单纯性寰椎关节半脱位的多层螺旋CT诊断价值分析

Value analysis of multislice CT diagnosis to simple atlanto-axial joint subluxation

目的探讨多层螺旋CT及其多平面重建技术在寰枢关节半脱位中的诊断价值。方法回顾性分析寰枢关节半脱位66例患者,34例进行张口位检查,32例进行中立位下螺旋CT平扫并进行多平面重建,测量其寰齿前间距(ADI),齿突侧块间距差值(VBLADI)。结果张口位发现3例寰枢关节半脱位,阳性率为17.6%。螺旋CT检查发现26例寰枢关节半脱位,阳性率为81.2%,其中向左侧侧方半脱位者(左侧明显增宽者)14例,向右侧侧方半脱位者(右侧明显增宽者)12例,寰齿前间距及齿突侧块间距差值均超过标准值范围,同时合并齿状突骨折6例,合并寰椎侧块内侧骨折3例,合并寰齿关节边缘骨质增生,硬化5例。两种检查方法阳性率有统计学差异。结论多层螺旋CT检查应作为诊断寰枢关节半脱位首选检查方法,而其多平面重建技术(MPR)的利用必不可少。诊断寰枢关节半脱位齿突侧块间距差值,必须要结合临床病史,方能做出诊断。

Objective To discuss value analysis of multislice CT and multiplanar reconstruction technique in the diagnosis of atlanto-axial joint subluxation.Methods 66 patients undergoing atlanto-axial joint subluxation were retrospectively analyzed.Among them there were 34 patients performed mouth-open check,32 cases performed spiral CT scan at neutral position and multiplanar reconstruction.Anlanto-odontoid spacing（ADI）,before the tooth side block space difference（VBLADI） of all cases were measured.Results There were 3 cases found atlanto-axial joint subluxation in the first group,and the positive rate is 17.6%.There were 26 cases found atlanto-axial joint subluxation in the second group which Spiral CT was performed,and the positive rate was 81.2%.Furthermore,in the second group,there were 14 cases having the left side subluxation（the apparent increase was shown on the left side）,and 12 cases having the right side subluxation（the apparent increase was shown on the right side）.The space of anlanto former odontoid and tooth side block space go beyond the standard range.And ther were 6 cases having dentate fractures,3 cases combined with medial atlas lateral mass fracture,5 cases combined with bone hyperplasia and hardening in side anlanto-odontoid joint.The differences were statistically significant between two kinds of inspection methods.Conclusion Multislice CT examination could be preferred method for diagnosis of atlanto-axial joint subluxation,and it is also necessary to use multiplanar reconstruction technique（MPR）.Furthermore,diagnosis of odontoid side block space difference on atlanto-axial joint subluxation must combine with clinical history.