枕颈部解剖、韧带骨化和骨关节炎对枕颈部疾病诊治的重要性

The importance of occipitocervical anatomy, ligament ossification, and osteoarthritis in the diagnosis and treatment of occipitocervical diseases

枕颈部解剖具有部位深在、结构复杂、功能独特等特点,其运动功能具有高度灵活性。如何以最小的创伤获得满意的脊髓减压效果,以及如何有效重建生物力学稳定和维持灵活的运动功能是目前亟待解决的重要临床问题。这也导致外科医生仅仅关注手术技术而忽略了对疾病的综合认识和治疗。临床中有三个常见但容易被忽视的问题:第一,枕颈部解剖学研究对提高临床诊疗的重要性,在临床诊治过程不应仅关注寰枢椎稳定性,还应考虑颅底、下位颈椎的稳定性;第二,寰枕、寰枢关节与局部后纵韧带骨化,寰枢椎的灵活性可能导致部分后纵韧带骨化最早出现在该区域;第三,寰枕、寰枢关节骨关节炎易被忽略,重视寰枕、寰枢关节骨关节炎的诊治将提高枕颈部疾病临床的总体疗效。

Occipitocervical anatomy is characterized by deep location,complex structure,and unique function.The motor function of the occipitocervical region is highly flexible.How to achieve satisfactory spinal cord decompression with minimal invasion and how to effectively reconstruct biomechanical stability and maintain flexible motor function are important clinical problems that need to be solved urgently.However,this has also led surgeons to focus too much only on surgical techniques rather than comprehensive understanding and treatment of the disease.There are three common but easily ignored issues in clinical practice:Firstly,the importance of occipitocervical anatomy research to improve clinical diagnosis and treatment.The stability of the base of the skull and the lower cervical vertebra should also be considered in clinical diagnosis and treatment.Secondly,atlanto-occipito-atlantoaxial joint and local ossification of the posterior longitudinal ligament.Atlantoaxial flexibility may lead to the earliest appearance of partial ossification of the posterior longitudinal ligament in this region.Thirdly,atlanto-occipito-atlantoaxial joint osteoarthritis is often neglected,and paying attention to the diagnosis and treatment of atlanto-occipito-axial joint osteoarthritis will improve the overall curative effect of occipito-cervical diseases.