Evaluation of the normal craniocervical junction craniometry in 137 asymptomatic patients / Evaluación de la craneometría de la unión craneocervical normal en 137 pacientes asintomáticos

SUMMARY: To our best knowledge, most of the craniometric studies on the normal craniocervical junction (CCJ), are still poorly studied and based on measurements taken from plain radiographs. In this study, the authors conducted a craniometric evaluation of the CCJ in a population without known CCJ abnormalities. The purpose of the study was to assess the normal CCJ craniometry based on measures obtained from CT scans. The authors examined 137 consecutive CCJ CT scans obtained in patients evaluated at their hospital for treatment of non-CCJ conditions between 2018 and 2019. Twelve craniometrical dimensions were conducted, including the relation of the odontoid with the cranial base, the atlantodental interval (ADI), the clivus length, and the clivus-canal angle (CCA).

Hasta donde sabemos, aun son escasos y pocos los estudios craneométricos respecto a la unión craneocervical normal (UCCN) y estos se basan en mediciones tomadas de radiografías simples. En este estudio, realizamos una evaluación craneométrica de la UCCN en una población sin anomalías conocidas. El propósito del estudio fue evaluar la craneometría UCCN normal en función de las medidas obtenidas de las tomografías computarizadas. Los autores examinaron 137 tomografías computarizadas UCCN consecutivas obtenidas en pacientes evaluados en su hospital para el tratamiento de condiciones no UCCN entre los años 2018 y 2019. Se realizaron doce dimensiones craneométricas, incluida la relación del proceso odontoides con la base del cráneo, el intervalo atlantodental (ADI), la longitud del clivus y el ángulo clivus-canal (CCA).

Artritis reumatoide de la columna cervical: aspectos clave para el cirujano ortopédico / Rheumatoid arthritis of the cervical spine: key aspects for the orthopedic surgeon

La artritis reumatoide es una enfermedad inflamatoria autoinmune crónica que afecta con frecuencia a la columna cervical. El diagnóstico clínico de la afección cervical puede ser difícil; por lo tanto, se recomienda la evaluación radiográfica sistemática de todos los pacientes. El tratamiento oportuno de estas lesiones es importante para preservar la independencia, la función neurológica, e, incluso, la vida de los pacientes. Este artículo es una revisión actualizada de todos los aspectos de la artritis reumatoide de la columna cervical relevantes para el cirujano ortopédico.

Rheumatoid arthritis is a chronic inflammatory autoimmune disease that frequently affects the cervical spine. The clinical diagnosis can be difficult; therefore, a systematic radiographic evaluation of all patients is recommended. The timely treatment of these lesions is important to preserve the self-reliance, the neurological function, and even the lives of the patients. The present article is an update of all the aspects pertaining to cervical spine rheumatoid arthritis that are relevant to the orthopedic surgeon.

Clinical symptoms and imaging findings of cervical instability in young adult / 中国骨伤

OBJECTIVE@#To explore clinical symptoms and X-ray imaging features of cervical instability in young adult represented by postgraduates with a master's degree in medicine.@*METHODS@#Totally 91 postgraduates with a master's degree in medicine were investigated from September to December 2021, including 45 males and 46 females;aged from 22 to 30 years old with an average of (25.30±2.18) years old. The cervical spondylosis-related discomfort symptoms of the subjects were collected and examined by the examiner for neck and shoulder tenderness point examination and cervical vertebra positive and lateral and functional X-ray radiography. According to the results of X-ray examination, the subjects were divided into stable cervical group and unstable cervical group.@*RESULTS@#Among 91 subjects, there were 50 patients with cervical instability, accounting for 54.90% of total number of subjects. The cervical curvature was abnormal in 78 patients, accounting for 85.70% of total number of subjects. Among 50 patients with cervical instability, 50 patients were diagnosed as cervical instability on the basis of angular displaxement(AD)≥ 11 °, including 13 cases of C3,4 instability, 30 cases of C4,5 instability and 7 cases of C5,6 instability;and 5 cases were diagnosed as cervical instability based on horizontal displacement(HD)≥ 3.5 mm, including 1 case of C3,4 instability and 4 cases of C4,5 instability. Compared with stable cervical group, the number of discomfort symptoms of neck pain, headache and shoulder pain in instability group was significantly higher than that of in stable cervical group(P<0.05);and the number of tenderness in spinous process space of C4,5 and C5,6, 2 cm adjacent to the spinous process of C2-C5 and the superior angle of the scapula (the stop point of levator scapulae) in the instability group was significantly higher than that in the stable cervical group (P<0.05);and the cervical curvature in the instability group was significantly lower than that in stable cervical group(P<0.05).@*CONCLUSION@#The incidence of cervical instability in young adult represented by postgraduates with a master's degree in medicine is high, they are mainly diagnosed as cervical instability on the basis of vertebral angular displacement ≥ 11°, and the instability segments are concentrated on C3,4, C4,5 and C5,6 segments, the occurrence of cervical instability is often accompanied by abnormalities of cervical curvature. Most of clinical manifestations are head, neck and shoulder pain, especially neck pain in unstable segment.

