CT 三維重組診斷寰樞關(guān)節(jié)不全脫位的實驗及臨床研究
段少銀 蔡國祥 林清池 葉鋒 黃錫恩 梁昆如
【摘要】 目的 比較寰樞關(guān)節(jié)的影像檢查方法及技術(shù), 評價CT 三維重組( CT 3D) 診斷寰樞關(guān)
節(jié)不全脫位的臨床價值。方法 實驗研究寰樞關(guān)節(jié)骨標(biāo)本1 套, 模擬出寰樞關(guān)節(jié)正常及脫位的模型,
進(jìn)行X 線、常規(guī)CT 及CT 3D 檢查。前瞻性分析影像學(xué)特點及診斷準(zhǔn)確率。臨床患者87 例進(jìn)行中立
位CT 3D 檢查, 其中28 例加行左、右旋轉(zhuǎn)位。分析CT 3D 顯示脫位征象的特點及診斷寰樞關(guān)節(jié)不全
脫位的臨床效果。結(jié)果 實驗組CT 3D 能清楚、直觀的顯示寰樞關(guān)節(jié)不全脫位各種征象, 診斷準(zhǔn)確
率達(dá)100% 。表面陰影法( SSD) CT 3D 顯示寰樞外側(cè)關(guān)節(jié)面錯位最清楚, 寰椎下關(guān)節(jié)面錯位程度測量
值與標(biāo)本測量值差異無統(tǒng)計學(xué)意義( P > 0. 05) 。87 例患者中診斷為寰樞關(guān)節(jié)不全脫位72 例, 其中旋
轉(zhuǎn)型脫位52 例, 前脫位13 例, 后脫位7 例。中立位顯示寰樞外側(cè)關(guān)節(jié)面錯位72 例, 旋轉(zhuǎn)位顯示為旋
轉(zhuǎn)固定8 例, 旋轉(zhuǎn)不對稱15 例。結(jié)論 CT 3D 能顯示寰樞關(guān)節(jié)不全脫位的各種征象, 特別是寰樞外
側(cè)關(guān)節(jié)面錯位。其中SSD 法3D 較X 線、常規(guī)CT 的診斷準(zhǔn)確率高, 具有成為診斷寰樞關(guān)節(jié)不全脫位
金標(biāo)準(zhǔn)的條件。
【關(guān)鍵詞】 寰樞關(guān)節(jié); 脫位; 體層攝影術(shù), X 線計算機(jī); 圖像處理, 計算機(jī)輔助
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 三維重組診斷寰樞關(guān)節(jié)不全脫位的實驗及臨床研究--骨格.rar