环枢关节错缝与上颈段解剖的关系

通过对三具尸体上颈段的介剖观察和分析，认为：１）枢椎是上颈段运动的应力中心，环枢关节错缝以旋转和侧方移位为主；２）对第一至第三颈神经后支的卡压和刺激是颈性头痛的主要原因；３）椎动脉的环枢横突间段在头颈旋转时受到明显牵拉和扭曲，是引起颈性眩晕的原因之一。     

颈椎病患者寰枢关节骨错缝的临床诊治价值的研究

目的 :探讨寰枢关节骨错缝对颈椎病发病的作用,为临床中医手法诊治颈椎病提供思路。方法 :研究设颈椎病和无颈椎病两组,其中颈椎病组(来源于2006年3月至2008年12月曙光医院骨伤科门诊)患者333例,男119例,女214例,平均年龄(48.11±12.21)岁;无颈椎病组受试者73例(来源于上海中医药大学在校大学生、曙光医院研究生和进修生及部分社区人员),男18例,女55例,平均年龄(45.99±11.47)岁。对两组受试者的颈椎开口位X线片进行寰枢关节位置关系观测,比较两组中寰枢关节骨错缝的发生率的差异性,并对两组寰枢关节骨错缝的临床特点进行分析比较。结果:与无颈椎病组相比,颈椎病组患者寰枢关节骨错缝的发生率高达81.38%(271/333),二者之间差异具有统计学意义(P=0.0000.01);且颈椎病组寰枢关节骨错缝的分型较复杂和多样化,其中单纯平移错缝占50.55%(137/271),单纯旋转错缝占7.01%(19/271),平移合并旋转错缝占42.44%(115/271)。结论 :寰枢关节骨错缝是各型颈椎病常见X线征象,且寰枢关节骨错缝形式较复杂和多样化,临床应重视寰枢关节骨错缝分型的研究,并按照不同临床分型,对寰枢关节进行定性、定点、定向手法矫正,将对颈椎病的临床防治具有重要指导意义。     

角度牵引、手法治疗寰枢关节错缝

颈椎病十分多见．人们多把注意力集中在下颈段,而忽略上颈段,部分患者疗效不佳。作者自2002年9月至2004年3月采用角度牵引、手法治疗以眩晕、头痛为主要症状的寰枢关节错缝患者79例,获得满意疗效．现总结如下：     

寰枢椎不稳或脱位的诊断与治疗

头部和颈椎在遭受强的外力作用下可发生急性寰枢椎脱位 ,使颈髓和延髓受压 ,引起致死性损伤。对因各种非外伤性疾患所致的寰枢椎脱位 ,近年来也逐渐有所认识。在名称上也有称“寰枢椎脱臼”或“寰枢关节脱臼 (ａｔｌａｎｔｏ ａｘｉａｌｄｉｓｌｏｃａｔｉｏｎ)”、“寰枢椎半脱臼 (ａｔｌａｎｔｏ ａｘ ｉａｌｓｕｂｌｕｘａｔｉｏｎ)”或者称“寰枢椎关节不稳定 (ａｔｌａｎｔｏ ａｘｉａｌｉｎｓｔａｂｉｌｉｔｙ)” ,但使用“寰枢椎脱位”者较多。按其脱位的方向 ,有向前方脱位、向后方脱位、旋转脱位、侧方脱位 (罕见 )及垂直脱位 (类…     

关于寰枢关节骨性关节炎的认识

枕颈部疼痛在临床是一种非常多见的症状。引起枕颈部疼痛有许多疾病,包括风湿性关节炎、感染、原发性和转移性肿瘤、创伤和各种形式的颈部退变和枕颈不稳。近年来,人们已经注意到骨性关节炎也可累及寰枢椎,引起枕颈部疼痛。由于寰枢椎关节骨性关节炎的病理、症状和体征与下颈椎相比有着不同特点,对寰枢关节的骨性关节炎较少引起人们注意,但寰枢椎关节骨性关节炎在临床上并不少见,占枕颈部疼痛的6%~10%,因缺乏足够认识常被忽略。1寰枢关节解剖学及生物学特性寰枢关节由4个关节组成,包括位于正中的2个寰齿关节和左右侧块的2个外侧关节。寰齿关…     

关于寰枢椎创伤诊断和治疗的若干问题

寰枢椎构成的寰枢关节位于颅颈交界区,是脊柱诸关节中活动度最大的关节,当暴力作用于头颈部时容易导致寰枢椎骨折或韧带损伤。寰枢椎骨折约占全部颈椎骨折的1／3。对寰枢椎损伤的诊断和治疗临床报道已有很多,但在临床工作中仍有很多问题须引起重视,也有必要做进一步探讨。     