Correlative analysis of cervical curvature and atlantoaxial instability / 中国骨伤

OBJECTIVE@#To investigate the correlation between the changes of cervical curvature and atlantoaxial instability.@*METHODS@#The correlation between the changes of cervical curvature and atlantoaxial instability was retrospectively studied in 50 outpatients with abnormal cervical curvature (abnormal cervical curvature group) from January 2018 to December 2019. There were 24 males and 26 females in abnormal cervical curvature group, aged from 18 to 42 years old with an average of(30.62±5.83) years. And 53 patients with normal cervical curvature (normal cervical curvature group) during the same period were matched, including 23 males and 30 females, aged from 21 to 44 years with an average of(31.98±6.11) years. Cervical spine X-ray films of 103 patients were taken in lateral position and open mouth position. Cervical curvature and variance of bilateral lateral atlanto-dental space(VBLADS) were measured and recorded, Pearson correlation coefficient analysis was used to study the correlation between the changes of cervical curvature and atlantoaxial instability.@*RESULTS@#Atlantoaxial joint instability accounted for 39.6%(21/53) in normal cervical curvature group and 84.0%(42/50) in abnormal cervical curvature group. There was significant difference between two groups(P<0.01). VBLADS in abnormal cervical curvature group was (1.79±1.01) mm, which was significantly higher than that in normal cervical curvature group(0.55±0.75) mm(P<0.01). Pearson correlation coefficient analysis showed that the size of cervical curvature was negatively correlated with VBLADS.@*CONCLUSION@#Cervical curvature straightening and inverse arch are the cause of atlantoaxial instability, the smaller the cervical curvature, the more serious the atlantoaxial instability.

Identification of dental calcification stages as a predictor of skeletal development phase

ABSTRACT Objective: This study aimed to establish a correlation between the stages of tooth calcification of mandibular canines and second molars with the phases of skeletal development. Methods: In a consecutive series of panoramic, cephalometric and hand-wrist radiographs of 113 individuals (60 females and 53 males) with an average age of 12.24 ± 1.81 years, the stages of mandibular canine and second molar calcification, cervical vertebrae maturation indicators (CVMI) and skeletal maturity indicators (SMI) were classified. The variables were correlated by means of the Spearman's Rank test: chronological age, SMI, CVMI and tooth calcification stages. In order to assess whether the CVMI and tooth calcification stages were significant predictors of the SMI, an ordinal regression analysis was carried out. Results: The stages of CVMI (OR = 16.92; CI 95% = 6.45-44.39; p< 0.001) and calcification of the second molars (OR = 3.22; CI 95% = 1.50-6.92; p= 0.003) were significant predictors of SMI, however similar result was not observed for canines (OR = 0.52, CI 95% = 0.18-1.54; p= 0.239). Calcification stage E for boys, and E and F for girls corresponded to the pre-peak phase of pubertal growth. Stages G and H for boys, and F and G for girls coincided with peak of growth. In the final growth phase, the majority of second molars presented with root apex closure (stage H). Conclusion: The stages of calcification of the second molar may be considered predictors of the stage of skeletal development in the population studied.

RESUMO Objetivo: O presente estudo objetivou estabelecer uma correlação entre os estágios de calcificação dentária de caninos e segundos molares inferiores e as fases do desenvolvimento esquelético. Métodos: Em uma série consecutiva de radiografias panorâmicas, cefalométricas e de mão e punho de 113 indivíduos (60 meninas e 53 meninos) com idade média de 12,24 ± 1,81 anos, foram classificados os estágios de calcificação do canino e do segundo molar inferiores, indicadores de maturação das vértebras cervicais (IMVC) e indicadores de maturação esquelética (IME). As variáveis foram correlacionadas pelo teste de Correlação de Rank de Spearman: idade cronológica, IME, IMVC e estágios de calcificação dentária. A fim de avaliar se os estágios do IMVC e da calcificação dentária foram preditores significativos do IME, foi realizada uma análise de regressão ordinal. Resultados: Os estágios de IMVC (OR = 16,92; IC 95% = 6,45-44,39; p< 0,001) e calcificação dos segundos molares (OR = 3,22; IC 95% = 1,50-6,92; p= 0,003) foram preditores significativos de IME; no entanto, esse não foi o caso com dentes caninos (OR = 0,52, IC 95% = 0,18-1,54; p= 0,239). Os estágios de calcificação E para meninos e E e F para meninas corresponderam à fase pré-pico de crescimento puberal. Os estágios G e H para meninos e F e G para meninas coincidiram com o pico de crescimento. Na fase final de crescimento, a maioria dos segundos molares apresentou fechamento do ápice radicular (estágio H). Conclusão: Os estágios de calcificação do segundo molar podem ser considerados preditores do estágio de desenvolvimento esquelético na população estudada.

