寰枢椎脱位与不稳定388例住院病例分析(1)
Analysis of 388 cases with atlanto-axial instability ZHOU Haitao, DANG Gengting, WANG Chao(The Third Hospital of Peking University,Beijing 100083)
【Abstract】 Objective To study the features of atlanto-axial instability caused by different reasons. Method 388 cases of atlanto-axial instability admitted in our hospital between Jan 1975 and Apr 2000 were studied retrospectively. Results 262 cases were caused by anomaly and 71 caused by trauma. It is difficult for nonunion fracture to restore than fresh fracture of the odontoid process.19 cases got worse between 3 month and 13 years post-trauma. Patients with nonunion of atlanto-axial fracture over 1 year were more likely to have secondary damage of spinal cord than those within 1 year. 238 cases had bony deformity including developmental anomaly of odontoid process, atlanto-occipital assimilation, skull basilar invagination etc. Anomaly of odontiod process is most common. Myelopathy occurs at the proximate possibility among each kind of deformity patients. But patients present symptoms for longer time are more likely to have myelopathy and more likely to have severe myelopathy. Conclusions atlanto-axial instability is more common caused by deformity than trauma. Once patients have atlanto-axial deformity present clinical manifestation, they should be treated. Traumatic atlanto-axial instability should be cured at the early stage to avoid myelopathy.
, 百拇医药
【keywords】Atlanto-axial joint Dislocation Instability AnormalyFracture
寰枢椎脱位(即寰枢椎不稳定)可以由不同的原因引起，创伤性寰椎与枢椎齿状突骨折、横韧带断裂、寰枢椎与枕骨大孔区发育异常、骨与关节的结核、肿瘤、类风湿性关节炎等都可以导致寰枢椎脱位。不同病因寰枢椎脱位的继发损伤不同，其病程演变、脱位的病理、治疗的难度与方法等也不相同。寰枢椎部位的创伤引起的寰枢椎脱位在临床上很少引起脊髓损伤，复位与固定相对容易，早期治疗得当，预后较好。发育异常引起的寰枢椎脱位常常病程长，寰椎与枢椎骨结构缺陷变形，脱位严重，形态复杂，引起的临床问题往往较复杂，治疗困难，预后也差。为了解不同病因引起的寰枢椎脱位的特点，对我院388例寰枢椎不稳定的病例作初步分析。
资料与方法
1975年1月~2000年4月，我院共收治寰枢椎脱位患者388例。所有患者均询问病史，临床查体，及做各种辅助检查，辅助检查包括以寰枢椎为中心的侧位和开口位X-线片，颈椎伸屈侧位片，部分患者有X-线断层片。在1980年以后的大多数患者有CT检查，而1990年以后患者多同时还有MRI检查。所有患者均经过查房讨论决定诊断。本文根据病历记载中查房讨论后的诊断结合X-线片，CT， MRI，确定枕寰枢复合体病变的性质，寰枢椎脱位的原因，对神经损伤程度作出评估与分析。
本文采用(2检验和t检验，以P<0.01作为有显著性差异的界限。
到目前为止，临床上尚无一个通用的判断寰枢椎不稳患者病情轻重的方法，本研究根据临床查体中是否存在膑阵挛或踝阵挛作为区分锥体束损害轻重的标准，凡是出现阵挛的患者归入重度脊髓损害；存在锥体束损害体征，但是没有阵挛的患者归入轻度脊髓损害。这种分类方法不一定能够完全反映临床状况，在这里仅作为一种替代的方法。, 百拇医药(周海涛 党耕町 王超)
【Abstract】 Objective To study the features of atlanto-axial instability caused by different reasons. Method 388 cases of atlanto-axial instability admitted in our hospital between Jan 1975 and Apr 2000 were studied retrospectively. Results 262 cases were caused by anomaly and 71 caused by trauma. It is difficult for nonunion fracture to restore than fresh fracture of the odontoid process.19 cases got worse between 3 month and 13 years post-trauma. Patients with nonunion of atlanto-axial fracture over 1 year were more likely to have secondary damage of spinal cord than those within 1 year. 238 cases had bony deformity including developmental anomaly of odontoid process, atlanto-occipital assimilation, skull basilar invagination etc. Anomaly of odontiod process is most common. Myelopathy occurs at the proximate possibility among each kind of deformity patients. But patients present symptoms for longer time are more likely to have myelopathy and more likely to have severe myelopathy. Conclusions atlanto-axial instability is more common caused by deformity than trauma. Once patients have atlanto-axial deformity present clinical manifestation, they should be treated. Traumatic atlanto-axial instability should be cured at the early stage to avoid myelopathy.
, 百拇医药
【keywords】Atlanto-axial joint Dislocation Instability AnormalyFracture
寰枢椎脱位(即寰枢椎不稳定)可以由不同的原因引起，创伤性寰椎与枢椎齿状突骨折、横韧带断裂、寰枢椎与枕骨大孔区发育异常、骨与关节的结核、肿瘤、类风湿性关节炎等都可以导致寰枢椎脱位。不同病因寰枢椎脱位的继发损伤不同，其病程演变、脱位的病理、治疗的难度与方法等也不相同。寰枢椎部位的创伤引起的寰枢椎脱位在临床上很少引起脊髓损伤，复位与固定相对容易，早期治疗得当，预后较好。发育异常引起的寰枢椎脱位常常病程长，寰椎与枢椎骨结构缺陷变形，脱位严重，形态复杂，引起的临床问题往往较复杂，治疗困难，预后也差。为了解不同病因引起的寰枢椎脱位的特点，对我院388例寰枢椎不稳定的病例作初步分析。
资料与方法
1975年1月~2000年4月，我院共收治寰枢椎脱位患者388例。所有患者均询问病史，临床查体，及做各种辅助检查，辅助检查包括以寰枢椎为中心的侧位和开口位X-线片，颈椎伸屈侧位片，部分患者有X-线断层片。在1980年以后的大多数患者有CT检查，而1990年以后患者多同时还有MRI检查。所有患者均经过查房讨论决定诊断。本文根据病历记载中查房讨论后的诊断结合X-线片，CT， MRI，确定枕寰枢复合体病变的性质，寰枢椎脱位的原因，对神经损伤程度作出评估与分析。
本文采用(2检验和t检验，以P<0.01作为有显著性差异的界限。
到目前为止，临床上尚无一个通用的判断寰枢椎不稳患者病情轻重的方法，本研究根据临床查体中是否存在膑阵挛或踝阵挛作为区分锥体束损害轻重的标准，凡是出现阵挛的患者归入重度脊髓损害；存在锥体束损害体征，但是没有阵挛的患者归入轻度脊髓损害。这种分类方法不一定能够完全反映临床状况，在这里仅作为一种替代的方法。, 百拇医药(周海涛 党耕町 王超)