枕颈部CT三维重建对颈椎病伴高血压患者寰枕和寰枢关节的研究

目的:通过对枕颈部CT图像进行数据测量,分析颈椎病患者的寰枕和寰枢关节结构性变化以及与高血压的关系。方法:选取48例符合颈椎病诊断标准的患者,依据血压检测情况将颈椎病伴有高血压的24例患者纳入观察组,将颈椎病无高血压的24例患者纳入对照组。两组均采用螺旋CT机扫描,范围从颅底至C7椎体下缘。对原始图像应用图像后处理工作站进行图像后处理。分别测量寰枕关节:寰枕关节与中立位夹角(AOJNP)、双侧寰枕关节与中立位夹角差值(ADBOJNP)、头颅与水平位夹角(ASHP)、寰椎与水平位夹角(AAH)、头颅与寰椎夹角差值(ADSA);寰枢关节:寰齿前间隙(ADI)、寰齿侧块间隙(LADI)、双侧齿突侧块间隙差值(VBLADI)、寰枢关节与中立位夹角(AAJNP)、双侧寰枢关节与中立位夹角差值(ADBAJNP)、枢椎与水平位夹角(AAHP)、寰枢椎夹角差值(ADAV)以及寰齿夹角(AOA)。结果:两组AAH、ADSA、ADI、AAJNP(左)、ADBAJNP以及AAHP比较,差异有统计学意义(t=2.68,t=2.68,t=-2.27,t=2.023.81,t=2.28;P<0.05);两组AOJNP(左)、AOJNP(右)、ADBOJNP、ASHP、LADI(左)、LADI(右)、VBLADI、AAJNP(右)、ADAV以及AOA比较,差异无统计学意义。结论:寰枕关节紊乱后寰椎的后移位、左右旋转以及枕-寰-枢关节混合紊乱后寰椎的旋转会牵拉刺激到局部血压相关神经,引起血压升高,其中寰椎旋转错位的相关性最强。寰椎的侧屈及前后屈伸对血压变化无实质性影响。

A study of CT 3D reconstruction of occiput and neck on the atlantooccipital and atlantoaxial joints of patients with cervical spondylosis and hypertension

Objective:To analyze the structural changes of atlanto-occipital and atlantoaxial joints of patients with cervical spondylosis and the relationship between them and hypertension through implemented data measurement for the computed tomography(CT)images of occiput and neck.Methods:48 patients with cervical spondylosis who met the diagnostic standard of cervical spondylosis were selected and their blood pressure was measured.And they were divided into observation group(24 cases with cervical spondylosis accompanied by hypertension)and control group(24 cases with cervical spondylosis but without hypertension).Spiral CT scanning was performed from the skull base to the lower margin of the C7 vertebral body in both groups.The original image was implemented image processing by image post-processing workstation.And then the atlanto-occipital joints and atlantoaxial joints of them were respectively measured.The measured angles of atlanto-occipital joints mainly included the angle between the occipital joint and neutral position(AOJNP),the angle difference between the bilateral occipital joint and neutral position(ADBOJNP),the angle between the skull and horizontal position(ASHP),the angle between atlas and horizon(AAH)and the angle difference between skull and atlas(ADSA).The measured angles of atlantoaxial joints mainly included atlanto-dental interval(ADI),the lateral atlanto-dental interval(LADI),variance of bilateral the lateral atlanto-dental interval(VBLADI),the angle between the atlantoaxial joint and the neutral position(AAJNP),the angle difference between the bilateral atlantoaxial joint and neutral position(ADBAJNP),the angle between the axis and the horizontal position(AAHP),the angle difference between atlantoaxial vertebra(ADAV)and anlanto-odontoid angle(AOA).Results:The differences of AAH,ADSA,ADI,AAJNP(left),ADBAJNP and AAHP between the two groups were significant(t=2.68,t=2.68,t=-2.27,t=2.023.81,t=2.28,P<0.05).And the differences of AOJNP(left),AOJNP(right),ADBOJNP,ASHP,LADI(left),LADI(right),VBLADI,AAJNP(right),ADAV and AOA between the two groups were no significant(P>0.05).Conclusion:The posterior displacement and left-right rotation of atlas post atlanto-occipital joint disorders as well as the rotation of atlas post occipital-atlanto-axial joint disorders can pull and stimulate the local blood pressures-related nerves,and cause the increase of blood pressure.And the rotation dislocation of atlas has the strongest correlation.The lateral flexion,and anteroposterior flexion and extension of atlas had no substantial effect on the change of blood pressure.