| OBJECTIVE Research the imaging information of the Normal population and patients with atlantoaxial subluxation, measured every bony landmark, found the difference between the normal population and the definite case of atlantoaxial subluxation, and we can analysis the imaging diadynamic criteria of the atlantoaxial subluxation.METHODS Randomly selected the 123 case's informations in our department of radiology between 2005 year to 2010 year, which include the X ray and CT of C-spine Open Mouth,C-spine LAT,C-spine dynamic flexion and extension. According to the case history,symptom,signs,Physical examination,Spiral CT three-dimensional reconstruction,follow up and so on,we can make sure that there are 72 cases who have no trauma history, no shoulder-neck pain,no tenderness of Atlanto-occipital area,no radiating pain and in the recent three months before the exam have no infection of pars laryngea pharyngis,then we used Spiral CT three-dimensional reconstruction and combined with the relevant medical history,Physical examinationt,finally we found there are 51 cases who had atlantoaxial subluxation in there. We divided the patients into two groups according to age:(1) negative cases of child group (age≤14 years, diagnosis of atlantoaxial subluxation was negative, N1 group) (n= 34); (2) negative patients of older group (age> 14 years, diagnosis of atlantoaxial subluxation was negative, N2 group) (n= 38); (3) positive cases of children group (age≤14 years,,diagnosis of atlantoaxial subluxation was positive, P1 group) (n= 27); (4) positive Patients of older group (age> 14 years, diagnosis of atlantoaxial subluxation was positive, P2 group) (n= 24). Loaded all of the imaging dates to the E-film workstation 2.1 imaging graphic workstation, regulated the image brightness,resolution,size, and MPR reconstruction of CT images, used the measure gauge to measure Atlantoodontoid interval (ADI),Posterior Atlantoodontoid interval (PADI),the distance between odontoid process to massa lateralis atlantis,angle of odontoid process eccentricity,Atlantoaxial Facies articularis lateralis justification or not,the distance between spinous process of axis to axoidean central line,the changes of the distance between arch of anterior atlas posterior border to odontoid process of anterior border in C-spine dynamic flexion and extension. Recorded the datas, Statistical analysis by SPSS Statistics 17.0 software, compared the normal population and cases of atlantoaxial subluxation in the imaging differences, and further study the imaging diadynamic criteria of the atlantoaxial subluxation.RESULTS Statistical analysis this study data, calculated the average,T test,x2 test and the result as follows:(1) ADI the average of the N1 group was 0.326±0.097cm, N2 group was 0.212±0.052 cm, P1group was 0.468±0.078cm, P2 group was 0.349±0.081cm. used T test,P<0.001, The index was statistically significant;(2) PADI Nl group was 1.940±1.176cm, N2 group was 1.969±1.132 cm, P1group was 1.888±1.151cm, P2group was 1.932±0.192cm,P>0.50, there was no Statistically significant; (3) VBLADS N1 group was 0.086±0.106cm, N2 group was 0.078±0.124cm, P1group was 0.136±0.114cm, P2group was 0.139±0.137cm, P>0.50, there was no significant difference; (4) angle of odontoid process eccentricity N1 group was 0.920±0.909°, N2 group was 1.210±1.437°, P1 group 1.440±1.158°, P2 group 1.346±1.231°, P>0.50, there was no Statistically significant; (5) The changes of Atlantoodontoid interval in C-spine dynamic flexion and extension the average of N1 group was 0.031±0.062cm,N2 group was 0.024±0.060cm, P1 group was 0.084±0.076cm, P2 group was 0.088±0.072cm.used T test,P<0.001, The index was statistically significant; (6) the offset distance of spinous process of axis, Nl group was 0.127±0.114cm, N2 group was 0.125±0.174cm, P1 group was 0.185±0.124cm, P2 group was 0.209±0.167cm, P>0.50, there was no Statistically significant; (7) Atlantoaxial Facies articularis lateralis was nonidentity N1 group had 4 cases,11.76% in the sample size;N2 group had 5 cases,13.16% in the sample size; and P1 group had 10 cases,37.04% in the sample size; p2 group had 10cases,41.67% in the sample size. Used x2 test,P<0.05, The index was statistically significant.CONCULUSION This clinical study showed that:(1) Abnormal enlargement of ADI,Atlanto-axial Facies articularis lateralis was nonidentity which had Important meaning for the clinical diadynamic criteria of the atlantoaxial subluxation. And also in C-spine dynamic flexion and extension, the chang of ADI was a actual respose for the condition of ligamentum transversum and alar ligamentum, which has a certain practical significance for the dignosis of atlanto-axial subluxation, but this examination was ao dangerous for cervical spine instability patiants, it must be carefully used in the clinic.(2) The phenomenon of inequality of atlanto-odontoid interval,angle of odontoid process eccentricity and deflection of spinous process of axis increased significantly in atlanto-axial subluxation patient, but in normal population there also had a lot of inequality, angle of odontoid process eccentricity also was a important reason for inequality of atlanto-odontoid interval, there had no statistical significance between them, these indexs were lack of evidence of evidence-based medicine as a diagnostic code,but if make them as the reference standards which may utility decrese the omission diagnosis of atlanto-axial subluxation. (3) PADI responded the practice space of spinal cord in the spinal canal intuitional, but doesn't have any statistical significance in diagnose atlanto-axial subluxation. (4) Despite the rapid development of imaging technology, but the diagnosis of atlanto-axial subluxation should still adhere to the medical history with physical examination, supplemented by imaging criteria. |
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