Reichel G, Stenner A, Janh A
Zh Nevrol Psikhiatr Im S S Korsakova. 2012;112(1):73-9.
Seventy-eight patients with confirmed primary cervical dystonia CD were studied. All patients underwent CT of the soft tissues of the neck using slices at cervical vertebrae and MRI images of the cervical spine and of soft tissues. MRI images of 50 patients who did not have CD were used for comparison. This was followed by measuring the largest diameter along with the description of the shape of all observable muscles including the small muscles of the occipital area. In lateral flexion and rotation, 19% of patients showed disorders of muscles acting on head joints (laterocaput/torticaput). Muscles that act on the cervical spine were affected (laterocollis/torticollis) in 20% of patients. Both types of the disorder, but with various degrees of the caput- and collis- involvement, were presented in 61% of patients. Consequently, the ratio for these forms was approximately estimated as 1:1:3. The following conclusions have been made: In lateral flexion, clinical differentiation between laterocollis and laterocaput is possible. Lateral shift is always a result of laterocollis on one side and laterocaput on the opposite side. In rotation, clinical differentiation between torticollis and torticaput is not always possible. CT slices at levels C1 and C2 are advisable in these cases. Comparing the positions of vertebrae on both levels will provide a safe differentiation between torticollis and torticaput. Analysis of forward flexion (differentiation between antecollis and antecaput) can be accomplished by lateral observation of the angles between the cervical spine and the thoracic spine, respectively, and between the cervical spine and the base of skull. The same applies to the analysis of backward flexion (differentiation between retrocollis and retrocaput). Sagittal shift forwards usually does not require further diagnosis: it is almost always caused by bilateral dystonic activities of the Mm. sternocleidomastoidei.
对78例确诊为原发性颈部肌张力障碍（CD）的患者进行了研究。所有患者均接受了颈部软组织CT检查，扫描层面为颈椎，同时还进行了颈椎及软组织的MRI成像。选取50例无CD的患者的MRI图像作为对照。随后测量了所有可观察到的肌肉（包括枕部小肌肉）的最大直径，并描述其形状。在侧屈和旋转时，19%的患者表现出作用于头部关节（侧头/斜头）的肌肉紊乱。20%的患者作用于颈椎的肌肉（侧颈/斜颈）受到影响。61%的患者同时出现了这两种类型的紊乱，但头颈部受累程度各不相同。因此，这些类型的比例约估计为1:1:3。得出以下结论：在侧屈时，侧颈和侧头之间的临床鉴别是可能的。侧方移位总是一侧侧颈和另一侧侧头的结果。在旋转时，斜颈和斜头之间的临床鉴别并非总是可行的。在这些情况下，建议拍摄C1和C2水平的CT切片。比较这两个水平的椎体位置将有助于安全地区分斜颈和斜头。通过分别从侧面观察颈椎与胸椎之间以及颈椎与颅底之间的角度，可以完成前屈（区分前颈和前头）的分析。后伸分析（区分后颈和后头）也是如此。矢状向前移位通常无需进一步诊断：几乎总是由双侧胸锁乳突肌的肌张力障碍活动引起。
