应用前方压迫指数评价寰枢椎脱位和复位情况

夏家杰廖正步夏永智晏怡

应用前方压迫指数评价寰枢椎脱位和复位情况

夏家杰*廖正步*夏永智*晏怡*

目的推导和应用前方压迫指数评价寰枢椎脱位和复位情况。方法对28例对照组和28例寰枢椎脱位患者行CT检查，分析正常情况、寰枢椎脱位术前及术后的前方压迫指数的情况。结果28例对照组的前方压迫指数为87.86±24.98；28例患者的术前前方压迫指数为230.44±97.60，术后前方压迫指数为106.27±73.53。患者术前组与对照组差异有统计学意义（t=-7.50，P＜0.0001），患者术后组与对照组相比没有统计学意义（t=-1.26，P=0.2171）；术前术后两组差异有统计学意义（t=10.35，P＜0.0001）。结论前方压迫指数可作为了解寰枢椎脱位严重程度和行后路复位手术的减压情况的评价指标。

寰枢椎脱位影像学指标复位

【Abstract】Objective The study was to investigate the value of deduction and application of anterior compression index in evaluation of atlantoaxial dislocation and restoration.Method Twenty-eight cases of the control group and 28 cases of atlantoaxial dislocation treated with posterior restoration and screw-rod internal fixation technique before and af⁃ter surgery were recruited in this study and their data was retrospectively analyzed.All of the people underwent sagittal computerized tomography scan films.The anterior compression index was measured in all cases.Results The mean value of anterior compression index of the control group was 87.86±24.98.The mean value of anterior compression index of the preoperative patients was 230.44±97.60 and the mean value of the postoperative patients was 106.27±73.53.There was significant difference in those two parameters between the preoperative patients and the controls（t=-7.50，P＜0.0001）. There was no significant difference between the postoperative patients and the control group（t=-1.26，P=0.2171）.Anteri⁃or compression index were significantly lower after surgical operation（t=10.35，compared with before，P＜0.0001）.Con⁃clusion Anterior compression index can be an excellent measurement tool for the assessment of relationship of atlas and axis in atlantoaxial dislocation patients before and after posterior restoration operation.

【Key Words】Atlantoaxial dislocation Radiographic index Restoration

寰枢椎脱位（atlantoaxial dislocation，AAD）是常见的颅颈交界区畸形，在我国和印度等亚洲国发病率较高。寰枢椎脱位的患者由于脱位的齿状突压迫延髓脊髓，并导致枕骨大孔狭窄而出现的神经功能障碍。对于有神经系统症状和体征且病情进行性发展的患者，手术是唯一的治疗方式。目前常通过几个参数如钱氏线（Chamberlain's line）、McGregor线、寰齿间隙（atlanto dental Inter⁃val，ADI）等评价寰枢椎脱位的术前、术后的影像学表现。上述指标可较好衡量齿状突向颅底的程度，但对于复杂颅颈交界区畸形［1］的评价存在一些局限性，且缺乏一个较直观的指标来评价齿状突对于延髓脊髓的压迫及手术前后压迫改善的程度。本项研究首创前方压迫指数，通过颅颈交界区CT矢状位上测量前方压迫指数来评价寰枢椎关系，为测定寰枢椎脱位严重程度和行后路复位手术的减压情况提供相关依据。……