RU2263470C1 - Method for predicting dislocation of axis' odontoid process - Google Patents

Abstract

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

Description

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

A known method of x-ray visualization of the cervical vertebrae (on the x-ray in the rear projection through the mouth). The application of this method allows us to evaluate the shape, contours and structure of the ossified parts of the atlas (first cervical vertebra, C I, atlas) and axis (second cervical vertebra, C II, axis) [Sadofieva V.I. Normal x-ray anatomy of the osteoarticular system of children. - L .: Medicine, 1990. - P.30-31].

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

- radiation exposure, since the X-ray examination is accompanied by the production of a series, or several, X-ray images. In this case, the patient is exposed to multiple x-rays;

- low accuracy of the study, since indicators characterizing the condition and relative position of the cervical vertebrae are valid only if the patient is strictly placed correctly during radiography;

- the probability of an erroneous conclusion about the condition of the cervical vertebrae, since when the patient’s head is inclined, the articular surfaces of the cervical vertebrae are displaced, including the dislocation of the tooth-like process of the axis. These changes can be erroneously interpreted as pathological (in the case of the norm) or normal (in the case of the pathology);

- lengthening the time for diagnosing the condition of the cervical vertebrae, including the dislocation of the axial tooth process, since the implementation of this method requires a series of operations: precise placement of the patient, serial x-ray examination, development, fixing and drying of the obtained x-ray images, description of x-ray images;

- an increase in the cost of the study, since when applying the method of X-ray visualization of the cervical vertebrae, consumables are involved (several copies of the X-ray film, chemical reagents for its processing).

Closest to the proposed invention in technical essence and the result (prototype) is a method of visualization of the atlanto-occipital joint. This method consists in the fact that for visualization of the atlanto-occipital joint, ultrasonic scanning is performed by coronary section through a large fontanel of the skull with an ultrasonic sensor with a frequency of 3.5 MHz. Moreover, through the large occipital foramen, the articular surfaces on the occipital bone and lateral masses of the atlas are examined [Plekhanov L.A. A method for visualizing an atlanto-occipital joint. A.S. RU 2179409].

However, the method of visualization of the atlanto-occipital joint, selected as a prototype, has the following disadvantages:

- the lack of an objective assessment of the state of the dislocation of the axial process of the tooth, since a visual determination of the shape of the tooth process of the axis and its location relative to the lateral mass of the atlas (massa Isteralis) on the right and left is not possible when performing ultrasound scanning through the large fontanel of the patient (child using this method) due to the imposition of a large number of anatomical formations between the ultrasound probe and the test object;

- a significant limitation of the number of patients who can conduct research, since the implementation of this method involves ultrasound examination of the cervical vertebrae through the acoustic window of a large fontanel. Therefore, in this way it is impossible to carry out research on children with a closed large fontanel and adults;

- the lack of the ability to objectively diagnose the dislocation of the dentate process of the axis, since the implementation of the method of visualization of the atlanto-occipital joint does not allow us to evaluate the location of the tooth process of the axis in relation to the lateral masses of the atlas;

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

All of these shortcomings do not allow the diagnosis of dislocation of the dentate process of the axis.

The essence of the invention lies in the fact that for the diagnosis of dislocation of the axillary process of the axis, ultrasound scanning is used in the patient’s supine position, resting on the forehead, and the ultrasound probe is placed on the patient’s skin at the level of the posterior atlant tubercle directly below the lower edge of the occipital bone so that the plane scan is located parallel to the lower edge of the occipital bone, determine the distance between the tooth-like process of the axis and the corresponding lateral mass of the atlas on the right and lev, the asymmetry value is calculated, while if the asymmetry is greater than 0.6 ± 0.3 mm, the dislocation is diagnosed odontoid Axis.

Such a method for diagnosing the dislocation of the dentate process of the axis allows the patient to provide an objective quantitative determination of the dislocation of the tooth process of the axis without radiological burden on the patient’s body, to establish the exact location of the dislocation of the tooth process of the axis, the possibility of establishing dynamic control of treatment results and the development of pathological processes at the level of the cervical vertebrae of atlas and axis, improving the accuracy and reliability of the study, as well as the implementation of expert assessment disability and prognosis of pathological conditions during the dislocation of the tooth-like process of the axis.

The absence of a radiological radiological load on the patient's body is ensured by the use of an ultrasound scanner to diagnose the dislocation of the tooth-like process of the axis.

An objective quantitative determination of the dislocation of the tooth-like process of the axis is carried out by accurate measurements of two distances: between the tooth-like process of the axis and the corresponding lateral mass of the atlas on the right and left. Then the results of these measurements are used to determine the magnitude of the asymmetry, which quantitatively characterizes the severity of the dislocation of the tooth-like process of the axis.

