Lin Peny, Chuang Tim Chung-Hsien, Baker Joseph F
Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand.
Department of Surgery, University of Auckland, Auckland, New Zealand.
J Craniovertebr Junction Spine. 2019 Jul-Sep;10(3):139-144. doi: 10.4103/jcvjs.JCVJS_59_19.
The aim of this study was to determine the reliability of a C1:C2 ratio in a cohort of patients with atlas fractures. Second, we aimed to consider the utility of the C1:C2 ratio with regard to diagnosis of transverse ligament (TL) injury.
This is a retrospective analysis.
Patients with atlas fractures in the Waikato region between 2008 and 2010 were identified retrospectively through clinical coding and collated radiology trauma database.
The maximal width of C1 and C2 was measured using the first-taken trauma radiograph series. Combined overhang of lateral masses (△mm) and a C1:C2 ratio was then calculated. Final ratio and atlanto-dens interval (ADI) were measured at the last clinical follow-up.
A total of 24 patients with full radiographic records were included. Of these, five patients (21%) had TL injuries confirmed on computed tomography or magnetic resonance imaging. No patient with a ratio 1.15 had an intact TL, whereas a ratio of >1.10 captured 80% of TL injuries. The ratio ( < 0.001) and delta values ( < 0.001) were statistically significantly different between TL-injured and TL-intact cohorts. Two patients in the TL injury group demonstrated increased ADI on final follow-up with a ratio of >1.10.
A C1:C2 ratio >1.10 on plain radiographs showed a sensitivity of 80% in detecting atlas fractures with associated TL injury. All patients with a ratio of ≥1.15 had TL rupture subsequently confirmed by an advanced modality. A ratio calculation on radiographs is a potentially useful method of describing atlas lateral mass displacement.
Level III.
本研究旨在确定一组寰椎骨折患者中C1:C2比值的可靠性。其次，我们旨在探讨C1:C2比值在诊断横韧带（TL）损伤方面的实用性。
这是一项回顾性分析。
通过临床编码和整理放射学创伤数据库，对2008年至2010年怀卡托地区的寰椎骨折患者进行回顾性识别。
使用首次拍摄的创伤X线片系列测量C1和C2的最大宽度。然后计算侧块联合悬垂（△mm）和C1:C2比值。在最后一次临床随访时测量最终比值和寰齿间隙（ADI）。
共纳入24例有完整影像学记录的患者。其中，5例（21%）经计算机断层扫描或磁共振成像证实有TL损伤。C1:C2比值≤1.15的患者中无一例TL完整，而比值>1.10可发现80%的TL损伤。TL损伤组和TL完整组之间的比值（<0.001）和差值（<0.001）在统计学上有显著差异。TL损伤组中有2例患者在最终随访时ADI增加，比值>1.10。
X线平片上C1:C2比值>1.10在检测伴有TL损伤的寰椎骨折时敏感性为80%。所有比值≥1.15的患者随后经高级影像学检查证实有TL断裂。X线片上的比值计算是描述寰椎侧块移位的一种潜在有用方法。
三级。
