CT 三维重组诊断寰枢关节不全脱位的实验及临床研究

CT 三维重组诊断寰枢关节不全脱位的实验及临床研究
段少银 蔡国祥 林清池 叶锋 黄锡恩 梁昆如
【摘要】 目的 比较寰枢关节的影像检查方法及技术, 评价CT 三维重组( CT 3D) 诊断寰枢关
节不全脱位的临床价值。方法 实验研究寰枢关节骨标本1 套, 模拟出寰枢关节正常及脱位的模型,
进行X 线、常规CT 及CT 3D 检查。前瞻性分析影像学特点及诊断准确率。临床患者87 例进行中立
位CT 3D 检查, 其中28 例加行左、右旋转位。分析CT 3D 显示脱位征象的特点及诊断寰枢关节不全
脱位的临床效果。结果 实验组CT 3D 能清楚、直观的显示寰枢关节不全脱位各种征象, 诊断准确
率达100% 。表面阴影法( SSD) CT 3D 显示寰枢外侧关节面错位最清楚, 寰椎下关节面错位程度测量
值与标本测量值差异无统计学意义( P > 0. 05) 。87 例患者中诊断为寰枢关节不全脱位72 例, 其中旋
转型脱位52 例, 前脱位13 例, 后脱位7 例。中立位显示寰枢外侧关节面错位72 例, 旋转位显示为旋
转固定8 例, 旋转不对称15 例。结论 CT 3D 能显示寰枢关节不全脱位的各种征象, 特别是寰枢外
侧关节面错位。其中SSD 法3D 较X 线、常规CT 的诊断准确率高, 具有成为诊断寰枢关节不全脱位
金标准的条件。
【关键词】 寰枢关节; 脱位; 体层摄影术, X 线计算机; 图像处理, 计算机辅助
Exper iment al a nd applied study of CT 3D-r econstr uction in diagnosing atlantoaxial subluxation
DUAN Sha o-yin, CAI Guo-xiang, LIN Qing-chi, YE Feng, HUANG Xi-en, LIANG Kun-ru. Department of
Imageology, The First Clinica l Acedmy of Medical College of Xiamen University, Xiamen Zhongshan
Hospital, Xiamen 361004, China
【Abstra ct 】 Object ive To compare the imaging examination and technique of atlantoaxial joint, and
evaluate CT three-dimensional ( 3D) reconstruction in diagnosing atlantoaxial subluxation and find out the
best way of 3D imaging. Methods In experimented study, one dry atlas ( C1) and axis ( C2 ) vertebral
specimen were chosen and simulated as the models of normal atlantoaxial joint and atlantoaxial subluxation.
All the models of specimen were examined by X-ray, CT scan and CT 3D. The imaging characteristic and
diagnostic accuracy were prospectively analyzed. In clinical study, 87 cases were examined by CT-3D in
neutral position, 28 of whom in additional rotary position. The characteristic in showing dislocation signs and
effectiveness in diagnosing atlantoaxial subluxation of CT 3D were retrospectively analyzed. Results Our
experiment shows that CT 3D imaging can demonstrate signs of atlantoaxial subluxation directly and clearly.
Its diagnostic accuracy was 100%, and SSD imaging shows articular facets dislocation of lateral atlantoaxial
joints most clearly in the technique of CT 3D. There is no significant difference between the dislocated
measurement of inferior articular surface of atlas vertebral on specimen models and on SSD 3D-images( P >
0. 05) . In the 87 cases, diagnosis of dislocation was obtained in 72, of whom rotary dislocation in 52,
anterior dislocation in 13, posterior dislocation in 7. In neutral position, there is articular facets dislocation
of lateral atlantoaxial joints in 72 cases, in rotary position, there is rotatory fixation in 8 and rotational
asymmetry in 15. Conclusion CT 3D imaging can clearly show all the signs of atlantoaxial subluxation,
especially articular facets dislocation of lateral atlantoaxial joints. Diagnostic accuracy of CT 3D is higher
than those of X-ray and CT scan. CT 3D is eligible to be the golden standard in diagnosing atlantoaxial
subluxation.
【Key wor ds】 Atlantoaxial joint; Dislocation; Tomography, X-ray computed; Image processing,
computer-assisted

CT 三维重组诊断寰枢关节不全脱位的实验及临床研究--骨格.rar