轴状突上关节面斜率可能决定了因齿状突而继发的寰枢椎前后移位和寰枕关节及颈下关节的代偿机制。
Axial superior facet slope may determine anterior or posterior atlantoaxial displacement secondary to os odontoideum and compensatory mechanisms of the atlantooccipital joint and subaxial cervical spine.
机构信息
Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China.
Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
出版信息
Eur Radiol. 2023 Aug;33(8):5606-5614. doi: 10.1007/s00330-023-09544-w. Epub 2023 Mar 22.
OBJECTIVE
To introduce novel parameters in determining directions of os odontoideum (OO) with atlantoaxial displacement (AAD) and compensations of cervical sagittal alignment after displacement.
METHODS
Analysis was performed on 96 cases receiving surgeries for upper cervical myelopathy caused by OO with AAD from 2011 to 2021. Twenty-four patients were included in the OO group and divided into the OO-anterior displacement (AD) group and the OO-posterior displacement (PD) group by displacement. Seventy-two patients were included as the control (Ctrl) group and divided into Ctrl-positive (Ctrl-P) group and Ctrl-negative (Ctrl-N) group by axial superior facet slope (ASFS) in a neutral position. ASFS, the sum of C2 slope (C2S) and axial superior facet endplate angle (ASFEA), was measured and calculated by combining cervical supine CT with standing X-ray. Cervical sagittal parameters were measured to analyse the atlantoaxial facet and compensations after AAD.
RESULTS
Atlas inferior facet angle (AIFA), ASFS, and ASFEA in Ctrl-P significantly differed from OO-AD.C0-C1, C1-C2, C0-C2, C2-C7, C2-C7 SVA, and C2S in Ctrl-P significant differed from the OO-AD group. C2-C7 SVA and C2S in Ctrl-N significantly were smaller than the OO-PD group. C1-C2 correlated with C0-C1 and C2-C7 negatively in the OO group. Slight kyphosis of C1-C2 in OO-AD was compared with lordosis of C1-C2 in Ctrl-P, inducing increased extension of C0-C1 and C2-C7. Mildly increased lordosis of C1-C2 in OO-PD was compared with C1-C2 in Ctrl-N, triggering augmented flexion of C0-C1 and C2-C7.
CONCLUSION
ASFS was vital in determining directions of OO with AAD and explaining compensations. ASFS and ASFEA could provide pre- and intraoperative guidelines.
KEY POINTS
• ASFS may determine the directions and compensatory mechanisms of AAD secondary to OO. • ASFS could be achieved by the sum of ASFEA and C2S.
目的
介绍一种新的参数，用于确定寰枕关节（OO）与寰枢椎脱位（AAD）之间的位移方向，以及位移后颈椎矢状位排列的代偿情况。
方法
对 2011 年至 2021 年期间因 OO 伴 AAD 而行上颈椎手术的 96 例患者进行分析。24 例患者纳入 OO 组，并根据位移分为 OO 前脱位（AD）组和 OO 后脱位（PD）组。72 例患者作为对照组（Ctrl），根据中立位轴性上关节突斜率（ASFS）分为 Ctrl 阳性（Ctrl-P）组和 Ctrl 阴性（Ctrl-N）组。通过颈椎仰卧位 CT 与站立位 X 线相结合，测量并计算 ASFS、C2 斜率（C2S）和轴向上关节突终板角（ASFEA）的总和。测量颈椎矢状位参数，分析 AAD 后的寰枢关节面和代偿情况。
结果
Ctrl-P 组的寰椎下关节突角（AIFA）、ASFS 和 ASFEA 与 OO-AD 的 C0-C1、C1-C2、C0-C2、C2-C7、C2-C7 SVA 和 C2S 显著不同。Ctrl-N 组的 C2-C7 SVA 和 C2S 明显小于 OO-PD 组。OO 组中 C1-C2 与 C0-C1 和 C2-C7 呈负相关。与 Ctrl-P 组相比，OO-AD 组的 C1-C2 呈轻度后凸，导致 C0-C1 和 C2-C7 伸展增加。与 Ctrl-N 组相比，OO-PD 组的 C1-C2 轻度前凸，导致 C0-C1 和 C2-C7 屈曲增加。
结论
ASFS 对于确定 OO 伴 AAD 的方向和解释代偿机制至关重要。ASFS 和 ASFEA 可提供术前和术中的指导。
关键点
• ASFS 可能决定 OO 伴 AAD 的方向和代偿机制。
• ASFS 可通过 ASFEA 和 C2S 的总和来获得。
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