Kocis J, Wendsche P, Visna P, Muzík V, Hart R
Klinika traumatologie LF MU v Urazové nemocnici, Brno.
Acta Chir Orthop Traumatol Cech. 2003;70(4):214-8.
The study presents a group of patients with traumatic spondylolisthesis of the axis. Views on the treatment of different types of spondylolisthesis vary. The aim of this study was to carry out a retrospective evaluation of the group of patients with this traumatic condition.
In the period from 1995 to 2002, 26 patients with traumatic spondylolisthesis of the axis were treated. They accounted for 5% of all patients admitted to our department for cervical spine injuries. Three types of traumatic spondylolisthesis were distinguished according to the Effendi classification. Type I was diagnosed in seven, type II in 18 patients and type III in one patients.
Type I traumatic spondylolisthesis was, as a rule, treated conservatively. A halo vest was used in four and a Philadelphia collar in three patients. Patients diagnosed with type II spondylolisthesis were treated surgically from the anterior approach (16 patients) or with a halo vest (two patients). The only patient with a type III fracture was operated on from the anterior approach.
Osseous healing was achieved in all patients. No pseudoarthrosis developed and no repeat surgery for infection or osteosynthesis failure was needed. No deterioration of neurological findings was recorded. The range of motion in the cervical spine after healing was not affected.
Views on the classification and therapy of traumatic spondylolisthesis of the axis are diverse. The greatest diversity is associated with making a decision on whether the injury is unstable and requires surgical treatment or not. Further arguments are related to the use of the most suitable approach. Treatment from the anterior approach is prevailing. Type III fractures are rare and must always be treated surgically.
Methods for treatment of traumatic spondylolisthesis of the axis are currently a topic of dispute. The decisive factor for therapy is whether the injury is stable or unstable. When instability is present, anterior C2-3 spondylodesis completed with plate osteosynthesis is the method of choice. Stable injuries are treated by the application of a halo vest or Philadelphia collar.
本研究介绍了一组创伤性枢椎滑脱患者。对于不同类型的脊椎滑脱的治疗观点各不相同。本研究的目的是对患有这种创伤性疾病的患者群体进行回顾性评估。
在1995年至2002年期间，治疗了26例创伤性枢椎滑脱患者。他们占我院收治的所有颈椎损伤患者的5%。根据埃芬迪分类法区分出三种类型的创伤性脊椎滑脱。I型诊断出7例，II型诊断出18例，III型诊断出1例。
I型创伤性脊椎滑脱通常采用保守治疗。4例使用头环背心，3例使用费城颈托。诊断为II型脊椎滑脱的患者采用前路手术治疗（16例）或使用头环背心（2例）。唯一一例III型骨折患者采用前路手术。
所有患者均实现骨愈合。未出现假关节形成，也无需因感染或内固定失败而再次手术。未记录到神经功能恶化。愈合后颈椎的活动范围未受影响。
关于创伤性枢椎滑脱的分类和治疗观点多种多样。最大的差异在于决定损伤是否不稳定以及是否需要手术治疗。进一步的争议涉及最合适方法的使用。前路治疗占主导地位。III型骨折罕见，必须始终进行手术治疗。
目前，创伤性枢椎滑脱的治疗方法是一个有争议的话题。治疗的决定性因素是损伤是否稳定。当存在不稳定时，采用前路C2 - 3椎体间融合并钢板内固定是首选方法。稳定损伤采用头环背心或费城颈托治疗。
