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,2023,22(11):1015-1020.[doi:10.3760/cma.j.cn101785-202307018-003]
儿童寰枢关节旋转固定性脱位中寰枢与寰枕旋转分离角特征分析
- Title:
- 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
- 摘要:
- 目的 分析寰枢关节旋转固定性脱位(atlanto-axial rotatory dislocation,AARD)患儿的CT数据,探讨AARD患儿寰枢和寰枕旋转分离角的特征。方法 本研究为回顾性研究,以2016年6月至2023年6月在北京大学第三医院骨科就诊并接受手术治疗的19例AARD患儿为研究对象,收集患儿术前CT影像、术前诊断、年龄、性别等临床资料。以双下颌支后缘连线代表枕骨实时位置,寰椎横突连线代表寰椎实时位置,枢椎椎体后缘平行线代表枢椎实时位置,测量寰枢旋转分离角(rotated separation angle of atlanto-axial joint,C1C2)、寰枕旋转分离角(rotated separation angle of occipito-atlantal joint,OcC1)以及枕枢旋转分离角(rotated separation angle of occipito-axial joint,OcC2)。以寰椎相对枢椎的旋转方向为正,根据寰枕关节旋转是否在儿童生理旋转范围内,将所有患儿分为OcC1绝对值(|OcC1|)≤3°组(n=9)和|OcC1|＞3°组(n=10),采用线性回归分析法计算各组OcC1的预测方程。结果 19例AARD患儿年龄(10.12±0.55)岁,病程中位数7个月;C1C2、OcC2分别为(24.5±2.9)°,(15.3±1.4)°;OcC1为-1.3 (-14.4,0.9)°。OcC1与C1C2呈显著负相关(r=-0.704,P<0.001),OcC2与C1C2呈显著正相关(r=0.602,P=0.006),OcC1与OcC2的相关性不显著(r=-0.033,P=0.892)。|OcC1|≤3°组和|OcC1|＞3°组的C1C2分别为(14.7±9.9)°和(30.8±14.0)°,差异有统计学意义(P=0.011);而两组间OcC2的差异无统计学意义(P=0.719)。分组对OcC1与C1C2、OcC2与C1C2进行回归分析,发现|OcC1|＞3°组的OcC1与C1C2(OcC1=-0.79×C1C2+10.44, R2=0.823,P<0.001)以及|OcC1|≤3°组的OcC2与C1C2(OcC2=0.95×C1C2+1.09, R2=0.987,P<0.001)线性拟合程度较高。结论 寰枕关节代偿角度与寰枢关节的旋转程度成正比;当AARD患者寰枢旋转分离角大于临界值(20.8°)时,其寰枕关节才可能开始反向旋转代偿寰枢关节的旋转移位。
- 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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备注/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