齿突游离小骨的病因学研究进展.docVIP

齿突游离小骨的病因学研究进展 赵 登，王圣林，刘晓光，王 超 （100191北京，北京大学第三医院骨科） [关键词] 齿突游离小骨；发生发育；病因学；先天性；获得性 [中图法分类号] [文献标志码] A Etiology analysis of os odontoideum Zhao Deng, Wang Shenglin, Liu Xiaoguang, Wang Chao (Department of Orthopedics, Third Hospital of Peking University, Beijing, 100191,China) [Abstract] Os odontoideum (OO) is an anatomical anomaly in which odontoid process separates from the body of C2, and appears as an ossicle with smooth circumferential cortical margins. OO may be incidental finding in asymptomatic patients. OO may also lead to instability of the atlanto-axial joint and can present with a wild range of symptoms and signs. The axis vertebra has a unique developmental organization. The final axis shape is formed by the sequential fusion of the apical cap of the dens, the body of dens and the axis body. The etiology of OO remains controversial in the literature. Some authors considered it is from congenital fusion failure between the dens and the body of the axis. Some authors supported the acquired hypothesis that OO resulted from an unrecognized fracture and subsequently avascular necrosis and osseous remodeling. The etiology for OO may be multifactorial which may include congenital and traumatic causes. [Key words] os odontoideum; embryology and development; etiology; congenital hypothesis; acquired hypothesis Corresponding author: Wang Chao , E-mail： HYPERLINK mailto:wangchaoo@ wangchaoo@ [通信作者] 王 超，男，硕士，教授，主任医师，《中华外科杂志》特邀编委、《中国脊柱脊髓杂志》特邀审稿人、《中华骨科杂志》通信编委。负责北京大学十五“211工程”运动系统疾病学科群子项目《寰枢关节外伤和先天畸形的外科治疗》，获得北京大学“211工程”《寰枢关节外伤和先天畸形的外科治疗》的项目资助。主要从事上颈椎病损的诊断和治疗方面的研究。以第一作者或通信作者发表论文十余篇。E-mail：wangchaoo@ 齿突游离小骨是指表面被以皮质骨的游离小骨取代了正常齿突，齿突与枢椎椎体间无骨性连接。由于寰枢关节的复杂结构，齿突游离小骨容易导致寰枢关节不稳或脱位。在临床上，齿突游离小骨患者可能没有任何症状，也可能出现头颈痛、斜颈、脊髓压迫症状，如感觉异常、肢体活动障碍等，甚至可能压迫延髓、脊髓交界区而产生相应的症状，临床上须引起重视。齿突游离小骨的病因尚有较大争议。明确齿突游离小骨的病因，可以对人群进行筛查，对发现齿突游离小骨畸形的个体进行密切观察、随访，避免严重临床症状的发生或及早手术干预，避免发生严重的脊髓病。本文仅就齿突的发育形成及当前关于齿突游离小骨的病因研究作一综述。 齿突的胚胎发生和发育 在胚胎学上椎体起源于外胚层细胞（epiblast cell）。由注定成为轴旁间充质（paraxial me