The determination of the exact localization of the dislocation of the dentate process of the axis is provided by the determination of the dislocation of the dentate process of the axis to the right or left side in a specific section of a small length between the lateral masses of the atlas by visual observation and determination of the magnitude of the asymmetry.

The ability to establish dynamic control of the treatment results and the development of pathological processes at the level of the cervical vertebrae of the atlant and axis in various vertebral and extravertebral pathological processes is carried out by conducting multiple ultrasound examinations of the dentate process of the axis and lateral masses of the atlas during the development of the disease and tracking changes in the dislocation of the dentate process of the axis. If during the first examination of the patient, the indicator of the dislocation of the dentate process of the axis, the asymmetry of the dentate process with respect to the lateral masses of the atlas was increased, then a decrease in the asymmetry during the second examination indicates a decrease in the severity of the dislocation of the dentate process of the axis, and an increase in the asymmetry indicates an increase in the severity of the dislocation of the dentate process axis.

An increase in the accuracy and reliability of the study was established by determining the distance between the tooth-like process of the axis and the lateral masses of the atlas on the right and left, as well as determining the asymmetry of the tooth-like process of the axis relative to the lateral masses of the atlas, which is the basis for accurate and reliable diagnosis of the dislocation of the tooth-like process of the axis.

The expert assessment of disability and the prediction of pathological conditions during the dislocation of the axial tooth process are carried out on the basis of the asymmetry values of the tooth process of the axis relative to the lateral masses of the atlas obtained by determining the difference in the distance between the toothlike process of the axis and the corresponding lateral mass of the atlas on the right and left.

The magnitude of the asymmetry of the toothlike process of the axis relative to the lateral masses of the atlant, amounting to 0.6 ± 0.3 mm or more, is optimal based on experimental data on determining the magnitude of the asymmetry obtained from studies of the claimed method in healthy people and patients (see table in FIG. .5).

The invention is illustrated by the drawing, in which Fig. 1 shows a general diagram of the diagnosis of dislocation of the dentate process of the axis, which implements a method for diagnosing dislocation of the dentate process of the axis, Fig. 2 is a diagram for determining the asymmetry of the dislocation of the dentate process of the axis, Fig. 3 is an ultrasound image of the atlas and axis is normal, in Fig.4 is an ultrasound image of atlant and axis in pathology, the table shows the distance between the tooth-like process of the axis and the lateral masses of atlant in healthy x and sick. Figure 2 additionally indicated: 3 - atlas; 4 - axis; 5 - lateral masses of the atlas; 6 - tooth-like process of the axis; 7 - the distance between the tooth-like process of the axis and the lateral mass of the atlas of the corresponding side. On the table, an asterisk additionally indicates that the differences in the deformation index in healthy and sick patients are significant: P <0.01 (P - significance of differences); M is the average value; m is the error of the mean.

A method for the diagnosis of dislocation of the tooth-like process of the axis is as follows. An ultrasound scan is performed in the patient’s position, lying on the stomach with support on the forehead, an ultrasound probe is placed on the patient’s skin at the level of the posterior tubercle of the atlas directly below the lower edge of the occipital bone so that the scanning plane is parallel to the lower edge of the occipital bone, the distance between the tooth-like process of the axis is determined and the corresponding lateral mass of the atlas on the right and left, the asymmetry value is calculated, and if the asymmetry value exceeds 0.6 ± 0.3 mm, the diagnostician dislocation of the tooth-like process of the axis.

An example of a specific implementation of the method for the diagnosis of dislocation of the tooth-like process of the axis.

The proposed method for diagnosing the dislocation of the axoid tooth process (Fig. 1) is implemented on an ultrasound scanner 1, for example, Spectra Masters (Diasonics, USA), having an ultrasonic sensor 2, for example, with an operating frequency of 5 MHz. The ultrasound sensor 2 is connected to the ultrasound scanner 1. The ultrasound scanner 1 allows you to get an image of the cervical vertebrae, such as Atlanta and Axis. During the study, the patient should be in a supine position with support on the forehead. An ultrasonic gel is applied to the scanning surface of the ultrasound transducer 2, and then it is placed on the patient’s skin at the level of the posterior tubercle of the atlas directly below the lower edge of the occipital bone so that the scanning plane is parallel to the lower edge of the occipital bone, the distance between the 7 tooth-like process of axis 6 is determined and the corresponding lateral mass of atlant 5 on the right and left, the asymmetry value is calculated, while if the asymmetry value exceeds 0.6 ± 0.3 mm, the disco is diagnosed tion dens Axis.

