寰齿关节和寰枢外侧关节退变性骨关节病的CT表现

目的：探讨寰齿（AO）关节与寰枢（AA）外侧关节退变的关系。方法：对164例接受头颅CT检查病人的AAU关节行CT扫描。结果：寰枢关节退变性骨关节病（AAOA）的影像学表现主要为关节间隙变窄和骨赘。二关节退变有相关性。结论：AO关节和AA外侧关节退变分别见于40岁和50岁以后,二者有一这一的关联。     

枕寰枢复合体创伤的影像学诊断

目的:探讨枕寰枢复合体(C_0-C_1-C_2)创伤的影像学诊断。方法:回顾性分析40例枕寰枢复合体创伤的X线、三维CT及MRI表现。结果:X线平片发现枕寰枢复合体骨折共15例,寰枢关节脱位7例,枢椎滑脱2例。三维CT发现枕寰枢复合体骨折28例,骨折合并寰枢关节脱位10例,寰枕关节半脱位5例,寰枢关节无骨折型脱位或半脱位8例。X线、CT检查阴性4例。MRI检查示28例枕寰枢骨折患者椎体有骨髓挫伤水肿表现,18例延髓或颈髓形态或信号异常,15例椎旁软组织及韧带损伤。结论:联合X线、三维CT及MRI诊断枕寰枢复合体创伤,可提高诊断准确性,为临床治疗提供依据。     

CT三维重组诊断寰枢关节不全脱位的实验及临床研究

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（CT3D）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CT3D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CT3D检查，其中28例加行左、右旋转位。分析CT3D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CT3D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）CT3D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 CT3D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。     

寰齿关节退行性骨关节病CT表现及临床相关性分析

目的 探讨寰齿关节退行性骨关节病的CT表现及其临床相关因素.资料与方法 回顾性分析114例颈椎CT表现.结果 寰齿关节退行性骨关节病67例,40例有慢性颈枕部疼痛症状,63例合并中下颈椎退行性骨关节病.骨质增生、齿状突周围钙化及关节间隙狭窄或消失发生率分别为95.52%、32.84%和17.91%.结论 寰齿关节退行性骨关节病与下颈椎退变密切相关,影像学特征包括关节边缘骨赘、关节间隙狭窄及齿状突周围钙化.     

寰枢关节不对称、钩突增生与中青年颈性眩晕的相关性

目的 探讨寰枢关节不对称、钩突增生与中青年颈性眩晕的相关性.方法 选取中青年颈性眩晕患者222例为眩晕组,无症状者203例为对照组.所有研究对象均摄取颈椎张口位及正侧位X线片,对其寰枢关节不对称及钩突增生情况做相关性分析.结果 颈性眩晕组中207例寰枢关节不对称,异常率93.24%;53例钩突增生,增生率23.87%.对照组中48例寰枢关节不对称,异常率23.65%;65例钩突增生,增生率32.02%.寰枢关节不对称与中青年颈性眩晕呈显著的负相关(r=-0.710,P＜0.01);钩突增生与中青年颈性眩晕无相关性(r=0.091,P＞0.05).结论 寰枢关节不对称与中青年颈性眩晕密切相关,是引起中青年颈性眩晕的重要因素之一.     

颈椎不稳症的影像诊断(附50例报告)

目的探讨颈椎不稳症的影像学诊断。方法回顾性分析50例经临床证实的颈椎不稳症患者的X线平片、CT和MRI检查资料。结果50例中上颈椎不稳16例,其中,寰枕关节不稳2例,表现为枕底—齿突线和斜坡—齿突线不连续,14例为寰枢关节不稳,其中,寰枢关节脱位7例;下颈椎不稳34例,其中,前屈不稳20例,后伸不稳14例。结论X线平片、CT和MRI综合分析能对颈椎不稳症作出准确的诊断。     

正常人寰枢关节间隙的CT研究

目的研究正常人寰枢关节CT图像关节间隙大小及功能位置间隙变化情况,并对相关因素进行探讨.方法120例正常人行中立位CT扫描,66例行冠状矢状位重建,56例行头颅左、右旋各15～25°扫描,30例行侧曲及屈、伸位扫描,56例均摄取中立位及左、右旋转位15～25°X线片.测量CT片寰齿间隙值,观察功能位间隙变化.结果寰齿前间隙(ADI)值在不同年龄阶段存在差异.齿突与环椎侧块间隙(LADS),青年儿童组两侧不对称比例及程度高于成人,间隙不对称者寰枢椎发育异常所占比例较高.发现寰枕间存在相对旋转者28例.头颅左、右旋转位,42.86%受检者旋转同侧LADS变窄,57.14%无明显改变与平片结果不同.结论CT扫描对于显示寰枢区结构有X线平片无可比拟的优越性,X线平片旋转位间隙变化不同于CT扫描.     

