Swinkels R A, Oostendorp R A
Faculty of Medicine and Pharmacy, Brussels Free University, Belgium.
J Manipulative Physiol Ther. 1996 Mar-Apr;19(3):185-94.
The purpose of this review is to examine the internal validity of the standardized clinical stability tests for the upper cervical spine in relation to symptomatology. Whether radiology can confirm the clinical diagnosis is also examined. The importance of radiology in this situation, the pathogenesis and the prevalence of atlanto-axial hypermobility and the clinical symptomatology are discussed.
A literature search from January 1984 to March 1995. We consulted the CD-ROM Medline with the keywords "atlanto-axial instability," "atlanto-axial dislocation," "hypermobility," "cervical spine" and "atlanto-axial joint." Ninety-six Dutch, French, German, and English publications were selected. The Documentation Centre of the Institute for Research and Postgraduate Education Physiotherapy (SWSF) was consulted with the keywords: atlanto-axial joint, upper cervical spine, segmental examination, interobserver-reliability, intraobserver-reliability, interobserver variation, intraobserver variation, manual therapy, examination, diagnostics. Finally, recent developments and views published during this study were added.
There seems to be no correlation between the amount of hypermobility or subluxation and the presence of clinical signs or neurological signs. The clinical signs can vary from relatively diffuse complaints, no symptoms and signs to serious ones. Radiology does not seem to be a reliable diagnostic mechanism in relation to upper-cervical instability. Conventional X-rays fail to give adequate information about atlanto-axial stability. CT-scan and MRI can visualize much more because of the direct sagittal projection but neither is an absolute standard. Furthermore, in relation to upper-cervical hypermobility, the validity of radiology is under debate.
There is no correlation between the measure of hypermobility and the presence of clinical symptoms. Also, the validity of the upper-cervical stability tests is questionable. In diagnostics, every radiological examination measures anatomical and morphological variables, not functional variables. Despite this, CT and MRI should be preferred in diagnostics over conventional functional radiology.
本综述旨在探讨上颈椎标准化临床稳定性测试与症状学相关的内部效度。同时也研究放射学能否证实临床诊断。讨论放射学在这种情况下的重要性、寰枢椎活动度过大的发病机制和患病率以及临床症状学。
检索1984年1月至1995年3月的文献。我们使用关键词“寰枢椎不稳”“寰枢椎脱位”“活动度过大”“颈椎”和“寰枢关节”查阅了光盘版医学文献数据库。共筛选出96篇荷兰语、法语、德语和英语出版物。还使用关键词“寰枢关节”“上颈椎”“节段性检查”“观察者间可靠性”“观察者内可靠性”“观察者间差异”“观察者内差异”“手法治疗”“检查”“诊断”咨询了物理治疗研究与研究生教育研究所文献中心（SWSF）。最后，补充了本研究期间发表的最新进展和观点。
活动度过大或半脱位的程度与临床体征或神经体征的存在之间似乎没有相关性。临床体征可能从相对弥散的主诉、无症状和体征到严重的体征不等。放射学似乎不是诊断上颈椎不稳的可靠机制。传统X线片无法提供关于寰枢椎稳定性的充分信息。CT扫描和MRI由于直接矢状面投影能显示更多情况，但两者都不是绝对标准。此外，关于上颈椎活动度过大，放射学的效度存在争议。
活动度过大的测量与临床症状的存在之间没有相关性。此外，上颈椎稳定性测试的效度也值得怀疑。在诊断中，每项放射学检查测量的是解剖和形态学变量，而非功能变量。尽管如此，在诊断中CT和MRI应优于传统功能放射学。
