Method for predicting dislocation of axis' odontoid process

FIELD: medicine, diagnostics.

SUBSTANCE: ultrasound scanning should be performed in patient's stomach-lying position at frontal support, ultrasound pick-up unit should be located at patient's skin at the level of atlas' posterior tuberculum directly under inferior edge of occipital bone so that scanning area should be parallel to inferior edge of occipital bone; then one should detect the distance between axis' odontoid process and corresponding atlas' lateral weight from the left and from the right to calculate the value of asymmetry, moreover, if the value of asymmetry exceeds 0.6±0.3 mm one should diagnose dislocation of axis' odontoid process. The innovation in question enables to establish accurate site of dislocation of axis' odontoid process without any roentgenological loading and provide quantitative detection of the dislocation mentioned.

EFFECT: higher accuracy and efficiency of diagnostics.

4 dwg, 2 ex, 1 tbl

 

The invention relates to medicine, namely to ultrasound diagnostics of pathology of the cervical spine, and can be used for the diagnosis of dislocation of the odontoid process (tooth, dens axis) of the axis (second cervical vertebra, axis).

There is a method of radiographic imaging of the cervical vertebrae (chest x-ray in the rear projection through the mouth). The application of this method allows to evaluate the shape, contour and structure ossification parts of Atlanta (the first cervical vertebra, With I, atlas and the axis (second cervical vertebra, II, axis) [Sadofyev V.I. Normal roentgenotherapy osteoarticular children. - L.: Medicine, 1990. - P.30-31].

However, the method of x-ray imaging of the cervical vertebrae has the following disadvantages:

beam load as conducting x-ray examinations is accompanied by the production of a series or multiple x-ray images. The patient undergoes multiple x-ray irradiation;

- low accuracy studies as indicators of the condition and positioning of the cervical vertebrae, is valid only under strictly correct laying of the patient during radiography;

- the probability of erroneous conclusions about the state of the cervical vertebrae, as at the inclined head for each patient the NTA is offset from the joint surfaces of the cervical vertebrae, including the dislocation of the odontoid process of the axis. These changes can be mistakenly interpreted as pathological (in the case of standards) or normal (in the case of pathology);

- lengthening the time of diagnosis of the condition of the cervical vertebrae, including the dislocation of the odontoid process of the axis, since the implementation of this method requires consistent conduct a range of operations: the exact styling of the patient, the implementation of serial x-ray manifestation, freezing, and drying the obtained x-ray images, description of x-ray images;

- increase the value of research, as using x-ray visualization of the cervical vertebrae is the attraction of consumables (multiple instances of x-ray films, chemicals for processing).

Closest to the proposed invention to the technical essence and the obtained result (prototype) is a method of visualising the Atlanto-occipital joint. This method consists in the fact that for visualization Atlanto-occipital joint by ultrasonic scanning of the coronary cut through a large fontanel skull ultrasonic transducer frequency 3.5 MHz. Through the great foramen explore the articular surface at the back of the bone and the lateral masses Atlanta [Plekhanov L.A. Visualization method Atlanto-occipital joint. A.S. EN 2179409].

However, the visualization Atlanto-occipital joint, selected as a prototype, has the following disadvantages:

- lack of providing an objective assessment of the dislocation of the odontoid process of the axis so as to visually detect the shape of the odontoid process of the axis and its location relative to the lateral mass of Atlanta (massa Isteralis) left and right impossible when performing ultrasonic scanning through a large fontanel investigated patient (child running this way) due to the superposition of a large number of anatomical structures between the ultrasonic sensor and the test object;

a significant limitation of the number of patients who may conduct research since the implementation of this method provides for an ultrasound of the cervical vertebrae through the acoustic window of the big spring. Therefore, this method cannot be implemented studies of children with private large fontanel and adults;

- the inability objective diagnosis of dislocation of the odontoid process of the axis as the implementation of the visualization method Atlanto-occipital joint is not possible to estimate the location of the odontoid process of the axis ' referred by the th to the lateral masses of Atlanta;

- low accuracy and lack of reliability, as the visualization of the Atlanto-occipital joint is on the large scanning depth is 15 cm or more by using sectoral probe 3.5 MHz. The study of anatomical objects at great depths is accompanied by a distortion of the shape of the objects and the distortion of distances.

All the above mentioned disadvantages to allow inspection of the dislocation of the odontoid process of the axis.

The invention consists in that for the diagnosis of dislocation of the odontoid process of the axis ' use ultrasound scan in patient lying on the stomach with the support on the forehead, and the ultrasonic transducer is placed on the patient's skin at the level of posterior tubercle of Atlanta directly under the lower edge of the occipital bone in such a way that the scanning plane is parallel to the bottom edge of the occipital bone, determine the distance between the odontoid process of the axis ' and the corresponding lateral mass of Atlanta right and left, calculate the value of asymmetry, if the value of asymmetry exceeds 0.6±0.3 mm, pinpoint the location of the odontoid process of the axis.

