RESUMO
The radiology literature describing the injuries of child abuse is very extensive. Articles on the distribution of injuries and the way in which a diagnosis was reached are less frequent. This article represents the detailed analysis of a cohort of patients, suspected of being victims of abuse, referred to the authors. It necessarily reflects personal experience and is not a population study. The distribution of the injuries in a cohort of 467 patients is reviewed.
Assuntos
Acidentes , Traumatismos Craniocerebrais/etiologia , Acidentes/mortalidade , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/lesões , Encéfalo/diagnóstico por imagem , Causas de Morte , Criança , Maus-Tratos Infantis/diagnóstico , Pré-Escolar , Estudos de Coortes , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/mortalidade , Diagnóstico Diferencial , Erros de Diagnóstico , Medicina Baseada em Evidências , Feminino , Humanos , Lactente , Escala de Gravidade do Ferimento , Imageamento por Ressonância Magnética , Masculino , Estudos Retrospectivos , Fraturas das Costelas/diagnóstico , Fraturas das Costelas/etiologia , Fraturas das Costelas/mortalidade , Síndrome do Bebê Sacudido/complicações , Síndrome do Bebê Sacudido/diagnóstico , Síndrome do Bebê Sacudido/mortalidade , Fraturas Cranianas/diagnóstico , Fraturas Cranianas/etiologia , Fraturas Cranianas/mortalidade , Análise de Sobrevida , Tomografia Computadorizada por Raios X , Reino Unido/epidemiologiaRESUMO
AIMS: To measure the range of rotation and determine the instantaneous axis of rotation of the atlanto-axial joint in healthy volunteers using magnetic resonance imaging (MRI) and to highlight the appearances of the rotated atlanto-axial joint on computed tomography (CT) and MRI. MATERIALS AND METHODS: Twenty-eight healthy volunteers were examined using MRI during maximal head rotation. In addition, an anatomical specimen of the atlanto-axial joint, fixed in varying degrees of rotation, was imaged using CT. RESULTS: At the extremes of physiological rotation in healthy subjects there is striking but incomplete loss of contact between the articular surfaces of the atlas (C1) and the axis (C2). The range of rotation to the right was 20-48.5 degrees (mean 32.4 degrees ) and to the left was 13-52.75 degrees (mean 34.2 degrees ). There was no significant difference between rotation to the right and left (P = 0.455). Total rotation was 45-88.5 degrees (mean 69.25 degrees ). The instantaneous axis of rotation was located within the odontoid peg. CONCLUSION: There is a wide range of atlanto-axial rotation in normal subjects. The instantaneous axis of rotation lies within the odontoid peg. The appearances of the rotated atlanto-axial joint are striking and may be misinterpreted as subluxation.
Assuntos
Articulação Atlantoaxial/fisiologia , Movimento/fisiologia , Adolescente , Adulto , Articulação Atlantoaxial/anatomia & histologia , Articulação Atlantoaxial/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Rotação , Tomografia Computadorizada por Raios XRESUMO
The vertebral column is composed of a series of joints, each capable of a specific range of movement. To investigate these movements, a study into the physiological range of rotation at the atlanto-axial joint has been undertaken. The movements and their interpretation under imaging conditions are crucial if any underlying spinal deformity or the consequences of trauma are present in an individual. 28 healthy volunteers were examined using dynamic Magnetic Resonance Imaging with maximum head rotation to the right and left sides in turn. An anatomical specimen of the atlanto-occipital joint was imaged using Computed Tomography with the specimen fixed in varying degrees of rotation. The results indicate that there is a significant but incomplete loss of contact between the articular surfaces of C1 (atlas) and C2 (axis). The range of motion to the right was between 20 and 48.5 degrees (mean 32.4 degrees) and to the left was between 13 and 52.75 degrees (mean 3.2 degrees). Statistical significance between left and right movement was not demonstrated. The instantaneous axis of rotation was examined for the joint and was found to be located within the odontoid peg (dens). These findings indicated that a wide range of movement occurs within the atlanto-axial joint in normal subjects. Furthermore, the appearances under imaging could be misinterpreted as a pathological subluxation. This has implications if the subject with a spinal deformity also has a dysplasia associated with a potential subluxation. The siting of the instantaneous axis of rotation within the odontoid is also important in furthering the understanding of the movement of this joint.