上颈椎不稳的病因和诊断

当寰枕、寰枢关节因各种原因导致其结构功能减退,以至在生理载荷下出现过度活动或异常活动,并出现一系列临床表现称上颈椎不稳[1]。上颈椎的稳定性是由枕骨髁、寰椎、枢椎的结构稳定性以及韧带、肌肉、关节囊、筋膜等共同维系。随着生物力学研究的深入,人们对上颈椎不稳的病因和诊断的认识不断深入,现综述如下:1　上颈椎不稳的病因　有创伤、炎症、先天性畸形、类风湿关节炎、结核、肿瘤、及医源性损伤。1.1　创伤　许多学者注意到创伤与上颈椎不稳的关系[2～3],创伤所致寰枕关节脱位,多涉及延髓,常在抢救前死亡[4]。而引起的寰枢关节不稳临…     

上颈椎非融合固定技术的研究进展

上颈椎包括寰椎和枢椎,主要涉及寰枕关节和寰枢关节,上承头颅,下接下位颈椎,生物力学复杂。颈椎具有旋转、屈伸和侧屈的运动功能,旋转运动的一半主要来自上颈椎的寰枢关节,屈伸主要来自寰枕关节。上颈椎损伤多由身体或头部加速撞击到静止物体上所致,主要包括寰枕关节脱位、寰枢关节脱位、寰椎骨折、枢椎齿状突骨折、枢椎创伤性滑脱和以上病变的叠加损伤。传统治疗上颈椎损伤的术式主要是寰枢椎融合术和枕颈融合术,但植骨融合技术在稳定结构的同时,导致上颈椎大部分活动度的丧失,旋转、屈曲等功能明显受限。上颈椎活动度的丧失对颈椎的生理和生物力学产生长期的负面影响,并对患者的生活质量产生不利影响。近年来,随着非融合理念和技术的推广,人工寰齿关节、经椎弓根动态固定系统等上颈椎非融合固定方式开始出现,以达到不植骨融合就可以同时实现稳定上颈椎结构和保留一定活动度的治疗目的。为进一步了解上颈椎非融合固定技术的研究进展,笔者对其做一综述。     

寰椎椎动脉沟环所致颈性眩晕患者的手术治疗

寰椎椎动脉沟环是引起颈性眩晕的原因之一。作者经治７例沟环所致颈性眩晕患者，经３－６年随访，优良者６例，疗效满意，文内探讨了沟环引起颈性眩晕的机制、诊断、鉴别诊断及手术适应证。作者认为手术切除沟环是治疗该病的有效手段之一     

脊柱定点旋转复位手法治疗颈性眩晕疗效观察

目的:探讨脊柱定点旋转复位手法治疗颈性眩晕的治疗作用及对颈椎动脉痉挛指数和寰枢关节位移指数的影响。方法:2002年1月至2008年5月将收治的颈性眩晕168例患者随机分成治疗组和对照组,每组84例。治疗组男22例,女62例;对照组男24例,女60例。治疗组患者采用脊柱定点旋转复位手法治疗,对照组使用辨证中药方治疗,观察治疗前后两组的症状评分、颈椎动脉痉挛指数(RI)、寰枢关节的位移指数(ADI),并对其进行比较。结果:脊柱定点旋转复位手法治疗后患者临床症状、体征积分有了明显下降,其中治疗组眩晕(2.75±1.01)分,颈肩痛(1.58±0.36)分,头痛(0.39±0.09)分,恶心、呕吐(1.58±1.30)分,耳鸣(0.48±0.32)分,旋颈试验阳性(0.59±0.21)分;对照组眩晕(5.68±2.02)分,颈肩痛(3.12±1.82)分,头痛(1.86±0.65)分,恶心、呕吐(3.25±0.69)分,耳鸣(1.64±0.61)分,旋颈试验阳性(1.79±0.67)分。颈椎动脉痉挛指数、寰枢关节的位移指数有了明显改善,其中治疗组颈椎动脉痉挛指数为0.54±0.07,对照组颈椎动脉痉挛指数为0.52±0.13;治疗组寰枢关节的位移指数为2.92±0.82,对照组寰枢关节的位移指数为4.50±1.32。结论:运用脊柱定点旋转复位手法治疗颈性眩晕,能够准确纠正单个或多个椎体移位,恢复椎体的正常位置,减少和消除对椎动脉的压迫和刺激,缓解前庭迷路缺血,解除眩晕症状。     

Traumatic atlantoaxial dislocation

In our series of traumatic atlantoaxial injuries we found a 21% incidence of dislocation without an associated fracture of the odontoid process (7 of 33 cases). Clinically these patients initially exhibited associated cranial trauma (5 cases), cervical pain and headache (5 cases), subjective neurological complaints (5 cases), and objective neurological abnormalities (4 cases); in 4 patients, diagnosis was delayed because diastasis of the atlantoaxial joint was not recognized on lateral cervical radiograms. The wide spectrum of clinical presentations is partially accounted for by the varying degrees of injury to the transverse atlantal ligament and other associated ligamentous injuries. The findings in this series emphasize the need for awareness of this disorder, which may represent a significant number of the injuries to the region.     