Establishment of an intelligent cervical vertebrae maturity assessment system based on cone beam CT data / 浙江大学学报·医学版

To establish an intelligent cervical vertebra maturity assessment system, and to evaluate the reliability and clinical value of the system. Sixty children aged were recruited in the study. Lateral cephalometric radiograph and cone beam CT (CBCT) were taken at the same period. Based on the CBCT data, the system automatically extracted the patient's facial area through Otsu's method, intercepted the sagittal plane by three-dimensional least squares method, captured the second to fourth cervical vertebrae by superpixel segmentation. And then selected points were marked automatically through morphological algorithm and manual method. Consistency test was performed on the two sets of data to compare the reliability of automated cervical morphology capture. According to the parameters of morphological identification, positioning and staging algorithms were designed to form the intelligent cervical vertebra maturity assessment system. The cervical vertebra maturity was also judged manually on the lateral cephalometric radiograph. The weighted Kappa test and the Gamma correlation coefficient were subsequently applied to evaluate the consistency and correlation. The results showed that the cervical vertebra features automatically captured based on CBCT data had a high accuracy on the overall morphological recognition. In the prediction of 8 inflection points out of 13 points, there was no significant difference between automatic and manual method on both X and Y axes (all >0.05). The assessment results of the cervical vertebra maturity of the intelligent system had strong consistency and correlation with the manual recognition results (weighted Kappa value=0.877, Gamma value=0.991, both <0.05). The intelligent cervical vertebrae maturity assessment system based on CBCT data established in this study presents reliable outcome and high degree of automation, indicating that the system may be used clinically.

Correlation between cervical curvature and cervical disc bulging in young patients with neck pain / 中国骨伤

OBJECTIVE@#To explore the correlation between the curvature of the cervical spine and the degree of cervical disc bulging in young patients with cervical pain.@*METHODS@#The clinical data of 539 young patients with neck pain from January 2015 to December 2018 were retrospectively analyzed. There were 251 males and 288 females, aged 18 to 40 (32.2±6.3) years old. The cervical curvature and cervical disc bulging were measured by cervical X-ray and MRI. According to cervical curvature, the patients were divided into 175 cases of cervical lordosis group (cervical curvature > 7 mm), 163 cases of cervical erection group (0

Fractura de "clay shoveler" como consecuencia de un accidente de trabajo en un peón agrícola: reporte de un caso / Clay shoveler's fracture as a result of a work injury in a manual laborer: case report

Resumen La fractura de "clay shoveler" es una fractura poco frecuente de la apófisis espinosa de las vértebras cervicales o torácicas superiores, más comúnmente entre C6 y T6 producida de manera aguda o crónica por fuerzas rotacionales ejercidas a nivel cervical en la labor de "palear", aunque también se han reportado casos asociados a la práctica de algunos deportes. Se presenta el caso de un péon agrícola de 43 años de edad que consulta por cervicalgia y sensación de inmovilidad luego de un movimiento brusco durante un levantamiento de tierra con pala, siendo que el ente asegurador no establece relación de causalidad, por lo que demanda a nivel judicial para valoración médico legal, documentándose fractura de "clay shoveler" en C7 y T1 según estudios radiológicos. La valoración médico legal del caso, que se sustentó en la documentación médica y estudios radiológicos, permitió determinar que la lesión evidenciada era consecuencia del accidente laboral reportado, estableciéndose la relación causal.

Abstract Clay shoveler's fracture is an infrequent lesion of the spinous process of the cervical or upper thoracic vertebrae, mainly between C6 and T6, produced acutely or chronically because of rotational forces exerted at the cervical level during shoveling, but some cases have been reported as a result of the practice of sports. We present the case of a 43-year old manual laborer who consulted because of cervical pain and range of motion limitation after a sudden move performed during shoveling, diagnosed with a clay shoveler's fracture in C7 and T1, treated conservatively. The patient was discharged after finishing treatment, since the insurance company dismissed causality. The medico legal assessment of the case, based on medical documentation, radiological findings and an Orthopedics consult, helped stablish causality since it was determined that the fracture was a result of the accident reported.

Cone beam computed tomography evaluation of the relationship between atlantodental interval and skeletal facial morphology in adolescents / Avaliação por tomografia computadorizada de feixe cônico da relação entre o intervalo atlantodental e a morfologia esquelética facial em adolescentes