Such a method for the diagnosis of dislocation of the odontoid process of the axis allows x-ray radiation load on the patient's body to provide about jective quantitative determination of the dislocation of the odontoid process of the axis the exact localization of the dislocation of the odontoid process of the axis from establishing a dynamic monitoring of treatment outcomes and the development of pathological processes at the level of the cervical vertebrae Atlanta and axis', improving the accuracy and reliability of the study, as well as implementing expert assessment of disability and prognosis of pathological conditions when dislocations odontoid process of the axis.

The absence of x-ray radiation load on the patient's body is achieved by using ultrasonic scanner for diagnosis of dislocation of the odontoid process of the axis.

Objective quantification of the dislocation of the odontoid process of the axis is carried out by precise measurement of two distances: between the odontoid process of the axis ' and the corresponding lateral mass of Atlanta right and left. Then the results of these measurements are used to determine the value of the asymmetry, which quantifies the severity of the dislocation of the odontoid process of the axis.

The exact localization of the dislocation of the odontoid process of the axis is ensured by the definition of the dislocation of the odontoid process of the axis to the right or to the left side in the specific area of small extent between the lateral masses of Atlanta by visual observation and determine the population of the asymmetry.

Establishing a dynamic monitoring of treatment outcomes and the development of pathological processes at the level of the cervical vertebrae Atlanta and the axis at different vertebral and extravertebral pathological processes is carried out by conducting multiple ultrasound odontoid process of the axis and the lateral masses of Atlanta during the development of the disease and track changes in the dislocation of the odontoid process of the axis. If this is the first study patient indicator of the dislocation of the odontoid process of the axis ' value of asymmetry odontoid process with respect to the lateral masses of Atlanta was increased, the reduction of the asymmetry in re-examination evidenced by a decrease in the severity of the dislocation of the odontoid process of the axis and the magnitude of the asymmetry is about increasing the severity of the dislocation of the odontoid process of the axis.

Improving the accuracy and reliability of the study is established by determining the distance between the odontoid process of the axis and the lateral masses of Atlanta right and left, as well as the definition of the asymmetry odontoid process of the axis relative to the lateral mass of Atlanta, which is the basis for accurate and reliable diagnosis of dislocation of the odontoid process of the axis.

Implemented the e expert assessment of disability and prognosis of pathological conditions when dislocations odontoid process of the axis ' are based on the values of the asymmetry of the odontoid process of the axis relative to the the lateral masses Atlanta, obtained by determining the difference of the distance between the odontoid process of the axis ' and the corresponding lateral mass of Atlanta right and left.

The magnitude of the asymmetry of the odontoid process of the axis relative to the lateral masses Atlanta, component 0,6±0.3 mm or more is optimal on the basis of experimental data to determine the value of the asymmetry obtained in the studies by the present method healthy individuals and patients (see table 5).

The present invention is illustrated in the drawing, in which figure 1 shows the General scheme of the diagnosis of dislocation of the odontoid process of the axis, which implements the method for diagnosis of dislocation of the odontoid process of the axis in figure 2 - scheme of the determination of the asymmetry of the dislocation of the odontoid process of the axis in figure 3 is an ultrasound picture of Atlas and axis ' OK, figs.4 - ultrasonic picture of Atlas and axis ' at pathology, the table shows the values of the distances between the odontoid process of the axis and the lateral masses of Atlanta in healthy and sick. Figure 2 additionally shows: 3 - Atlant; 4 - axis'; 5 - lateral masses of Atlanta; 6 - odontoid process of axis'; 7 - the distance between the odontoid process of the axis and the lateral mass of Atlanta proper side. On the table of the stars is ccoi additionally marked the difference of the indices of deformation in healthy and diseased reliable: P<0,01 (P - significance of differences); M - mean value; m is the average error value.

Method for diagnosis of dislocation of the odontoid process of the axis is as follows. Produce ultrasound scan of the patient lying on the stomach with the support on the forehead, the ultrasonic transducer is placed on the patient's skin at the level of posterior tubercle of Atlanta directly under the lower edge of the occipital bone in such a way that the scanning plane is parallel to the bottom edge of the occipital bone, determine the distance between the odontoid process of the axis ' and the corresponding lateral mass of Atlanta right and left, calculate the value of asymmetry, if the value of asymmetry exceeds 0.6±0.3 mm, pinpoint the location of the odontoid process of the axis.

A specific example of the method for diagnosis of dislocation of the odontoid process of the axis.

