摘要
目的探讨枢椎侧块关节面不均匀沉降(nonuniform settlement of the C_(2) lateral mass,C_(2)LM-NUS)的寰枢关节解剖特征及其与寰枢椎骨关节炎的相关性。方法回顾性分析2022年1月1日至2022年12月31日于陆军军医大学第二附属医院(新桥医院)接受头颈部或颈椎薄层CT检查的522例住院患者的临床和影像学资料,男288例、女234例,年龄(60.8±11.2)岁(范围18~83岁)。对CT数据进行多平面重建,测量枢椎侧块关节面沉降值(settlement of C_(2) lateral mass,C_(2)LMS),将双侧枢椎侧块C_(2)LMS的差值(d-C_(2)LMS)>1.4 mm定义为C_(2)LM-NUS。C_(2)LM-NUS组137例,男71例、女66例,年龄(63.3±11.6)岁;正常组385例,男217例、女168例,年龄(59.9±11.0)岁。测量两组患者寰枢关节影像学参数,包括C_(1,2)冠状位倾斜角(C_(1,2) coronal inclination,C_(1,2)CI)、寰齿前间隙(atlanto-dental interval,ADI)、寰齿侧方间隙(lateral atlanto-dental interval,LADI)、齿突偏斜角(coronal deviation angle of the odontoid process,Od-CDA)和寰枢关节相对旋转角(C_(1,2) relative rotation angle,C_(1,2)RRA),记录寰枢椎骨关节炎的患病情况。在正常组中选择1名48岁女性的CT数据建立正常C 0~C 3三维有限元模型,依据C_(2)LM-NUS组和正常组寰枢关节解剖形态参数的差值建立C_(2)LM-NUS有限元模型,分析在不同屈伸、侧弯和轴向旋转扭矩下两种有限元模型枢椎侧块关节面的应力分布。结果C_(2)LM-NUS组寰枢关节解剖形态呈不对称改变,双侧C_(1,2)CI和LADI的差值分别为8.5°(5.8°,11.3°)和0.8(0.1,1.4)mm,大于正常组的1.7°(0.8°,2.7°)和0.2(0.1,0.5)mm,差异有统计学意义(P<0.05);Od-CDA和C_(1,2)RRA分别为3.9°(2.0°,5.4°)和7.2°(5.0°,10.0°),大于正常组的0°(0°,1.0°)和0°(0°,5.5°),差异有统计学意义(P<0.05)。寰枢椎骨关节炎组中C_(2)LM-NUS占比为37.8%,高于非寰枢椎骨关节炎组的22.8%,差异有统计学意义(P<0.05)。寰枢椎骨关节炎组患者年龄、女性占比和C_(1,2)RRA均大于非寰枢椎骨关节炎组,差异均有统计学意义(P<0.05)。调整年龄、性别和C_(1,2)RRA后,二分类变量logistic回归分析显示C_(2)LM-NUS是寰枢椎骨关节炎的独立危险因素[OR=2.024,95%CI(1.300,3.150),P<0.001]。三维有限元分析结果显示C_(2)LM-NUS有限元模型较正常模型C_(1,2)节段的活动范围下降,在不同力矩条件下颈椎模拟屈伸、侧屈和旋转活动过程中C_(2)LM-NUS模型沉降侧的侧块关节面应力分布均大于对侧。结论C_(2)LM-NUS与寰枢关节解剖形态不对称改变相关,可导致寰枢椎骨关节炎风险增高。C_(2)LM-NUS导致枢椎侧块关节面应力集中是寰枢椎骨关节炎风险增高的生物力学因素。
ObjectiveTo investigate the anatomical characteristics of the atlantoaxial joint associated with nonuniform settlement of the C_(2) lateral mass(C_(2)LM-NUS)and its correlation with atlantoaxial osteoarthritis.MethodsA retrospective analysis was conducted on clinical and imaging data of 522 hospitalized patients(288 males,234 females;mean age 60.8±11.2 years;range 18-83 years)who underwent CT scans of the head/neck or cervical spine at the Second Affiliated Hospital of Army Medical University between January 1,2022 and December 31,2022.Multiplanar reconstruction of CT data was performed to measure the settlement of the C_(2) lateral mass(C_(2)LMS).Patients with a difference in bilateral C_(2)LMS(d-C_(2)LMS)>1.4 mm were classified into the C_(2)LM-NUS group(137 cases;71 males,66 females;mean age 63.3±11.6 years),while the normal group included 385 patients(217 males,168 females;mean age 59.9±11.0 years).Imaging parameters of the atlantoaxial joint were measured,including the C_(1,2) coronal inclination angle(C_(1,2) CI),atlanto-dental interval(ADI),lateral atlanto-dental interval(LADI),coronal deviation angle of