Nieminen R A
Ann Chir Gynaecol Fenn. 1975;64(6):375-84.
In a series of 285 cases of injuries of the lower cervical spine, fractures of the vertebral arch constituted 12.6%. 27 cases treated conservatively were analysed in view of their subtyping and clinical properties and with reference to the choice of treatment. Five different main subtypes of fractures of the vertebral arch of the lower cervical spine can be distinguished: 1) Bilateral fracture of lamina, without displacement of the vertebra or with subluxation. The assessment of potential instability is discussed, and criteria for its evaluation are presented; 2) Bilateral fracture of lamina combined with locked luxation, which is difficult to reduce by conservative means; 3) Detachment of the articular mass, which invariably causes instability, which, however, is usually relative because of the preserved posterior ligamentary complex. Conservative treatment is seldom able to produce a reduced position, but the only associated drawback is the theoretical possibility of continuous or intermittent compression of the injured spinal cord; 4) Bilateral pedicular fracture which is rare; 5) Combined fractures of the arch, which are highly unstable. The frequency of neurological complications necessitating skull traction is high in association with fractures of vertebral arches of the lower cervical spine. However, some bilateral fractures of lamina and detachments of the articular mass can be treated satisfactorily with an orthopaedic brace or a plaster collar. Indications for operative treatment are present in a few cases only, the main indication being early mobilizaiton.
在285例下颈椎损伤病例中，椎弓骨折占12.6%。对27例保守治疗的病例进行了分析，考虑了其亚型、临床特征以及治疗选择。下颈椎椎弓骨折可分为五种不同的主要亚型：1）椎板双侧骨折，椎体无移位或有半脱位。讨论了潜在不稳定性的评估，并提出了评估标准；2）椎板双侧骨折合并绞锁脱位，难以通过保守方法复位；3）关节突分离，必然导致不稳定，但由于后韧带复合体保留，通常为相对不稳定。保守治疗很少能使骨折复位，但唯一的相关缺点是理论上存在对损伤脊髓持续或间歇性压迫的可能性；4）双侧椎弓根骨折，较为罕见；5）弓部复合骨折，极不稳定。下颈椎椎弓骨折伴有需要颅骨牵引的神经并发症的发生率很高。然而，一些椎板双侧骨折和关节突分离病例用矫形支具或石膏颈托治疗效果满意。仅在少数病例中有手术治疗指征，主要指征是早期活动。