The proposed method for the diagnosis of dislocation of the odontoid process of the axis (figure 1) is implemented on the ultrasound scanner 1, such as Spectra Masters (Diasonics, USA), with the ultrasonic sensor 2, for example, with an operating frequency of 5 MHz. The ultrasonic probe 2 is connected with an ultrasound scanner 1. Ultrasound scanner 1 allows to obtain an image of the cervical vertebrae,such as Atlanta and axis'. During the examination the patient should be lying on his stomach, based on his forehead. On the scanning surface of the ultrasonic sensor 2 is applied ultrasonic gel, and then place it on the patient's skin at the level of posterior tubercle of Atlanta directly under the lower edge of the occipital bone in such a way that the scanning plane is parallel to the bottom edge of the occipital bone, determine the distance between 7 odontoid process of the axis 6 and the corresponding lateral mass of Atlanta 5 to the right and to the left, calculate the value of asymmetry, if the value of asymmetry exceeds 0.6±0.3 mm, pinpoint the location of the odontoid process of the axis.

Clinical examples.

Diagnosis of dislocation of the odontoid process of the axis.

Example 1.

The group of healthy patients.

Figure 3 presents an ultrasound picture of Atlas and axis ' normal (healthy patient 18 years of age). From the analysis of the obtained image was defined as the distance between the odontoid process of the axis and the lateral mass of the Atlanta right - 5 mm, and the distance between the odontoid process of the axis and the lateral mass of Atlanta left - 5 mm degree of asymmetry is 0 mm

In accordance with the claimed method was investigated by a group of healthy patients (24 men) aged 15 to 22 years. R the research results presented in the table. The table shows that the distance between the odontoid process of the axis and the lateral mass of Atlanta in healthy patients, the right and left, did not significantly differ. The magnitude of the asymmetry of the distance between the odontoid process of the axis and the lateral mass of Atlanta in healthy averaged 0,6±0,3 mm

Example 2.

Patient A. 19. The main complaint of the patient for stress headaches, dizziness (in some cases accompanied by nausea and vomiting, tinnitus, facts sudden drop (without loss of consciousness), a progressive disorder of visual acuity in the last 2 years. In history marked by severe birth with podostemaceae and attendants.

The radiological examination craniovertebral area on the radiograph in rear projection through the mouth was defined dislocation odontoid process of the axis.

The patient performed an ultrasound of the cervical vertebrae by the present method. The study was received ultrasound picture of Atlas and axis are presented in figure 4. From the analysis of the obtained image was defined as the distance between the odontoid process of the axis and the lateral mass of the Atlanta right - 5.8 mm, and the distance between the odontoid process of the axis and the lateral mass of Atlanta left - 2,9 mm Size asymm the tree - 2,9 mm In this case, diagnose the location of the odontoid process of the axis.

In accordance with the claimed method was investigated group of patients with dislocation of the odontoid process of the axis (14 persons) aged 14 to 21 years old. Preliminary x-ray study allowed us to establish the fact of the dislocation of the odontoid process of the axis. The results are shown in the table. The table shows that the distance between the odontoid process of the axis and the lateral mass of Atlanta in patients of this group on the right and left, did not significantly differ. The magnitude of the asymmetry of the distance between the odontoid process of the axis and the lateral mass of Atlanta in patients with dislocation of the odontoid process of the axis ' average was 1.4±0.4 mm, which was significantly higher than the analogous indicator obtained in the study of healthy patients.

Thus, the use of the invention allows x-ray radiation load on the patient's body to provide an objective quantification of the dislocation of the odontoid process of the axis to establish the precise localization of the dislocation of the odontoid process of the axis from establishing a dynamic monitoring of treatment outcomes and the development of pathological processes at the level of the cervical vertebrae Atlanta is the axis improving the accuracy and reliability of the study, as well as implementing expert assessment of disability and prognosis of pathological conditions when dislocations odontoid process of the axis.

The inventive method can be applied in the departments of diagnostic ultrasound, specialized classrooms ultrasound for the diagnosis of dislocation of the odontoid process of the axis.

The inventive method for the diagnosis of dislocation of the odontoid process of the axis ' simple to use and provides a small investment of time for its execution.

Indicators of the distance between the odontoid process of the axis and the lateral masses of Atlanta in healthy volunteers and patients (M±t)

Table
Patient groupThe number of observationThe distance between the odontoid process of the axis and the lateral mass of Atlanta, mmThe magnitude of the asymmetry mm
RightLeft
Healthy244,9±0,35,0±0,40,6±0,3
Sick145,0±0,35,2±0,31,4±0,4*

Method for the diagnosis of di is the location of the odontoid process of the axis ' by ultrasound scanning, characterized in that an ultrasound scan carried out with the patient lying on his stomach with the support on the forehead, and the ultrasonic transducer is placed on the patient's skin at the level of posterior tubercle of Atlanta directly under the lower edge of the occipital bone in such a way that the scanning plane is parallel to the bottom edge of the occipital bone, determine the distance between the odontoid process of the axis ' and the corresponding lateral mass of Atlanta right and left, calculate the value of asymmetry, in this case, if the value of asymmetry exceeds 0.6±0.3 mm, pinpoint the location of the odontoid process of the axis.



 

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