Abstract Introduction: In the pediatric population, computed tomography examination of the upper cervical spine plays an important role in the diagnosis of neurological injuries involving that region. Due to the interconnected nature of the craniofacial structures, a structural change in one is expected to also cause changes in the other structures. Objective: The aim of this study was to evaluate relationships between atlantodental interval, cervical vertebral morphology, and facial structure in healthy adolescents using cone beam computed tomography. Methods: Thirty subjects aged 14-20 years (10 males, mean age: 17.2 years; 20 females, mean age: 17.9 years) were included in the study. The anterior, lateral and posterior atlantodental intervals, and vertical and anteroposterior dimensions of the first and second cervical vertebrae were evaluated from cone beam computed tomography images. Facial morphology was evaluated using 7 parameters on lateral cephalometric cone beam computed tomography images and 6 parameters on posteroanterior images. The Mann-Whitney U test and Wilcoxon test were used for statistical analyses. Results: Comparisons between males and females showed that most parameters were larger in males, with significant differences in vertical facial dimensions (anterior lower face height: p= 0.05; anterior upper face height: p= 0.001), (distance between the most internal point of the frontozygomatic suture and midsagittal reference plane; p= 0.01), (the distance between the deepest point of the right alveolar maxillar process and midsagittal reference plane; p= 0.001), and C2 vertebral dimensions. The anterior and lateral atlantodental interval values correlated with maxilla position relative to the mandible angle, and the anterior atlantodental interval correlated with lower anterior facial height (p= 0.05). Dimensional measurements of the C1 and C2 vertebrae were correlated with both anterior facial heights and some posteroanterior parameters. Conclusion: Sagittal, vertical, and transverse facial dimensions and positions were strongly associated with C1 and C2 vertebral dimensions, and the maxillomandibular relationship may affect atlantodental interval. Therefore, including craniofacial features in assessment of the atlantodental area and vertebral distances in adolescents may be beneficial.

Resumo Introdução: Na população pediátrica, a tomografia computadorizada da coluna cervical alta tem um importante papel no diagnóstico de lesões neurológicas que envolvem essa região. Devido à natureza interconectada das estruturas craniofaciais, espera-se que uma mudança estrutural em uma delas também cause alterações nas outras estruturas. Objetivo: Avaliar as relações entre o intervalo atlantodental, a morfologia vertebral cervical e a estrutura facial em adolescentes saudáveis com a tomografia computadorizada de feixe cônico. Método: Trinta indivíduos entre 14 e 20 anos (10 homens, média de 17,2 anos; 20 mulheres, média de 17,9 anos) foram incluídos no estudo. O intervalo atlantodental anterior, lateral e posterior e as dimensões vertical e anteroposterior da primeira e segunda vértebras cervicais foram avaliados a partir de imagens de tomografia computadorizada de feixe cônico. A morfologia facial foi avaliada utilizando-se sete parâmetros em imagens de tomografia computadorizada de feixe cônico cefalométricas laterais e seis parâmetros em imagens posteroanteriores. O teste U de Mann-Whitney e o teste de Wilcoxon foram utilizados para as análises estatísticas. Resultados: As comparações entre homens e mulheres mostraram que em sua maioria os parâmetros foram maiores no sexo masculino, com diferenças significantes nas dimensões faciais verticais (altura facial anterior inferior: p = 0,05; altura facial anterior superior: p = 0,001), distância entre o ponto mais interno da sutura fronto-zigomática e plano de referência médio-sagital; p = 0,01distância entre o ponto mais profundo do processo alveolar do maxilar direito e o plano de referência médio-sagital; p = 0,001) e as dimensões do corpo vertebral C2. O intervalo atlantodental anterior e lateral correlacionaram-se com o ângulo da posição da maxila em relação à mandíbula e o intervalo atlantodental anterior correlacionou-se com altura facial anterior inferior (p = 0,05). Medidas das dimensões das vértebras C1 e C2 foram correlacionadas com as alturas faciais anteriores e alguns parâmetros póstero-anteriores. Conclusão: As dimensões e posições faciais sagitais, verticais e transversais foram fortemente associadas às dimensões dos corpos vertebrais C1 e C2 e a relação maxilomandibular pode afetar o intervalo atlantodental. Portanto, incluir características craniofaciais na avaliação da área atlantodental e das distâncias vertebrais em adolescentes pode ser benéfico.

Espondiloptosis traumática C7-T1 sin compromiso neurológico / Traumatic spondyloptosis C7-T1 without neurologic deficit

Resumen: La espondiloptosis traumática es una lesión muy rara y grave generalmente causada por traumatismos de alta energía. Consiste en la dislocación anterior o posterior de 100% o más al cuerpo vertebral subyacente, lo que puede generar compresión y lesión total de la médula espinal, produciendo déficit neurológico; este tipo de lesión representa la etapa 4 y 5 de Allen. Caso clínico: Masculino de 50 años quien sufre accidente automovilístico al colisionar contra muro de contención, generándose lesión de tipo hiperextensión-compresión cervicotorácica, manejado con hemicorpectomía C7, discectomía C7-T1, espondilodesis con placa anterior (C6-C7, C7-T1), toma y aplicación de injerto, abordaje posterior + fascetectomías de C7 + fijación transfacetaria C6 y transpedicular de T1. Discusión: Encontramos que la estabilización temprana con pinza de Gardner más el abordaje anterior y posterior brindan adecuados resultados en cuanto a integridad sensitiva y motora del paciente así como una pronta rehabilitación.