The role of torsion in cervical spine trauma

A dynamic servocontrolled torsion machine has been used to characterize cervical injury due to pure rotation of the head. Resultant force moment, torque, and applied rotation have been measured. Torque applied to the base of the skull resulted in injury to the atlantoaxial joint. No evidence of lower cervical injury was observed by computed tomography, magnetic resonance imaging, in situ fluoroscopy, or visual inspection. Torque applied directly to the lower cervical spine induced ligamentous injury and unilateral facet dislocation; however, the torque to injure the lower cervical spine was significantly greater than the torque to injure the atlantoaxial joint. It was concluded that pure rotation of the head does not mediate lower cervical ligamentous injury because of the comparative weakness of the atlantoaxial joint.     

Septic arthritis of the atlantoaxial joint: case report

Bacterial epidural abscess formation of cervical spine was rarely seen and all these cases were associated with osteomyelitis of the odontoid process. To the author's knowledge, only 1 case of septic arthritis of the C1-C2 lateral facet joint has been reported in the English literature. A 76-year-old woman presented with progressive neck pain and stiffness in the left side of her neck with fever. Coronal computed tomography clearly demonstrated destructive change of the atlantoaxial joint. Contrast magnetic resonance imaging demonstrated infection of the atlantoaxial joint resulting in epidural abscess formation. Because of lack of neurologic deficit, we treated her with halo-fixation together with appropriate antibiotics administration. The patient was successfully treated with antibiotics and immobilization. Septic arthritis of the lateral atlantoaxial joint should be added to the differential diagnosis of severe neck pain with fever, although it is very rare clinical entity. Early analysis of computerized tomography and magnetic resonance imaging although maintaining a high suspicion for this disease is mandatory to avoid delayed diagnosis and subsequent morbidity.     

CT evaluation of the pattern of odontoid fractures in the elderly—relationship to upper cervical spine osteoarthritis

Odontoid fractures are common in the elderly following minor falls. Almost all of them have osteoarthritis of the cervical spine below the axis vertebra. As a result, there is increased stress on the spared upper cervical spine, resulting in a higher incidence of injuries. As movement in the upper cervical spine involves participation of five joints, degeneration in any one particular joint may affect the biomechanics of loading of the upper cervical spine. We aimed to analyse the relationship of odontoid fractures to the pattern of upper cervical spine osteoarthritis in the elderly. We studied the CT-scan images of the cervical spine in 23 patients who were over the age of 70 years and had odontoid fractures. In each patient, the type of odontoid fracture and the characteristics of the degenerative changes in each joint were analysed. Twenty-one of 23 patients had Type -II odontoid fractures. The incidence of significant atlanto-odontoid degeneration in these individuals was very high (90.48%), with relative sparing of the lateral atlantoaxial joints. Osteoporosis was found in 13 of 23 patients at the dens-body junction and in seven of 23 patients at the odontoid process and body of the axis. With ageing, progressively more severe degenerative changes develop in the atlanto-odontoid joint. These eventually obliterate the joint space and fix the odontoid to the anterior arch of the atlas. In contrast, the lateral atlantoaxial joints are hardly affected by osteoarthritis. Thus, ultimately, atlantoaxial movements including atlantoaxial rotation are markedly limited by osteoarthritis of the atlanto-odontoid joint. However, there is still potential for movement in the lateral atlantoaxial joints, as they remain relatively free of degenerative change. The vulnerability of the atlantoaxial segment is further increased by markedly limited rotation below the axis vertebra due to severe facet-joint degeneration. As a consequence, a relatively low-energy trauma to the lateral part of the face, for instance by a fall, will induce forced atlantoaxial rotation. This, with the marked limitation of movement at the atlanto-odontoid joint, will produce a torque force at the base of the odontoid process leading to a Type II fracture.     

Tuberculous altantoaxial subluxation: a case report with review of literature

Involvement of upper cervical and craniovertebral junction is rare but might lead to lethal consequences if the diagnosis is delayed. We present a case of atlantoaxial joint tuberculosis, resulting in gross instability of the joint. The patient was treated with antitubercular medication combined with posterior decompression and transarticular screw fixation. Patient improved neurologically, and clinical and radiological improvements were maintained at the latest follow-up of 2 years.     