CT图像后处理及MR诊断在寰枢关节半脱位的临床分析

目的探讨CT图像后处理及MR扫描在寰枢关节半脱位患者中诊断价值。方法 2010年1月~2013年12月在我院及温州医学院附属第二医院放射科检查的寰枢关节半脱位患者24例,观察X线、CT及后处理、MRI对于24例寰枢关节半脱位患者齿状突是否居中、齿状突断裂、横韧带及脊髓损伤等表现的显示情况。结果 X线检查发现12例患者寰枢关节齿状突不居中,CT扫描、CT图像后重建处理、MRI分别发现22例、24例、20例,CT图像重建及MRI显示齿状突断裂情况较X线及CT扫描更加明显,24例患者寰枢关节处未见骨折征象,脊髓未见明显受压征象;横韧带位于双侧侧块内侧和齿状突后方,T_2WI显示均匀低信号影,MRI显示3例横韧带损伤。结论单纯依靠CT显示寰枢关节齿状突不居中并不能明确诊断寰枢关节半脱位,MRI可以良好的显示横韧带等软组织结构损伤等情况,对寰枢关节半脱位具有重要的诊断价值。     

椎弓根螺钉技术治疗游离齿状突并寰枢椎脱位的疗效观察

目的 评估椎弓根螺钉技术治疗游离齿状突并寰枢椎脱位的疗效和影像学变化.方法 对15例游离齿状突并寰枢椎脱位患者利用椎弓根螺钉技术行枕颈融合术或寰枢椎固定术,其中2例难复型脱位者先行经口入路寰枢关节松解术、1例行后弓切除加枕颈融合术;2例寰椎畸形及1例幼儿行枕颈融合术;其余患者均行寰枢椎椎弓根螺钉内固定术.随访患者临床表现和影像学改变,评估临床疗效. 结果 所有患者均获随访7～47个月,平均26个月.15例患者中,症状明显改善13例,好转2例.日本骨科学会(JOA)评分由术前平均8.27分增加到术后6个月的15分.根据Hirabayashi方法 计算术后改善率,平均改善率为77％,其中优10例,良5例,优良率为100％.颈髓延髓角由术前平均130.3°增加到术后151.7°;术后X线片及CT提示寰枢椎序列良好,所有患者均获得骨性融合,无内固定脱落、断裂等并发症. 结论 利用椎弓根螺钉技术行枕颈融合术或寰枢椎固定术是治疗游离齿状突合并寰枢椎脱位的有效方法 .     

64层螺旋CT血管成像显示寰枕融合伴寰枢关节脱位椎动脉V3段走行48例

寰枕融合,又称寰椎枕化,是寰椎的某一部分或整体与枕骨大孔底部存在先天性骨性连接,并使寰枕关节活动完全丧失[1]。寰椎侧块固定是治疗该病常用的手术方法,但寰枕融合伴寰枢关节脱位常伴有椎动脉走行异常,同时颅颈交界位置深、解剖复杂,普通X线片和常规CT、MRI常常不能很好地观察病变形态与周围组织关系。笔者收集2009-03至2012-12武警北京总队第二医院治疗寰枕融合伴寰枢关节脱位48例,重点探讨椎动脉V3段的走行、与变异的影像学特点,以期为手术提供可靠的客观依据。     

颌面部骨折并颅颈交界区损伤的CT诊断

目的 探讨颌面部骨折合并颅颈交界区损伤的影像学特点及多层螺旋CT诊断。方法 收集10例颌面部外伤合并颅颈交界区损伤的螺旋CT重建扫描资料，比较常用影像学检查手段的诊断价值。结果 上、下颌骨双骨折并颧弓骨折者5例，下颌骨骨折5例。其中3例合并颞颌关节脱位，3例合并有轻、中度颅脑损伤。合并颅颈交界区损伤有：枕颈脱位2例，枕骨髁撕脱骨折2例，寰枢椎旋转性半脱位6例，结论 颌面部外伤骨折合并上颈椎损伤多为韧带型损伤，影像学特点为小片的撕脱性骨折及枕颈半脱位、寰枢椎旋转性半脱位；多层螺旋CT重建技术是诊断本病的最佳方式；提高对本病的警惕，重视颅颈交界区解剖标志间关系的画线测量是防止漏诊的关键。     