Clinical examples.

Diagnostics of the dislocation of the tooth-like process of the axis.

Example 1

A group of healthy patients.

Figure 3 presents the ultrasound image of the atlas and axis normal (almost healthy patient 18 years old). From the analysis of the obtained image, the following were determined: the distance between the tooth-like process of the axis and the lateral mass of the atlas on the right is 5 mm, and the distance between the tooth-like process of the axis and the lateral mass of the atlas on the left is 5 mm. The magnitude of the asymmetry is 0 mm.

In accordance with the claimed method, a group of practically healthy patients (24 people) aged 15 to 22 years was investigated. The research results are presented in the table. From the table it follows that the distance between the tooth-like process of the axis and the lateral mass of the atlas in healthy patients on the right and left did not differ significantly. The magnitude of the asymmetry of the distance between the tooth-like process of the axis and the lateral mass of Atlant in healthy people averaged 0.6 ± 0.3 mm.

Example 2

Patient A. 19 years. The main complaints of the patient are tension headaches, dizziness (in some cases accompanied by nausea and vomiting), tinnitus, facts of a sudden fall (without loss of consciousness), progressive visual impairment over the past 2 years. A history of a severe course of childbirth with birth control and obstetrics was noted.

When X-ray examination of the craniovertebral region on the x-ray in the rear projection through the mouth, the dislocation of the tooth-like process of the axis was determined.

The patient underwent ultrasound examination of the cervical vertebrae according to the claimed method. As a result of the study, an ultrasound image of Atlant and Axis was obtained, which are presented in Fig.4. From the analysis of the obtained image, the following were determined: the distance between the tooth-like process of the axis and the lateral mass of the atlas on the right is 5.8 mm, and the distance between the tooth-like process of the axis and the lateral mass of the atlas on the left is 2.9 mm. The magnitude of the asymmetry is 2.9 mm. In this case, we diagnose the dislocation of the tooth-like process of the axis.

In accordance with the claimed method, a group of patients with a dislocation of the axial process of the tooth (14 people) aged 14 years to 21 years was investigated. A preliminary X-ray examination made it possible to establish the fact of the dislocation of the tooth-like process of the axis. The research results are presented in the table. It follows from the table that the distance between the tooth-like process of the axis and the lateral mass of the atlas in the patients of this group on the right and left did not significantly differ. The magnitude of the asymmetry of the distance between the tooth-like process of the axis and the lateral mass of the atlas in patients with dislocation of the tooth-like process of the axis averaged 1.4 ± 0.4 mm, which is significantly larger than the same indicator obtained in the study of healthy patients.

Thus, the use of the present invention allows, without radiation x-ray load on the patient’s body, to provide an objective quantitative determination of the dislocation of the dentate process of the axis, to establish the exact localization of the dislocation of the tooth process of the axis, the possibility of establishing dynamic control of treatment results and the development of pathological processes at the level of the cervical vertebrae of atlas and axis, increase accuracy and reliability of the study, as well as the implementation of expert evaluation net the ability and prognosis of pathological conditions during the dislocation of the tooth-like process of the axis.

The inventive method can be applied in the departments of ultrasound diagnostics, specialized cabinets of ultrasound diagnostics, for the diagnosis of dislocation of the dentate process of the axis.

The inventive method for the diagnosis of dislocation of the dentate process of the axis is simple to use and provides a small investment of time for its implementation.

The distance between the tooth-like process of the axis and the lateral masses of the atlas in healthy and sick (M ± t)

Table Patient groups Amount of observation The distance between the tooth-like process of the axis and the lateral mass of the atlas, mm The value of asymmetry, mm On right Left Healthy 24 4.9 ± 0.3 5.0 ± 0.4 0.6 ± 0.3 Sick 14 5.0 ± 0.3 5.2 ± 0.3 1.4 ± 0.4 *

Claims (1)

A method for diagnosing a dislocation of the tooth-like process of the axis by ultrasound scanning, characterized in that the ultrasound scan is performed in the patient’s position, lying on his stomach, resting on his forehead, and the ultrasound probe is placed on the patient’s skin at the level of the posterior atlant tubercle directly below the lower edge of the occipital bone in such a way that the scanning plane is parallel to the lower edge of the occipital bone, the distance between the tooth-like process of the axis and the corresponding lateral masses is determined of the atlas of the right and left, calculate the magnitude of the asymmetry, while if the magnitude of the asymmetry exceeds 0.6 ± 0.3 mm, the dislocation of the tooth-like process of the axis is diagnosed.

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