Psoriatic arthritis with C-1-C-2 subluxation as a neurosurgical complication

A 39-year-old man presented with a 10-year history of psoriatic arthritis, and more recently a progressive high cervical myelopathy. The development of the myelopathy syndrome was unassociated with trauma or any other specific inciting cause. Cervical spine x-rays demonstrated a significant atlantoaxial subluxation. Other x-ray features of the spine met the criteria for diagnosis of psoriatic spondylitis. The association of a high cervical myelopathy with atlantoaxial subluxation in psoriatic spondylitis is rare. Conversely, atlantoaxial subluxation without high cervical myelopathy has been reported in 45% of cases of psoriatic spondylitis. The authors report this case with a review of the diagnosis, possible pathogenesis, and treatment of atlantoaxial subluxation in psoriatic spondylitis.     

The cervical spine in mutilant juvenile chronic arthritis.

OBJECTIVE: To describe inflammatory cervical spine disorders in juvenile chronic arthritis (JCA) patients with arthritis mutilans (AM) hand deformity. METHODS: The series consisted of 18 patients affected by AM hand deformity who fulfilled the European League of Associations for Rheumatology criteria for JCA. The patient records and the most recent cervical spine radiographs were evaluated for subluxations, atlantoaxial impaction (AAI) and apophyseal joint ankylosis. RESULTS: Seventeen (94%) patients had subluxation, AAI or apophyseal joint ankylosis in the cervical spine. Apophyseal joint ankylosis was noted in 12 (67%) patients and AAI in 10 (56%). Anterior atlantoaxial subluxation was detected in five (28%) patients. CONCLUSION: Almost all of the JCA patients with AM hand deformity evinced some inflammatory changes in the cervical spine. Apophyseal joint ankylosis, AAI and multiplicity of changes in cervical spine may be considered characteristic in this subset of JCA patients. Patients with JCA and AM hand deformity tend to have severe changes also in the cervical spine.     

疏筋整复手法治疗寰枢关节紊乱症的力学量化研究

目的: 探讨疏筋整复手法治疗寰枢关节紊乱症生物力学参数的量效关系。方法: 自2022年10月至2023年5月收治寰枢关节紊乱症患者18例,其中男10例,女8例;年龄24~27(25.50±1.10)岁;颈椎CT示齿状突右侧偏歪16例,左侧偏歪2例。采用穿戴式按摩手法测量手套测量疏筋整复手法治疗寰枢关节紊乱症的力学参数,量化疏筋时力的大小、频率及力学曲线图和整复时启动力、扳动力、扳动时间及力学曲线图,比较患侧和对侧手法操作的差异性。结果: 疏筋手法实施中风池穴部位患侧最大作用力、频率为(19.82±2.02) N、(116.83±14.49)次/分,对侧分别为(13.87±2.19) N、(188.89±16.03)次/分;两侧最大作用力、频率比较,差异有统计学意义(P<0.05)。缺盆穴患侧最大作用力、频率为(14.44±3.27) N、(139.06±28.47)次/分,对侧为(9.41±1.38) N、(142.50±28.47)次/分;两侧最大作用力比较,差异有统计学意义(P<0.05)。整复手法实施中患侧启动力、扳动力、扳动时间分别为(14.16±5.98) N、(11.56±6.63) N、(0.14±0.03) s,对侧分别为(8.94±3.39) N、(8.30±4.64) N、(0.18±0.04) s;两侧启动力、扳动力、扳动时间比较,差异有统计学意义(P<0.05)。结论: 疏筋整复手法针对患侧施以轻巧的疏筋力即可恢复颈椎间的力学平衡,加强寰枢关节紊乱的恢复趋势,在此基础上再施以轻巧的旋扳力便能够使得寰枢椎齿状突回位,体现了手法安全性高的特点。     

后路钉棒内固定非融合治疗创伤性寰枢关节旋转脱位

目的评估后路钉棒内固定非融合治疗创伤性寰枢关节旋转脱位的疗效。方法对7例创伤性寰枢关节旋转脱位患者采用颅骨牵引复位,后路钉棒内固定,不做植骨融合。影像学检查确定骨折愈合后取出内固定。评估寰枢关节复位及侧块骨折愈合情况、颈椎旋转度、颈部疼痛及有无旋转脱位复发。结果7例颅骨牵引复位均获成功。患者均获得随访,时间15~24个月。内固定术后12个月骨折愈合,无内置物松动、断裂。取出内固定3个月后,颈椎旋转度110°~150°,1例颈部仍轻微疼痛。所有患者无旋转脱位复发。结论后路钉棒内固定非融合是治疗创伤性寰枢关节旋转脱位的有效方法,可促进骨折及韧带修复,恢复寰枢关节旋转功能。