Park Moon Soo, Moon Seong-Hwan, Kim Tae-Hwan, Oh Jae Keun, Nam Ji Hoon, Jung Jae Kyun, Riew K Daniel
Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
Asian Spine J. 2016 Feb;10(1):123-8. doi: 10.4184/asj.2016.10.1.123. Epub 2016 Feb 16.
Retrospective study.
To propose a new radiographic index for occipito-cervical instability.
Symptomatic atlanto-occipital instability requires the fusion of the atlanto-occipital joint. However, measurements of occipito-cervical translation using the Wiesel-Rothman technique, Power's ratio, and basion-axial interval are unreliable because the radiologic landmarks in the occipito-cervical junction lack clarity in radiography.
One hundred four asymptomatic subjects were evaluated with lateral cervical radiographs in neutral, flexion and extension. They were stratified by age and included 52 young (20-29 years) and 52 middle-aged adults (50-59 years). The four radiographic reference points were posterior edge of hard palate (hard palate), posteroinferior corner of the most posterior upper molar tooth (molar), posteroinferior corner of the C1 anterior ring (posterior C1), and posteroinferior corner of the C2 vertebral body (posterior C2). The distance from posterior C1 and posterior C2 to the above anatomical landmarks was measured to calculate the range of motion (ROM) on dynamic radiographs. To determine the difference between the two age groups, unpaired t-tests were used. The statistical significance level was set at p<0.05.
The ROM was 4.8±7.3 mm between the hard palate and the posterior C1, 9.9±10.2 mm between the hard palate and the posterior C2, 1.7±7.2 mm between the molar to the posterior C1, and 10.4±12.1 mm between the molar to the posterior C2. There was no statistically significant difference for the ROM between the young- and the middle-aged groups. The intra-observer reliability for new radiographic index was good. The inter-observer reliability for the ROM measured by the hard palate was low, but was better than that by the molar.
ROM measured by the hard palate might be a useful new radiographic index in cases of occipito-cervical instability.
回顾性研究。
提出一种用于枕颈不稳的新影像学指标。
有症状的寰枕不稳需要进行寰枕关节融合术。然而，使用维塞尔 - 罗斯曼技术、鲍尔比率和基底 - 枢椎间距来测量枕颈平移是不可靠的，因为枕颈交界处的放射学标志在X线片上不够清晰。
对104名无症状受试者进行中立位、屈曲位和伸展位的颈椎侧位X线片评估。他们按年龄分层，包括52名年轻人（20 - 29岁）和52名中年人（50 - 59岁）。四个影像学参考点为硬腭后缘（硬腭）、最后一颗上磨牙的后下角（磨牙）、C1前弓的后下角（C1后方）和C2椎体的后下角（C2后方）。测量C1后方和C2后方到上述解剖标志的距离，以计算动态X线片上的活动范围（ROM）。为确定两个年龄组之间的差异，采用不成对t检验。统计学显著性水平设定为p<0.05。
硬腭与C1后方之间的ROM为4.8±7.3毫米，硬腭与C2后方之间的ROM为9.9±10.2毫米，磨牙与C1后方之间的ROM为1.7±7.2毫米，磨牙与C2后方之间的ROM为10.4±12.1毫米。年轻组和中年组之间的ROM无统计学显著差异。新影像学指标的观察者内可靠性良好。由硬腭测量的ROM的观察者间可靠性较低，但优于由磨牙测量的ROM。
在枕颈不稳的情况下，由硬腭测量的ROM可能是一个有用的新影像学指标。