脊髓空洞症的诊断与显微手术治疗

探讨显微外科技术对脊髓空洞症的治疗效果。127例脊髓空洞症经CT或MRI扫描检查确诊后应用显微外科技术，采取枕-颈减压、空洞切开术或空洞-蛛网膜下腔分流术治疗，并进行平均1.5年以上的随访以评判治疗效果。结果表明，84例经空洞-蛛网膜下腔分流术或空洞切开术的治疗，空洞腔均闭合；43例行枕-颈减压的Arnold-Chiari畸形或脊髓闭合不全者，空洞腔亦见明显缩小，但未全闭合。提示对脊髓空洞症宜采取显微外科手术治疗，可根据病情特点选择枕-颈减压、空洞切开术或空洞-蛛网膜下腔分流的外科术式。     

Relationship between atlanto-odontoid osteoarthritis and idiopathic suboccipital neck pain

We discuss the relationship of atlanto-odontoid (AO) (anterior C1-C2 joint) osteoarthritis to suboccipital pain. A questionnaire regarding suboccipital neck pain was presented to 210 consecutive patients undergoing computed tomography (CT) of the brain or sinuses for a variety of indications. In all patients the AO joint and the lateral scout image of the cervical spine were studied. In 104 (49%) degenerative changes were seen at the AO joint. There were 89 patients (42%) who reported pain in the suboccipital region, although this was not the reason for CT in any patient. Statistical analysis of the prevalence of suboccipital neck pain in all patients showed the presence of AO osteoarthritis seen on CT to be associated with occurrence of these symptoms. This association remained significant in the same study population after excluding patients with a history of rheumatoid arthritis, migraine, stress and neck trauma and patients with signs of degenerative changes of C2-C7 on the computed lateral scout image.     

Relationship between atlanto-odontoid osteoarthritis and idiopathic suboccipital neck pain

We discuss the relationship of atlanto-odontoid (AO) (anterior C1–C2 joint) osteoarthritis to suboccipital pain. A questionnaire regarding suboccipital neck pain was presented to 210 consecutive patients undergoing computed tomography (CT) of the brain or sinuses for a variety of indications. In all patients the AO joint and the lateral scout image of the cervical spine were studied. In 104 (49 %) degenerative changes were seen at the AO joint. There were 89 patients (42 %) who reported pain in the suboccipital region, although this was not the reason for CT in any patient. Statistical analysis of the prevalence of suboccipital neck pain in all patients showed the presence of AO osteoarthritis seen on CT to be associated with occurrence of these symptoms. This association remained significant in the same study population after excluding patients with a history of rheumatoid arthritis, migraine, stress and neck trauma and patients with signs of degenerative changes of C2–C7 on the computed lateral scout image.     

The incidence of sacroiliac joint disease in patients with low-back pain.

PURPOSE: The clinical presentation of intervertebral disc, facet joint, nerve root, and sacroiliac (SI) joint diseases are often indistinguishable. SI joint arthritis likely accounts for a significant proportion of what is called "low-back pain" or "sciatica." Our goal was to determine the incidence of SI joint arthritis in patients with this presentation. METHODS: Computed tomographic (CT) scans of the lumbosacral spine (LSS) of patients referred with low-back pain, sciatica, spinal stenosis or disc pathology were gathered over a 3-month period. Scans were retrospectively reviewed by 2 independent readers for SI joint arthritis. When there was disagreement, the 2 readers reviewed the case and reached a concensus opinion. SI joint arthritis was considered to be present if subchondral sclerosis, osteophytosis, or cartilage loss was noted on the CT scan. RESULTS: The SI joint(s) were visualized by both readers on 64 LSS CT scans performed in 29 women and 35 men, mean age 52 years. By the aforementioned criteria, 16 SI joints (25%) were considered normal by both readers. In 48 cases (75%), there was evidence of osteoarthritis. The diagnosis of osteoarthritis was made by concensus opinion in 8 of these 48 cases (16%). CONCLUSION: There is a relatively high incidence of SI joint arthritis in patients undergoing evaluation for "low-back pain" or "sciatica." Hence, SI joint arthritis should be considered a possible diagnosis in these patients.     

Subtalar arthrosis: evaluation with CT

The surgical implantation of a Silastic wedge into the lateral subtalar joint (subtalar arthrosis) is designed to restrict the osseous malalignment associated with a flexible or neurogenic flatfoot deformity. We used CT to examine patients who had persistent pain after a subtalar arthrosis and retrospectively reviewed our experience with CT scans of 13 subtalar implants (seven patients) during a 3.5-year period. The CT scans of four asymptomatic subtalar implants showed each implant in the expected position and orientation, and the findings were considered normal. Conversely, the findings on CT scans of all nine painful implants (seven patients) were interpreted as abnormal. The scans showed oblique orientation of four implants (44%), loosening of three implants (33%), extruded methyl methacrylate in the subtalar joint in two implants (22%), and abnormal calcaneal recession in two implants (22%). Five of the nine painful implants were revised with improvement or resolution of symptoms. Our experience suggests that CT scanning of the subtalar joint can show the position and orientation of a subtalar implant and identify causes of persistent pain after a subtalar arthrosis.     