Abstract: Traumatic spondyloptosis is a serious injury usually caused by high-energy trauma; It consists of the anterior or posterior dislocation of 100% or more of the underlying vertebral body, which can become a total injury of the spinal cord, producing a neurological deficit; this type of injury represents stage 4 and 5 of Allen-Ferguson. Clinical case: A 50-year-old man who suffers a car accident, he receive frontal impact when he was a driver, colliding with the retaining wall, referred from another hospital to emergency room, managed with C7 hemicorpectomy, c7-t1 discectomy, spondylodesis with anterior plate (C6-T1), and posterior approach + Fascetectomies of C7-T1, facet joint screws C6 and transpedicular fixation of T1. Discussion: Subaxial cervical spondyloptosis is relatively rare clinical entity, a complete clinical examination is important in diagnosis, taking in considerations the injury mechanism. For treatment we have a multiple options, at this case anterior-posterior (360 degrees) treatment it was the better option for Us; however, must be personalized and consider the early rehabilitation of patient.

Population distribution and clinical characteristics in rheumatoid arthritis patients with cervical spine instability / 北京大学学报(医学版)

OBJECTIVE@#To investigate the population distribution of cervical spine instability in rheumatoid arthritis (RA) patients, and to analyze the clinical characteristics in RA patients with cervical spine instability.@*METHODS@#A total of 439 RA patients who had completed cervical spine X-ray examination from Department of Rheumatology and Immunology of Peking University Shenzhen Hospital and Peking University Third Hospital from August 2015 to March 2019 were enrolled. The clinical data, laboratory data and cervical radiographic data were collected and analyzed by t-test, rank sum test and Chi-square test to clarify the clinical characteristics in the RA patients with cervical spine instability.@*RESULTS@#Of the 439 RA patients, 80.9% (355/439) were female, with an average age of (52.9±13.9) years, a median duration of the disease was 60 months, the shortest history was 2 weeks, and the longest history was up to 46 years. 29.6% (130/439) of the RA patients showed cervical spine instability. Among them, 20 RA patients were complicated with two different types of cervical instability, the atlantoaxial subluxation (AAS) accounted for 24.6% (108/439), the vertical subluxation (VS) accounted for 7.3% (32/439) and the subluxial subluxations (SAS) accounted for 2.3% (10/439). The patients with cervical spine instability had a longer duration of disease [120 (36, 240) months vs. 48 (12, 120) months], a higher proportion of peripheral joint deformity (56.9% vs. 29.9%), and a higher visual analog scale (VAS) measuring general health score (4.89±2.49 vs. 3.93±2.38), a lower hemoglobin [(111.31±19.44) g/L vs. (115.56±16.60) g/L] and a higher positive rate of anti-cyclic citrullina-ted peptide (CCP) antibody (90.8% vs. 76.6%). There were no significant differences in gender, age, number of swollen joints, number of tenderness joints, erythrocyte sedimentation rate, rheumatoid factor level, 28-joint disease activity score, positive rate of anti keratin antibody, duration of glucocorticoid use and duration of disease modifying anti-rheumatic drugs use between the two groups.@*CONCLUSION@#In the study, 29.6% of the RA patients showed cervical spine instability. RA patients with cervical spine instability had a long-term disease, a higher proportion of peripheral joint deformity, a higher VAS measuring general health score, a lower hemoglobin and a higher positive rate of anti-CCP antibody.

Subluxación atloaxoidea. Emergencia en la atención clínico quirúrgica / Atlantoaxial subluxation. Emergency in clinical surgical care

Introducción: la subluxación atloaxoidea es un trastorno de la columna cervical, a nivel de las vértebras C1 y lC2 que causa deterioro en la rotación del cuello porque la faceta anterior de C1 se fija en la faceta de C2. Objetivo: enfatizar la importancia del diagnóstico temprano de la subluxación atlantoaxoidea en pacientes con o sin evidencia de trauma para que sea identificada como emergencia clínico quirúrgica. Desarrollo: en el presente trabajo se enfatiza en la necesidad de identificar eventos o complicaciones de la subluxación atloaxoidea que pongan en peligro la vida de los pacientes y requieran de la atención clínico quirúrgica de manera emergente por la compresión de médula espinal que puede ocasionar, de modo que en algunos reportes bibliográficos es clasificada como una emergencia. Conclusiones: existen muchas formas de presentación de la subluxación atloaxoidea, muchas de ellas pueden cursar con complicaciones que constituyan emergencias, así como variados tratamientos que deben ser valorados críticamente porque pueden ocasionar consecuencias mayores que la propia enfermedad, lo que habla a favor de lo imprescindible de un diagnóstico certero y de un enfoque multidisciplinar(AU)

