Value and Application of the Plain X-ray Film of Open Mouth View Titled Left and Right Flexion for the Treatment of Atlantoaxial Joint Instability

目的探讨寰枢关节不稳诊治时应用左右侧屈张口位X线片的临床意义。方法收治8例不典型寰枢椎不稳患者均有颈部轻微外伤史,外伤后出现枕部或枕颈交界区疼痛,寰枢椎常规行CT三维重建、MRI检查以及X线片张口位、屈伸动力位均未见明显异常。非手术治疗时间大于3个月,效果不佳。颈椎左右侧屈张口位X线片可见齿状突至枢椎左右侧块的距离不等,依据该影像学检查结合临床症状即可诊断为寰枢关节不稳,选择Gallie术式并采用Margel技术空心螺钉固定寰枢关节。结果患者术后均用枕颈胸支具颈部制动,获3～9个月随访,平均6个月,术后患者症状均消失。结论左右侧屈张口位X线片为寰枢关节不稳的诊治提供了新的影像学依据,并依此选择Gallie术式采用Margel技术空心螺钉固定寰枢关节,是寰枢关节不稳诊治的有效方法。

Objective To explore the treatment of atlantoaxial joint instability by the application of the plain X-ray film of open mouth view titled left and right.Methods A retrospective review of 8 patents with non-typical atlanto-axial asymmetry who were cured in our hospital.There were 7 males and 1 female,with a mean age of 20 years.（range,15 to 26 years）.They were all associated with microtrauma.After microtraumatic they all feel pain in occipital or occipital-cervical junction region.The routine radiological examinations of cervical spine did not find abnormality.They were treated conservatively more than 3 months.The treatment was not working.The X-ray film of open mouth view titled left and right could find odontoid lateral mass asymmetry.One lateral mass which appeared to be wider and closer to the midline,whereas the opposite mass appeared to be narrower and farther from the midline.All patients were treated with bilateral C1-2 posterior transarticular screw fixation and then undergone one-stage Magerl surgery combined with C1-2 posterior Gallie.After operation their cervial spine were fixed by occipital cervical thoracic brace for 1 month.Results Mean time of follow-up was 6 months（range,from 3 to 9 months）.JOA scores were 17.Conclusion The X-ray film of open mouth view titled left and right flexion is a new evidence for making a diagnosis of atlantoaxial joint instability.It is an effective method to make the diagnosis of atlantoaxial instability and thereafter adopt therapy of operation.