小儿寰枢关节半脱位的X线诊断价值

X-ray diagnostic value of atlantoaxial subluxation in children

目的:通过对38例临床怀疑小儿寰枢关节半脱位X线影像资料的分析,结合文献资料,分析误诊的原因,预防的措施。方法:回顾性总结分析2010年3月至2014年4月前来我院就诊的15例和外院提供的23例临床怀疑寰枢关节脱位的患儿,将其分成两组。一组查体时临床症状不典型者有24例,另一组临床症状典型者有14例。两组患儿均摄颈椎侧位+张口位,测量及比较ADI、VBLADS及偏离齿状突距离,观察寰枢椎外侧关节面是否对齐例数。结果:两组ADI测量值及寰枢椎外侧关节面不对齐的例数有统计学差异(P<0.05),两组BVLADS值及偏离齿状突距离未见统计学差异。结论:准确测量ADI,观察寰枢椎外侧关节面是否错位是X线诊断小儿寰枢关节半脱位较可行的方法。齿状突与寰椎两侧块间距离的差值(VBLADS)和寰底线中点垂线偏离齿状突轴线的距离作为诊断的参考指标。

Objective：With the help of literature, we discussed reasons for misdiagnosis and preventions by analyzing x-ray imaging of suspected atlantoaxial subluxation among 38 children. Methods：We reviewed all cases （15 cases from our hospital and 23 cases from others） of suspected atlantoaxial subluxation from Mar 2010 to Apr 2014 . 38 cases were divided into two groups based on clinical symptoms（24 cases were untypical clinical symptoms）. They all were evaluated and compared ADI, VBLADS, the distance from odontoid in lateral radiograph of the temporal cervical vertebra and open-mouth , and observed the aligned number of lateral atlantoaxial articular surface. Results：ADI and ragged number of lateral atlantoaxial articular surface were statictically significant （P〈0.05）. BVLADS and the deflected distance from odontoid were no significant different . Conclusions： To measure ADI and observe lateral articular surface of atlantoaxial vertebral accurately are feasible methods to diagnose atlantoaxial subluxation in children. VBLADS and the distance from odontoid can be known as diagnostic criteria.