Introduction: the atlantoaxial subluxation is a disorder of the cervical spine, at the level of the C1 and C2 vertebrae that causes deterioration in the rotation of the neck because the anterior facet of C1 is fixed on the facet of C2. Objective: To emphasize the importance of early diagnosis of atlantoaxial subluxation in patients with or without evidence of trauma to be identified as a surgical clinical emergency. Development: In the present work, emphasis is placed on the need to identify events or complications of atlantoaxial subluxation that endanger the life of patients and require surgical clinical attention in an emergent manner due to the compression of the spinal cord that may result from so that in some bibliographic reports it is classified as an emergency. Conclusions: There are many forms of presentation of atlantoaxial subluxation, many of them can present complications that constitute emergencies, as well as various treatments that must be critically evaluated because they can cause greater consequences than the disease itself, which speaks in favor of the essential of an accurate diagnosis and a multidisciplinary approach(AU)

B-mode ultrasonography and gray scale histogram for evaluation of the nuchal ligament in Quarter horse / Ultrassonografia modo-B e histograma em escala de cinza para avaliação do ligamento nucal em equinos da raça Quarto de Milha

The gray scale histogram (GSH) makes it possible to measure the amount and distribution of gray shade frequencies, providing quantitative information on both echogenicity and echotexture of tissues. There is a need to diminish the subjectivity of the ultrasound images of the nuchal ligament (NL). This work proposes to evaluate the NL by ultrasound B-mode GSH images in different ages of Quarter horses. It used 15 healthy Quarter horses, which were classified by age into three different groups: "baby" (1), "sobreano" (2) and "adult" (3). The animals were submitted to chemical restraint for the ultrasound examination. Subsequently, the GSH tool was used in each image for statistical analysis. There was a significant difference between Mean and Mode between groups. Group 1 differed significantly when compared to Group 2 and 3. Group 2 presented superior echogenicity to Group 1 and 3. The height of the NL did not vary considerably between groups. GSH indicated that the echogenicity of NL in Quarter horses varies with age.(AU)

O histograma em escala de cinza (HEC) possibilita a mensuração da quantidade e distribuição da frequência de tonalidades de cinza, fornecendo informações quantitativas, tanto sobre a ecogenicidade quanto a ecotextura dos tecidos. Havendo a necessidade de diminuir a subjetividade das imagens ultrassonográficas do ligamento nucal (LN), esse trabalho propôs avaliar o LN por imagens ultrassonográficas modo-B pelo HEC em diferentes idades de cavalos da raça Quarto de Milha. Utilizou 15 cavalos da raça Quarto de Milha saudáveis os quais foram classificados por idade em três grupos diferentes: "baby" (1), "sobreano" (2) e "adulto" (3). Os animais foram submetidos a contenção química para a realização do exame ultrassonográfico. Posteriormente, a ferramenta HEC foi empregada em cada imagem para análise estatística. Houve diferença significativa entre as variáveis "Mean" e "Mode" entre os grupos. O Grupo 1 diferenciou significativamente quando comparado ao Grupo 2 e 3. O Grupo 2 apresentou ecogenicidade superior ao Grupo 1 e 3. Quanto à altura do LN não teve variação considerável entre os grupos. O HEC indicou que a ecogenicidade do LN em cavalos Quarto de Milha varia conforme a idade.(AU)

Correlación entre la edad cronológica y dental con los estadios de maduración vertebral en pacientes de 5 a 15 años / Correlation between the chronological and dental age with the vertebral maturation stages in patients from 5 to 15 years old

El uso de un método rápido y efectivo para la estimación de la maduración esquelética de los pacientes pediátricos es fundamental para la aplicación oportuna de tratamientos ortopédicos/ortodónticos. En Odontología Pediátrica, la toma de una radiografía panorámica, como método diagnóstico de rutina, puede servir para estimar con precisión el estadio de maduración en estos pacientes, mediante el cálculo de la edad dental. El objetivo del presente trabajo fue determinar la correlación entre las edades cronológica y dental con los estadios de maduración esquelética de las vértebras cervicales, a través del método estadístico no paramétrico con Rho de Spearman. Se utilizó un diseño observacional, transversal y analítico. La muestra consistió en 516 expedientes de pacientes entre los 5 y 15 años de edad, sistémicamente sanos, con radiografías panorámica y lateral de cráneo, tomadas en la misma fecha. Se determinó la edad cronológica de cada paciente según su historia clínica. Se realizó el cálculo de la edad dental de cada paciente con el método de Demirjian, y se determinó el estadio de maduración de vértebras cervicales con el método de Lamparski. Se determinó una correlación de 72 % entre la edad cronológica y la maduración ósea vertebral; una correlación del 66 % entre la edad dental y la maduración ósea, y una correlación del 86 % entre la edad cronológica y la dental. De acuerdo con estos resultados, tanto la edad cronológica y dental presentan una alta correlación con la edad de maduración vertebral. Se concluye así que la edad dental y cronológica son indicadores apropiados para estimar el estadio de maduración esquelética de los pacientes pediátricos.