the odontoid(Od-CDA),and C_(1,2) relative rotation angle(C_(1,2) RRA).Osteoarthritis prevalence was recorded.A normal C 0-C 3 finite element(FE)model was constructed using CT data from a 48-year-old female in the normal group.A C_(2)LM-NUS FE model was developed based on anatomical differences between the C_(2)LM-NUS and normal groups,and stress distribution on the C_(2) lateral mass articular surface was analyzed under flexion-extension,lateral bending,and axial rotation torques.ResultsThe C_(2)LM-NUS group exhibited asymmetric atlantoaxial joint morphology,with bilateral differences in C_(1,2)CI and LADI of 8.5°(5.8°,11.3°)and 0.8(0.1,1.4)mm,respectively,significantly greater than those in the normal group[1.7°(0.8°,2.7°)and 0.2(0.1,0.5)mm,P<0.05].Od-CDA and C_(1,2)RRA were 3.9°(2.0°,5.4°)and 7.2°(5.0°,10.0°)in the C_(2)LM-NUS group,exceeding the normal group's values[0°(0°,1.0°)and 0°(0°,5.5°),P<0.05].The prevalence of C_(2)LM-NUS was 37.8%in the atlantoaxial osteoarthritis group,significantly higher than in the non-osteoarthritis group(22.8%,P<0.05).Significant differences were observed in age(68.3±9.4 vs.58.6±10.8 years),sex distribution(50/69 vs.238/165),and C_(1,2)RRA[5.6°(0°,8.2°)vs.3.8°(0°,6.2°)]between the osteoarthritis and non-osteoarthritis groups(P<0.05).After adjusting for age,sex,and C_(1,2)RRA,binary logistic regression identified C_(2)LM-NUS as an independent risk factor for atlantoaxial osteoarthritis[OR=2.024,95%CI(1.300,3.150),P<0.001].FE analysis demonstrated a reduced C_(1,2) range of motion in the C_(2)LM-NUS model,with elevated stress concentrations on the settled side lateral mass during simulated flexion-extension,lateral bending,and rotation.ConclusionsThe study indicated that C_(2)LM-NUS is associated with asymmetric anatomical changes in the atlantoaxial joint,increasing the risk of osteoarthritis.Stress concentration on the C_(2) lateral mass articular surface,caused by C_(2)LM-NUS,is a biomechanical contributor to this heightened risk.
作者
唐超
王清
张莹
廖烨晖
唐强
杨思振
邱浩
钟德君
初同伟
Tang Chao;Wang Qing;Zhang Ying;Liao Yehui;Tang Qiang;Yang Sizhen;Qiu Hao;Zhong Dejun;Chu Tongwei(Department of Orthopaedics,the Second Affiliated Hospital of Army Medical University(Xinqiao Hospital),Chongqing 400037,China;Department of Orthopaedics,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)
出处
《中华骨科杂志》
北大核心
2025年第9期531-541,共11页
Chinese Journal of Orthopaedics
基金
重庆市技术创新与应用发展重点项目(CSTB2022TIAD-KPX0192)
四川省自然科学基金项目(2024NSFSC0682)。
关键词
枢椎
颈椎
寰枢关节
骨关节炎
有限元分析
不均匀沉降
Axis,cervical vertebra
Atlanto-axial joint
Osteoarthritis
Finite element analysis
Nonuniform settlement
