Zhang Cheng, Chen Jinguo, Tian Yinglun, Xue Shilin, Gao Guodong, Gao Qiyue, Gan Zhihang, Xu Nanfang, Wang Shenglin
Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.
Neurosurg Rev. 2025 Jan 9;48(1):30. doi: 10.1007/s10143-025-03184-y.
The combination of congenital C1 occipitalization and C2-3 non-segmentation (i.e. "sandwich fusion") results in early development of atlantoaxial dislocation (AAD). A thorough understanding of the morphometry of the C1-2 zygapophysial joints is important to ensure a safe surgery. This study was aimed to evaluate the C1-2 zygapophysial joint in AAD patients with sandwich fusion by morphological research based on CT scans. This was a retrospective case-control study including 155 AAD patients with sandwich fusion in sandwich group and 55 with os odontoideum (OO) in control group. The C1 listhetic distance, sagittal inclination angle (SIA), coronal inclination angles (CIA) were measured from the CT and compared between two groups. The listhetic grade was defined according to the ratio of the listhetic distance and length of the superior facet of C2: less than 25% as mild, 25-75% as moderate, and greater than 75% as severe. Patients in the sandwich group had higher listhetic grade than the OO group (17.4% vs. 70.6%, 50.3% vs. 29.4% and 32.3% vs. 0 were of mild, moderate, and severe, respectively). The SIA and CIA in the sandwich group were greater than those in the OO group (30.1° vs. 5.0°, 36.6° vs. 31.0°, respectively). Asymmetric listhesis was found in 0.0%, 63.3%, and 85.7% of sandwich patients with mild, moderate and severe listhetic grade, respectively. AAD with sandwich fusion was a three-dimensional deformity characterized by the high prevalence of asymmetric and moderate-to-severe listhesis.
先天性枕骨化与C2-3节段融合（即“夹心融合”）相结合会导致寰枢椎脱位（AAD）的早期发展。全面了解C1-2关节突关节的形态测量对于确保手术安全很重要。本研究旨在通过基于CT扫描的形态学研究评估夹心融合的AAD患者的C1-2关节突关节。这是一项回顾性病例对照研究，夹心组纳入155例夹心融合的AAD患者，对照组纳入55例齿状突骨（OO）患者。从CT测量C1滑脱距离、矢状倾斜角（SIA）、冠状倾斜角（CIA）并在两组之间进行比较。根据C2上关节面的滑脱距离与长度之比定义滑脱分级：小于25%为轻度，25%-75%为中度，大于75%为重度。夹心组患者的滑脱分级高于OO组（轻度分别为17.4%对70.6%，中度分别为50.3%对29.4%，重度分别为32.3%对0）。夹心组的SIA和CIA大于OO组（分别为30.1°对5.0°，36.6°对31.0°）。在轻度、中度和重度滑脱分级的夹心患者中，不对称滑脱的发生率分别为0.0%、63.3%和85.7%。夹心融合的AAD是一种三维畸形，其特征是不对称和中度至重度滑脱的发生率较高。