The use of fast and effective methods for estimating the skeletal maturity for pediatric patients, is fundamental for the opportune application of orthopedic/orthodontic treatments. In pediatric dentistry, the panoramic radiography as a routine diagnostic method, can be used to estimate the stage of maturation in these patients, through the calculation of dental age. The aim of the present study is to determine the correlation between the chronological and dental ages, with the cervical vertebrae stages of skeletal maturity, through the non-parametric Spearman statistical method. An observational, transversal, and analytical design was employed. The sample consisted of 516 records from patients between 5 and 15 years of age, systemically healthy, with panoramic and lateral skull radiographs taken on the same date. The chronological age of each patient was determined according to the clinical history. Dental age of each patient was calculated with the Demirjian approach, and the stage of maturation of cervical vertebrae was determined by means of the Lamparski method. The results showed a correlation of 72 % between chronological age and bone maturation, a correlation of 66 % between dental age and bone maturation, and a correlation of 86 % between chronological and dental age. It is concluded that both chronological and dental age exhibit a high correlation with the correspondent stage of vertebral maturity. Thus, dental and chronological age are appropriate indicators to estimate, with high precision the stage of skeletal maturation in pediatric patients.

Análisis craneocervical en sujetos con respiración oral y nasal / Craneocervical analysis in subjects with oral and nasal breathing

La influencia de la función respiratoria en el desarrollo de estructuras orofaciales y postura craneocervical ha sido ampliamente discutida. El objetivo del estudio fue comparar valores cefalométricos de la región craneocervical e hioidea en sujetos con respiración nasal y oral. Se incluyeron sujetos de entre 18 y 27 años, de ambos sexos, donde 20 presentaban diagnóstico de respiración oral y 20 no presentaban esta alteración; mediante telerradiografía lateral de cabeza y cuello se realizó análisis cefalométrico craneocervical de Rocabado y aplicación de la técnica de Penning, obteniendo medidas craneocervicales e hioideas, dimensión anterior nasofaríngea y curvatura cervical. Para el análisis estadístico se utilizó la prueba de normalidad Shapiro-Wilk y la prueba T para muestras independientes, considerando un valor de p <0,05 para obtener diferencias significativas; en aquellos parámetros en donde no se presentó distribución normal se aplicó la prueba U de Mann-Whitney. No se encontraron diferencias significativas entre los grupos de estudio y los valores cefalométricos analizados, a excepción de la distancia entre la base del hueso occipital y el arco posterior del atlas (p=0,03). Existen limitadas diferencias cefalométricas entre sujetos con respiración oral y respiración nasal, no asociándose el espacio aéreo nasofaríngeo con las modalidades de respiración estudiadas. Deben ser consideradas condiciones de morfología facial o mandibular, para determinar más adecuadamente la influencia de los parámetros cefalométricos en el diagnóstico del modo respiratorio en estudios futuros.

The influence of respiratory function on the development of orofacial structures and craniocervical posture has been widely discussed. The objective of the study was to compare cephalometric values of the craniocervical and hyoid region in subjects with nasal and oral respiration. Subjects between 18 and 27 years of age, of both sexes, were included, where 20 presented oral breathing diagnosis and 20 did not present this alteration; using lateral telerradiography of the head and neck, craniocervical cephalometric analysis was performed of Rocabado and Penning technique was applied, obtaining craniocervical and hyoid measurements, anterior nasopharyngeal dimension and cervical curvature. For the statistical analysis we used the Shapiro-Wilk normality test and the T test for independent samples, considering a value of p <0.05 to obtain significant differences; in those parameters where no normal distribution was presented, the MannWhitney U test was applied. No significant differences were found between the study groups and the cephalometric values ??analyzed, except for the distance between the base of the occipital bone and the posterior arch of the atlas (p=0.03). There are limited cephalometric differences between subjects with oral breathing and nasal breathing, with no association of the nasopharyngeal air space with the breathing modalities studied. Conditions of facial or mandibular morphology should be considered in order to determine more adequately the influence of cephalometric parameters in the diagnosis of the respiratory mode in future studies.

Síndrome de Klippel-Feil autosómico dominante: una malformación de segmentación vertebral / Klippel-Feil autosomal dominant syndrome: a malformation of vertebral segmentation

