颅颈交界畸形寰枢侧方关节与寰枢稳定性的关系

颅颈交界畸形寰枢侧方关节与 寰枢稳定性的关系 余新光 尹一恒 周定标 许百男 张远征 刘策 [摘要] 目的 分析先天性颅颈交界区畸形的寰枢侧方关节的形态学变化及与寰枢稳定性的 关系。方法 回顾性分析98例行薄层CT扫描的患者和20例正常对照者。数据导入MIMICS三维 成像软件，以Frankfort平面作为新的轴位进行重新分割，分别在重建的矢状面和冠状面上测量寰枢 侧方关节面的倾斜角度；对寰枢侧方关节的三维构型进行分析，依据其脱位程度和关节面的倾斜方 向进行分型。结果 与正常的形态对比，发现有4种畸形的寰枢侧方关节。Ⅰ型特点是上下关节面 向前轻度倾斜，但二者接触良好无滑脱；Ⅱ型的特点是上下关节面间有部分滑脱，整个侧方关节结构 呈明显的前倾；Ⅲ型以两关节面的完全滑脱或完全分离为特征；Ⅳ型特点是寰枢侧方关节面向后方 倾斜。61例至少有一侧关节面前倾（Ⅰ、Ⅱ或Ⅲ型），其中57例有寰枢脱位；33例双侧关节面后倾 （Ⅳ型），均无脱位。结论 寰枢侧方关节的前倾及骨性异常可能是先天性颅颈交界区畸形中寰枢间 不稳定的直接因素，且寰枢间不稳定性随着寰枢侧方关节面倾斜角度的增大而加重。通过分析寰枢 侧方关节的三维形态可能对诊断先天性颅颈交界区畸形的稳定性提供一个新的方法，并对手术策略 的合理选择提供帮助。 先天性畸形； 颅颈交界区； 寰枢侧方关节； 寰枢稳定性 The lateral atlantoaxial articulation in congenital anomaly of the craniovertebral junction and the atlantoaxiai stability YU Xin-guang* YIN Yi-heng ZHOU Ding-biaoXU Bai-nanZHANG Yuan- zhengLIU Ce* Department of Neurosurgery, the General Hospital of PLA, Beijing 100853, China [ Abstract] Objective To establish the morphological changes of the lateral atlantoaxial articulations (LAA) in congenital anomaly of the craniovertebral junction (CACVJ) and its relationship with the atlantoaxial stability. Methods A series of 98 cases of CACVJ and 20 control subjects who had underwent thin - slice CT scanning were retrospectively reviewed. CT data were imported into the MIMICS software and Frankfort horizontal plane was chosen as the new basal plane of the axial plane. The obliquity of the atlantoaxial articular facets was measured in reconstructed sagittal and coronal planes, respectively. The three - dimensional configurations of LAA were analyzed and categorized based on the degree of olisthy and inchnation orientation of the articular facets. Results Compared to the normal configuration of LAA in control subjects, four types of malformed configuration of LAA in CACVJ were found. Type Ⅰ, characterized by slight anteversion of LAA without olisthy of the inferior and superior facets; Type Ⅱ, characterized by partial olisthy of the two facets and evident anteversion of LAA; Type Ⅲ, defined by the separation or complete olisthy of the two facets; Type Ⅳ, wherein the articular facets sloped dorsally. 57 of 61 cases in the former three types wherein AAF sloped ventrally had atlantoaxial dislocation (AAD). All 33 type Ⅳcases wherein AAF sloped dorsally had no AAD. Conclusion Atlantoaxial instability in CACVJ is likely a direct result of the anteversion of LAA and bony malformation of this region and it aggravates with the increasing obliquity of anteversion of the atlantoaxial articular facets. Demonstrating 3D morphological changes of LAA may provide a new means to diagnosis instability in atlantoaxial articular facets and a basis for rational surgical treatment. [ Key words ] Congenital anomaly; Craniovertebral junction; Lateral atlantoaxial articulation; Atlantoaxial stability 10. 3760/cma. j. issn. 1001-2346. 2011.10. 