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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/04/05 23:50:33」(JST)

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The atlanto-axial joint is a joint in the upper part of the neck between the first and second cervical vertebrae; the altas and axis.

The atlanto-axial joint is of a complicated nature. It consists of no fewer than four distinct joints.^{[citation needed]}

There is a pivot articulation between the odontoid process of the axis and the ring formed by the anterior arch and the transverse ligament of the atlas.

Lateral and medial joints

There are two atlanto-axial joints: median and lateral:^[1]

The median atlantoaxial joint is sometimes considered a double joint:^[2]
- one between the posterior surface of the anterior arch of atlas and the front of the odontoid process
- one between the anterior surface of the ligament and the back of the odontoid process

The lateral atlantoaxial joint involves the lateral mass of atlas and axis.^[3] Between the articular processes of the two bones there is on either side an arthrodial or gliding joint.

Ligaments

The ligaments connecting these bones are:

Articular capsules
Anterior atlantoaxial ligament
Posterior atlantoaxial ligament
Transverse ligament of the atlas

The atlantoaxial joint in common terminology is actually a composition of three: two lateral and one median atlantoaxial joints. Because of its proximity to the brain stem and importance in stabilization, fracture or injury at this level can be catastrophic. Common trauma and pathologies include (but are not limited to):

The Dens: significant depression on the skull can push the dens into the brainstem, causing death. The dens itself is vulnerable to fracture due to trauma or ossification.

Transverse ligament: Should the transverse ligament of the atlas fail due to trauma or disease, the dens is no longer anchored and can travel up the cervical spine, causing paralysis. If it reaches the medulla death can result. Alar ligaments: stress or trauma can stretch the weaker alar ligaments, causing an increase in range of motion of approximately 30%.

Posterior Atlanto-Occipital Membrane: genetic traits can sometimes result in ossification, turning the groove into an foramen.

Capsule

The atlantoaxial articular capsules are thick and loose, and connect the margins of the lateral masses of the atlas with those of the posterior articular surfaces of the axis.

Each is strengthened at its posterior and medial part by an accessory ligament, which is attached below to the body of the axis near the base of the odontoid process, and above to the lateral mass of the atlas near the transverse ligament.

References

^ Federative Committee on Anatomical Terminology (1998). Terminologia anatomica: international anatomical terminology. Thieme. pp. 27–. ISBN 978-3-13-114361-7. Retrieved 17 June 2010.
^ Carmine D. Clemente (2010). Clemente's Anatomy Dissector. Lippincott Williams & Wilkins. pp. 361–. ISBN 978-1-60831-384-6. Retrieved 17 June 2010.
^ ii/l/lateral_atlantoaxial_joint article at GE's Medcyclopaedia

Bibliography

Dalley, Arthur F; Moore, Keith L. Clinically Oriented Anatomy Fourth Edition. Baltimore. Lippincott Williams & Wilkins, 1992.
Saladin, Kenneth S. Anatomy &Physiology: the Unity of Form and Function. New York. McGraw Hill, 2007.

External links

Roche Lexicon - illustrated navigator, at Elsevier 25420.000-1

UpToDate Contents

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English Journal

Atlantoaxial dislocation in a child affected by warfarin embryopathy: a case report.

Agarwal M, Phadke SR.SourceDepartment of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Clinical dysmorphology.Clin Dysmorphol.2013 Jul;22(3):124-6. doi: 10.1097/MCD.0b013e3283630275.
PMID 23722702

Symptomatic Atlantoaxial Instability in an Adolescent with Trisomy 21 (Down's syndrome).

Dedlow ER, Siddiqi S, Fillipps DJ, Kelly MN, Nackashi JA, Tuli SY.Source1University of Florida, Gainesville, FL, USA.
Clinical pediatrics.Clin Pediatr (Phila).2013 Jul;52(7):633-8. doi: 10.1177/0009922813482178. Epub 2013 Apr 5.
Atlantoaxial instability (AAI) occurs in 15% of children with Trisomy 21. Health supervision guidelines were revised by the American Academy of Pediatrics in 2011 to reflect advances in care for children with special health care needs (CSHCN). Previous guidelines recommended cervical spine radiologi
PMID 23564301

Strain rate dependent properties of human craniovertebral ligaments.

Mattucci SF, Moulton JA, Chandrashekar N, Cronin DS.SourceUniversity of Waterloo, Waterloo, ON, Canada N2L 3G1.
Journal of the mechanical behavior of biomedical materials.J Mech Behav Biomed Mater.2013 Jul;23:71-9. doi: 10.1016/j.jmbbm.2013.04.005. Epub 2013 Apr 17.
Craniovertebral ligaments were tested to failure under tensile loading. Ligaments tested included: transverse ligament, anterior atlanto occipital membrane, posterior atlanto occipital membrane, capsular ligaments between Skull-C1 and C1-C2, anterior atlantoaxial membrane, posterior atlantoaxial mem
PMID 23665484

Japanese Journal

経験と考察軸椎歯突起後方偽腫瘍に対して手術的治療を施行した経験

富永冬樹,白澤建蔵,山下彰久 [他]
整形外科 = Orthopedic surgery 66(4), 311-314, 2015-04
NAID 40020401799

Two cases of multiple infarctions due to vertebral arterial occlusion associated with atlantoaxial subluxation caused by rheumatoid arthritis

Baba Hideo,Tateishi Yohei,Tagami Atsushi,Tsuda Keiichi,Yoda Itaru,Koseki Hironori,Tomita Masato,Kawakami Atsushi,Osaki Makoto
Acta medica Nagasakiensia 59(3), 99-102, 2015-03
… This revealed a destroyed right atlantoaxial (AA) joint and right VA occlusion, which had caused the infarction. …
NAID 120005593511

Surgical Treatment of Gorham's Disease with Massive Osteolysis of the Skull and Cervical Spine: A Case Report and Review of Literature

, , , ,
NMC Case Report Journal 2(2), 80-84, 2015
… Although 10 cases involving the skull and cervical spine have been reported in the literature, little is available concerning the surgical treatment of either atlantoaxial dislocation or basilar impression. … Multiple surgical treatments to decompress the spinal cord and stabilize the skull and upper cervical spine with autologous fibular grafts were performed in order to prevent the progression of atlantoaxial dislocation and basilar impression. …
NAID 130005064618

Related Pictures

★リンクテーブル★

リンク元	「環軸」「環軸椎」「atlanto-axial」
拡張検索	「atlantoaxial subluxation」

「環軸」

Atlanto-axial joint
	Anterior atlantooccipital membrane and atlantoaxial ligament
	Posterior atlantooccipital membrane and atlantoaxial ligament
Latin	Articulatio atlantoaxialis mediana, articulatio atlantoaxialis lateralis
Gray's	subject #73 292
MeSH	Atlanto-Axial+Joint