多层螺旋CT在成人寰齿关节炎分级诊断中的应用

The application of hierarchical diagnosis of osteoarthritis of the atlanto-odontoid joint in adults using multi-detector computed tomography

目的：通过多层螺旋CT（ MDCT）观察寰齿关节炎的发病及分级情况。方法回顾性分析2011年5月—2012年5月山东大学附属济南市传染病医院影像科和山东省医学影像学研究所行上颈椎MDCT检查的700例成人的临床资料。其中男313例,女387例；年龄18.2~88.8岁,平均46.4岁。患者按不同年龄段分成≥18-25、〉25-30、〉30-40、〉40-50、〉50-60、〉60-70,〉70岁组,每组100例。使用16层MDCT机,运用多层面重建后处理技术,从任意角度观察寰齿关节情况,参照关节炎的四分之一分类标准对病例进行分级,观察统计不同年龄组寰齿关节炎的发病及分级构成情况。从700例中随机选出100例,评价采用MDCT对寰齿关节炎进行诊断及分级的稳定性。结果本组700例,寰齿关节炎男女发病率分别为54.3%（170/313）、53.2%（206/387）,差异无统计学意义（χ2=0.082, P〉0.05）；随年龄的增加,寰齿关节炎的发病率逐渐增加,差异均有统计学意义（χ2=229.725, P值均〈0.01）。采用 MDCT对寰齿关节炎进行分级,结果稳定性较好（ K =0.720）。结论寰齿关节炎不同性别的发病率无差异,但随年龄的增加发病率逐渐增加。 MDCT可以很好的显示并诊断寰齿关节炎,采用MDCT进行分级,稳定性良好。

Objective To reveal the morbidity and classification of osteoarthritis of the atlanto-odontoid joint with MDCT in adults. Methods A series of 700 selected domestic patients （387 female and 313 male） over 18 years old （ aged 18. 2 -88. 8 years old, average 46. 4 years old） underwent an upper cervical MDCT scan were divided equally into seven age groups in this retrospective study. According to distribution of their age, all of 700 patients were divided into 7 groups, with 100 patients in each group. Multi-planar reconstruction was performed in a 16-slices spiral CT, osteoarthritis of the atlanto-odontoid joint was viewed from any direction and classified into four grades, which were normal, mild, moderate, and severe by Fourth classification criteria. One hundred patients were randomly selected for assessing the reproducibility of MDCT grading. Results The incidence rates of osteoarthritis of the atlanto-odontoid joint in male and female were 54. 3%（170/313）, 53. 2%（206/387）. There was no significant difference （χ2 =0. 082, P〉0. 05）. The incidence of osteoarthritis showed a gradual upward trend （χ2 =229. 725, P 〈0. 01）. MDCT grading was used to assess the inter-observer reliability（ K=0. 720）. Conclusions The incidence is unrelated to gender, but increases with age gradually. MDCT grading in Osteoarthritis of the atlanto-odontoid joint is stable.