强直性脊柱炎的临床、实验室检查特点和骶髂关节CT表现分析

目的　对 2 2例强直性脊柱炎的临床、实验室特点和骶髂关节的CT表现进行分析。方法　 2 2例患者 ,男 2 0例、女 2例 ,年龄 14～ 70岁 ,平均 2 7.9岁。全部病例行骶髂关节的CT轴位平扫 ,并记录其显著的几项临床、实验室检查特点。结果　临床特点中 ,骶髂关节的疼痛、腰痛、弯腰受限居于前三位 ,出现百分率依次为 6 3.6 %、40 .9%、31.8%。实验室检查结果 ,HLA -B2 7阳性、血沉(ESR)变快、C反应蛋白 (CRP)增高、类风湿因子 (RF)阳性出现百分率各为 10 0 %、90 .9%、31.8%、2 7.2 %。CT征象 ,以骶髂关节变毛糙、模糊、受侵蚀出现率最高 ,6 8.1%。其他如关节硬化 ,5 0 % ;关节间隙变窄 36 .3% ;关节融合 9.1%。结论　强直性脊柱炎患者最常出现的临床表现为髋部疼痛 ;化验检查HLA -B2 7呈阳性 ,ESR加快 ,CRP增高是重要的诊断依据 ;骶髂关节的CT检查 ,常见骶髂关节变毛糙、模糊、受侵蚀征象。     

Radiologic and clinical spectrum of occipital condyle fractures: retrospective review of 107 consecutive fractures in 95 patients

OBJECTIVE: We proposed to characterize the radiologic spectrum of occipital condyle fractures in a large series of patients and to correlate fracture pathology with neurosurgical treatment and patient outcome. MATERIALS AND METHODS: We conducted a retrospective review of the findings on conventional radiography, CT, and MR imaging in 95 patients with 107 occipital condyle fractures. We described fracture patterns according to two previously published classification systems. Clinical findings, neurosurgical management, and patient outcome were obtained from the medical records. RESULTS: Inferomedial avulsions (Anderson and Montesano type III) were the most common type of occipital condyle fracture, constituting 80 (75%) of 107 overall fractures. Unilateral occipital condyle fractures were found in 73 (77%) of 95 patients, and 58 patients were treated nonoperatively; occipitocervical fusion was required in nine patients for complex C1-C2 injuries, and six patients died. Bilateral occipital condyle fractures or occipitoatlantoaxial joint injuries were seen in 22 (23%) of 95 patients. Occipitocervical fusion or halo traction for the craniocervical junction was required in 12 patients, all of whom had CT evidence of bilateral occipitoatlantoaxial joint disruption and six of whom showed normal craniocervical relationships on conventional radiographs. Six patients with nondisplaced fractures were treated nonoperatively, and four patients died. Thirty (32%) of 95 patients showed continued disability, whereas 55 (57.5%) of 95 patients had good outcomes at 1 month. Associated cervical spine injuries were present in 29 (31%) of 95 patients. CONCLUSION: Given their associated traumatic brain and cervical spine injuries, occipital condyle fractures are markers of high-energy traumas. That conventional radiographs alone may miss up to half of the patients with acute craniocervical instability has not been well established. Avulsion fracture type and fracture displacement are associated with both injury mechanism and the need for surgical stabilization. In this series, most unilateral occipital condyle fractures were treated nonoperatively, whereas bilateral occipitoatlantoaxial joint injuries with findings of instability usually required surgical stabilization.     

多层螺旋CT曲面重组技术显示下腰椎小关节病的研究

目的:探讨CT曲面重组成像(CPR)技术对诊断腰椎小关节病的意义。方法:对 76 例慢性腰腿痛患者行L3~S1 多层螺旋CT扫描后进行椎小关节冠状面曲面重组,与用相同技术获得的 10 例青壮年正常腰椎椎小关节冠状面CPR图像进行对比。结果:62例(81.5%)椎小关节有以下病变:关节突增生硬化,关节间隙狭窄,骨性关节面毛糙,关节突变形,脱位或半脱位,关节内真空现象。结论:CPR技术能够较好显示腰椎小关节病变。