INTRODUCCIÓN: El síndrome de Klippel-Feil constituye un desorden esquelético complejo altamente heterogéneo caracterizado por la fusión congénita de dos o más vértebras cervicales. La triada clínica clásica consiste en cuello corto, implantación baja del cabello y limitación para los movimientos del cue llo. Las mutaciones asociadas se localizan en los loci del gen GDF3 (cromosoma 12p13.31), GDF6 (cromosoma 8q22.1) y MEOX1 (cromosoma 17q21.31). OBJETIVO: Describir los hallazgos clínico- radiológicos y genealogía de una paciente con síndrome de Klippel-Feil. CASO CLÍNICO: Paciente de 5 años de edad con cuello corto, cabello de implantación baja posterior, limitación para los movimientos de lateralización. La radiografía cervical en flexión y extensión evidenció bloques de fusión entre C1-2-3, C4-5 y C6-7. En la tomografía axial computarizada de tórax se apreció múltiples hemivértebras del tercio superior de las vértebras torácicas correspondientes a las costillas I-IV. El cariotipo fue normal, 46, XX. La penetrancia reducida estuvo presente en cinco de los miembros de la familia. La fusión de C2-3 predominó en cuatro y en un individuo la fusión baja en C5-6. Tres de los cinco individuos afectados tenían fusión entre el hueso grande y ganchoso. CONCLUSIÓN: La malformación de segmentación vertebral congénita constituye un caso de interés por tratarse de un diagnóstico infrecuente en la edad pediátrica y cuya sospecha puede generarse a partir del examen clínico, estudio de imágenes complementado con la interpretación de la genealogía en los trastornos de herencia mendeliana, permitiendo brindar un oportuno asesoramiento genético a la familia.

INTRODUCTION: Klippel-Feil syndrome is a highly heterogeneous complex skeletal disorder characterized by the con genital fusion of two or more cervical vertebrae. The classic clinical triad consists of a short neck, low hairline, and neck movements limitation. The associated mutations are located in the loci of the GDF3 gene (chromosome 12pl3.31), GDF6 (chromosome 8q22.1), and MEOXI (chromosome 17q21.31). OBJECTIVE: To describe the clinical-radiological findings and pedigree of a patient with Klippel-Feil syndrome. CLINICAL CASE: A 5-year-old patient with short neck, low posterior hairline, and limitation of lateral movements. The cervical flexion and extension radiographs showed fusion blocks between C1-2-3, C4-5, and C6-7. The chest CT scan showed multiple hemivertebrae in the upper third of the thoracic vertebrae corresponding to ribs 1-tv. The karyotype was normal, 46, XX. Reduced penetrance was present in five of the family members. The fusion of C2-3 was present in four members and one individual had low fusion in C5-6. Three of the five affected individuals had a fusion between the capitate and the hamate bone. CONCLUSION: The malformation of congenital vertebral segmentation is a case of interest since it is an uncommon diagnosis in the pediatric age and whose clinical suspicion can be generated from the clinical examination, radiological study com plemented with the pedigree interpretation in Mendelian inheritance disorders, allowing to provide opportunely genetic counseling to the family.

Método não ionizante de rastreamento da escoliose idiopática do adolescente em escolares / Non-ionizing method of screening adolescent idiopathic scoliosis in schoolchildren

Resumo Escoliose idiopática do adolescente (EIA) atinge de 2% a 4% de jovens no Brasil. Repetidas exposições aos exames radiológicos, no acompanhamento desta deformidade, podem ser danosos à saúde. O objetivo deste estudo é apresentar um protocolo de fotogrametria, como método não ionizante para quantificação da escoliose, e relacioná-lo ao método radiológico de Cobb. Dezesseis indivíduos portadores de escoliose idiopática (21,4 ± 6,1 anos de idade e 19,8±0,2 de índice de massa corporal) foram submetidos à radiografia posteroanterior do tronco, de pé e, posteriormente, fotografia do tronco posterior, após receberem marcadores anatômicos nos processos espinhosos das vértebras C7 até L5. As imagens foram encaminhadas para análise independente de dois examinadores treinados na quantificação da escoliose para o tipo de imagem recebida. A média angular torácica de Cobb e de fotogrametria foram 36,14° e 36,43°, respectivamente. A diferença média entre os métodos foi de 4,1°. Não houve diferença estatisticamente significante (p-valor < 5%) entre eles. A fotogrametria, por ser não ionizante, ter baixo custo e ser portátil, poderá representar uma alternativa ao método radiológico. Novos estudos são necessários no aprimoramento das técnicas não ionizantes no rastreamento da EIA.

Abstract Adolescent idiopathic scoliosis (AIS) affects 2% to 4% of young people in Brazil. Repeated exposures to radiation used in the monitoring of the deformity can be harmful to the health. This study aimed to present a photogrammetry protocol as a non-ionizing method to quantify scoliosis and relate it to the Cobb radiological method. Sixteen individuals with idiopathic scoliosis (age: 21.4 ± 6.1 years, body mass index: 19.8 ± 0.2 kg/m2) underwent standing posteroanterior X-ray examination of the trunk. Additionally, markers were placed on the spinal processes of the C7 to L5 vertebrae, and posterior trunk photographs were taken. All images were sent for independent analysis by two examiners who were trained in the quantification of scoliosis. The average of the thoracic curvature evaluated through the photogrammetry and Cobb methods were 36.43° and 36.14°, respectively. With an average difference of 4.1°, the methods were not statistically different (p < 0.05). As a non-ionizing method that is low cost and portable, photogrammetry may represent a suitable alternative to the radiological method. Further studies are needed for the improvement of non-ionizing techniques in AIS screening.