018 国家自然科学基金( 30973032) 作者单位：100853北京，解放军总医院神经外科（余新光、尹一恒、周定标、许百男、张远征）；解放军第309医院 神经外科（刘策） 万方数据 ·1030· 万方数据 .】03 1 万方数据 ·1032· 万方数据 @@[1]周定标，段国升，张纪，等.先天性寰枢椎脱位的诊断与治 疗.中华外科杂志，1991，29：733 -736. @@[2] 周定标，张远征，余新光，等.自发性寰枢椎脱位（附155 例 ）.中华神经外科杂志，2000，16:270-273. @@[3]刘策，周定标，余新光.寰枕融合畸形患者寰枢侧块关节形 态变化与寰枢椎脱位的三维特征.中华神经医学杂志， 2009,8:57-60. @@[4]段光明，周定标.自发性寰枢椎脱位病因和发生机制的研究 现状.中国微侵袭神经外科杂志，2007，12:282-284. @@[5] Dvorak J, Panjabi MM. Functional anatomy of the alar liga ments. Spine (Phila Pa 1976), 1987, 12: 183-189. @@[6] Steinmetz MP, Mroz TE, Benzel EC. Craniovertebral junction: biomechanical considerations. Neurosurgery, 2010, 66 (3Suppl) : 7-12. @@[7] Gholve PA, Hosalkar HS, Ricchetti ET, et al. Occipitalization of the atlas in children. Morphologic classification, associations, and clinical relevance. J Bone Joint Surg Am , 2007, 89: 571-578. @@[ 8 ] Goel A. Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation. J Neurosurg Spine, 2004, 1 : 281 -286. @@[9] Wang C, Yan M, Zhou HT, et al. Open reduction of irreducible atlantoaxial dislocation by transoral anterior atlantoaxial release and posterior internal fixation. Spine ( Phila Pa 1976), 2006, 31 : E306-313. @@[ 10] Jian FZ, Chen Z, Wrede KH, et al. Direct posterior reduction and fixation for the treatment of basilar invagination with atlantoaxial dislocation. Neurosurgery, 2010, 66: 678-687; discussion 687. 2011-07-09 2011-07-25 超低位大骨瓣开颅治疗大面积脑梗死 赵明 杜国森 王马军 潘柏林 韦超 方乃成 我科于2000年3月至2010年5月间，对66例大面积脑 梗死患者行去骨瓣减压术，其中35例采用超低位大骨瓣开 颅，疗效较好，现报告如下。 10. 3760/cma. j. issn. 1001-2346. 2011.10. 019 311800 浙江省诸暨市人民医院神经外科 2011-05-13 2011-09-16 万方数据 颅颈交界畸形寰枢侧方关节与寰枢稳定性的关系 作者： 余新光， 尹一恒， 周定标， 许百男， 张远征， 刘策， YU Xin-guang， YIN Yi-heng， ZHOU Ding- biao， XU Bai-nan， ZHANG Yuan-zheng， LIU Ce 作者单位： 余新光,尹一恒,周定标,许百男,张远征,YU Xin-guang,YIN Yi-heng,ZHOU Ding-biao,XU Bai-nan,ZHANG Yuan-zheng(解放军总医院神经外科,北京,100853)， 刘策,LIU Ce(解放军总医院解放军第309医院神经外 科,北京,100853) 刊名： 中华神经外科杂志 英文刊名： Chinese Journal of Neurosurgery 年，卷(期)： 2011,27(10) 参考文献(10条) 1.周定标;段国升;张纪 先天性寰枢椎脱位的诊断与治疗[期刊]-中华外科杂志 1991 2.周定标;张远征;余新光 自发性寰枢椎脱位(附155 例报告)[期刊论文]-中华神经外科杂志 2000(5) 3.刘策;周定标;余新光 寰枕融合畸形患者寰枢侧块关节形态变化与寰枢椎脱位的三维特征[期刊论文]-中华神经医学杂志 2009(1) 4.段光明;周定标 自发性寰枢椎脱位病因和发生机制的研究现状[期刊论文]-中国微侵袭神经外科杂志 2007(6) 5.Dvorak J;Panjabi MM Functional anatomy of the alar ligaments 1987 6.Steinmetz MP;Mroz TE;Benzel EC Craniovertebral junction:biomechanical considerations 2010(3Suppl) 7.Gholve PA;Hosalkar HS;Ricchetti ET Occipitalization of the atlas in children.Morphologic classification,associations,and clinical relevance[外文期刊] 2007 8.Goel A Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation[外文 期刊] 2004(3) 9.Wang C;Yan M;Zhou HT Open reduction of irreducible atlantoaxial dislocation by transoral anterior atlantoaxial release and posterior internal fixation[外文期刊] 2006 10.Jian FZ;Chen Z;Wrede KH Direct posterior reduction and fixation for the treatment of basilar invagination with atlantoaxial dislocation[外文期刊] 2010(4) 本文链接：http://d.g.wanfangdata.com.cn/Periodical_zhsjwkzz98201110018.aspx