Lan Qifeng,Zhou Xingyu,Yan Ming,et al.Characteristics of rotated separation angle of atlanto-axial and occipito-atlantal joint in atlantoaxial rotatory dislocation in children[J].Journal of Clinical Pediatric Surgery,,22():1015-1020.[doi:10.3760/cma.j.cn101785-202307018-003]
Characteristics of rotated separation angle of atlanto-axial and occipito-atlantal joint in atlantoaxial rotatory dislocation in children
- Keywords:
- Atlanto-Axial Joint; Congenital Abnormalities; Surgical Procedures; Operative; Child; Dislocations
- Abstract:
- Objective To acquire the computed tomography (CT) data of children with atlanto-axial rotatory dislocation (AARD) and explore the characteristics of rotated separation angles of atlanto-axial and occipito-atlantal joints in AARD children.Methods For this retrospective study,19 AARD children hospitalized were selected as subjects at Department of Orthopedics of Peking University Third Hospital from June 2016 to June 2023.Preoperative CT images,preoperative diagnosis,age,gender and other clinical data were collected.The line connecting posterior edges of bilateral mandibular supports was utilized for representing real-time position of occipital bone,line connecting transverse processes of atlas real-time position of atlas and parallel line of posterior edge of axis body real-time position of axis.Rotated separation angle of atlanto-axial joint (C1C2),rotated separation angle of occipito-atlantal joint (OcC1) and rotated separation angle of occipito-axial joint (OcC2) were measured.With rotation direction of atlas relative to axis as positive,they were assigned into two groups of |OcC1|≤3° (n=9) and |OcC1|>3° (n=10) according to whether or not rotation of occipito-atlantal joint was within a physiological rotation range.The inter-group differences in other rotated separation angles were also examined.Linear regression analysis was performed for calculating the prediction equations for OcC1.SPSS 27.0 was employed for statistical analysis.Results A total of 19 AARD children aged (10.12±0.55) years had a median disease course of 7 months.C1C2 and OcC2 were (24.5±2.9)° and (15.3±1.4)° respectively; OcC1 was -1.3°(-14.4°,0.9°).OcC1 was significantly correlated negatively with C1C2 (r=-0.704,P<0.001),OcC2 significantly correlated positively with C1C2 (r=0.602,P=0.006) and no significant correlation existed between OcC1 and OcC2 (r=-0.033,P=0.892).C1C2 values for |OcC1|(r=and |OcC1|>3f groups were (14.73 for |and (30.8.73for | respectively,with a statistically significant difference (P=0.011); no statistically significant difference existed in OcC2 (P=0.719).Regression analysis was performed for OcC1 vs C1C2 and OcC2 vs C1C2 and |OcC1|>3° group had a high degree of linear fit between OcC1 and C1C2 (OcC1=-0.79×C1C2+10.44,R2=0.823,P<0.001) as well as |OcC1| of linear fit between OcC1 and C1C2 (OcC1=etween OcC2 and C1C2 (OcC2=0.95×C1C2+1.09,R2=0.987,P<0.001).Conclusions The compensatory Angle of atlanto-occipital joint is proportional to the rotation degree of atlanto-axial joint. When the atlantoaxial rotation separation Angle of AARD patients is greater than the critical value (20.8°), the atlantooccipital joint may begin to reverse rotation to compensate for the rotational displacement of the atlantoaxial joint.
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Memo
收稿日期:2023-7-11。
基金项目:北京大学第三医院队列建设项目(BYSYDL202106)
通讯作者:许南方,Email:xunanfang@foxmail.com