Radiological And Clinical Study Of Atlantoaxial Rotatory Dislocation

Part 1:introductionAtlantoaxial ratatory dislocation typically occurs in children after serious infection in the head and neck region, and rarely in the adult. It represents a rare pathological condition of the upper cervical spine that is frequently misdiagnosed, leading to reducing difficultly. Thus, it was important of emphasize of the early diagnosis and treatment, which are essential to obtain the best clinical results.Typical signs of Atlantoaxial ratatory dislocaton include torticollis, motional neck pain and a rotatary fixation of the head. After dignosis, firstly, conservative treatment is taken,including wearing Philadelphia cervical collar,a halo device and skull traction.if falls,it is followed by atlantoaxial arthrodesis in common. By now,there were any disputes in dignosis,treatment and prognosic evaluation.Therefore,we plan to measure the atlantoaxial rotatoray range of normal persons, and to apply it into dignosis,treatment,prognosic evaluation of atlantoaxial rotatory dislocation. And we speculate it would be helpful for diagnos,treatment and prognosis evaluation of AARD.Part 2:To measure of the relative rotatory range of C1 on C2 in adultObjective:To investigate the extremly relative rotatory angle of C1 on C2 using 3-D CT in normal persons,and to setup the quantitative standard of the range of relative totatory of C1 on C2. The purpose of the study is to help the diagnos,treatment and prognosis evaluation of the AARD. Methods : The atlantoaxial vertibrae of 60 normal persons were scanned with the head roating maximum to the right or left.Then,these 60 normal subjects divide into 3 teams by age(18-25,25-40,40-55),or into 2 teams by gender(male or female). Between relative teams,the relative angle C1 on C2 in maximum site were measured.Finally,we would get the average of the relative angle C1 on C2 in normal persons. Results: There were not differences in the relative angle of C1 on C2 of different age or gender. The realtive rotation range of C1 on C2 was 69.0±8.9°. Conclusions: Measuring the relative rotation angle of C1 on C2 in normal person would be helpful for the diagnos, treatment and prognosis evaluation of AARD.Part 3 clinical study of atlantoaxial rotatory fixation/dislocationObjective: To discuss appropriate strategy about diagnosis treatment and prognosis evaluation of atlantoaxial rotatory dislocation.And to study application of the quantitative standard of the atlantoaxial rotatory range in the dignosis,treatment and prognosis of atlantoaxial rotatory dislocation. Methods: 23 adult cases of atlantoaxial rotatory dislocation were analyzed retrospectively from Sep. 2004 to Dec. 2006, including 17 males and 6 females. Their age were between 18 and 65 years, with an average of 37 years old. During the treatment, the atlantoaxial rotatory ranges were measure by 3D-CT scaning. All of 23 cases were followed up from 3 to 24 months with an average of 15 months.Results: These cases of the atlantoaxial articulation rotatory range between 69.0±8.9°have a high ratio of conservative treatment and would get better results by conservative treatment than those out of normal ranges(69.0±8.9°).Conclusion: Measuring the relative rotatory angle of C1 on C2 was helpful for dignosis, treatment, prognosis evaluation of the atlantoaxial rotatory dislocation.