Chandra P Sarat, Goyal Nishant, Chauhan Avnish, Ansari Abuzer, Sharma Bhawani Shankar, Garg Ajay
Department of Neurosurgery and Neuroradiology, All India Institute of Medical Sciences, New Delhi, India.
Neurosurgery. 2014 Dec;10 Suppl 4:621-9; discussion 629-30. doi: 10.1227/NEU.0000000000000470.
Joint-distraction and intra-operative manipulation surgeries to correct basilar invagination (BI) and atlantoaxial dislocation (AAD) are becoming standard procedures. However, current data are unable to aid in the understanding of normal and abnormal morphology of the C1/C2 joints.
To study various aspects of C1/C2 joint morphology to create normative and patient data on joint abnormalities that could provide the surgeon with objective data for surgical planning and approach.
Seventy patients (age, 15-45 years) were compared with an equal number of age- and sex-matched control subjects (age, 21.9±8.2 years) with irreducible BI and AAD from a developmental origin (May 2010-July 2013). Joint anatomy was studied with the use of thin-slice computed tomography scans. The joint parameters studied included sagittal joint inclination, craniocervical tilt, coronal joint inclination, surface area, joint overlap index, and joint reciprocity. The severity of BI and the severity of AAD were compared.
Sagittal joint inclination and craniocervical tilt significantly correlated with both BI and AAD (P<.01). Coronal joint inclination correlated with BI (P=.2). The mean sagittal joint inclination value in control subjects was 87.15±5.65° and in patients with BI and AAD was 127.1±22.05°. The mean craniocervical tilt value in controls was 60.2±9.2° and in patients with BI and AAD was 84.0±15.1°. The mean coronal joint inclination value in control subjects was 110.3±4.23° and in patients with BI and AAD was 121.15±14.6°.
This study has demonstrated for the first time the important role of joint orientation and its correlation with the severity of BI and AAD and has described new joint indexes.
关节撑开术和术中整复手术用于矫正颅底凹陷（BI）和寰枢椎脱位（AAD）正逐渐成为标准术式。然而，目前的数据尚无法帮助理解C1/C2关节的正常和异常形态。
研究C1/C2关节形态的各个方面，以建立关于关节异常的规范数据和患者数据，从而为外科医生提供手术规划和入路的客观数据。
将70例患者（年龄15 - 45岁）与同等数量年龄和性别匹配的对照者（年龄21.9±8.2岁）进行比较，这些对照者患有发育源性不可复位的BI和AAD（2010年5月至2013年7月）。使用薄层计算机断层扫描研究关节解剖结构。研究的关节参数包括矢状关节倾斜度、颅颈倾斜度、冠状关节倾斜度、表面积、关节重叠指数和关节相互关系。比较BI的严重程度和AAD的严重程度。
矢状关节倾斜度和颅颈倾斜度与BI和AAD均显著相关（P <.01）。冠状关节倾斜度与BI相关（P = 0.2）。对照者的平均矢状关节倾斜度值为87.15±5.65°，患有BI和AAD的患者为127.1±22.05°。对照组的平均颅颈倾斜度值为60.2±9.2°，患有BI和AAD的患者为84.0±15.1°。对照者的平均冠状关节倾斜度值为110.3±4.23°及患有BI和AAD的患者为121.15±14.6°。
本研究首次证明了关节方向的重要作用及其与BI和AAD严重程度的相关性，并描述了新的关节指数。
