Kocis J, Wendsche P, Visna P, Muzík V, Hart R
Klinika traumatologie LF MU, Brno.
Acta Chir Orthop Traumatol Cech. 2004;71(1):50-5.
To present the current tends in the diagnosis and management of isolated atlas fractures based on the retrospectively evaluated group of patients with this trauma.
In the period from 1995 to 2002, we treated 486 injuries to the cervical spine at our department. Out of these, 19 patients sustained an isolated fracture of the first cervical vertebra. This group consisted of 12 men and seven women; the average age was 46.6 years. Neurological findings in 18 patients were classified as Frankel E and, in one, as Frankel A. The causes of injury included a fall from height in five patient, a fall in the street in five pedestrians, a car accident in five patients, a dive into shallow water in three and a shooting injury in one patient.
We treated 16 patients conservatively, using a halo-vest in eight patients and a Philadelphia collar also in eight patients. In two patients with unstable atlas injury, we carried out C1-C2 transarticular stabilization according to Magerl. In the patient who had been shot, we removed the bullet transorally.
All patients healed completely without signs of instability. One patient with postraumatic pentaplegia, who died within 24 h of surgery due to septic shock, had not been included in the follow-up. Two patients reported neck pain at rest, three after exercise and 13 were without any pain. The patient after C1-C2 transarticular stabilization had a significant restriction of the range of motion in the cervical spine; the rest of the patients were without limitation. None of the patients showed any deterioration of neurological findings during the treatment, nor was any post-traumatic atlantoaxial instability recorded after the therapy was completed.
Isolated fractures of the atlas account for 1 to 2% of all spinal fractures. Many fractures may remain unnoticed and, therefore, it is important to X-ray patients with a symptomatic injury to the cervical spine in three standard projection planes (anteroposterior, lateral and transoral). When a fracture of the atlas is suspected, it is necessary to examine them by computed tomography to obtain a more accurate presentation of fracture lines. Views on the method of treating isolated fractures of the atlas, particularly unstable ones, are not consistent.
Isolated fractures of the first cervical vertebra, in terms of therapy, are stable and unstable. Stable fractures heal within 8 to 12 weeks. A Philadelphia collar or halo-vest provide sufficient immobilization. Surgical stabilization or a halo-vest immobilization for a period of 12 weeks are recommended in unstable injuries that are characterized by the lateral mass displacement of more than 7 mm or extension of the space before the dens (predental space) by more than 3 mm, or in which magnetic resonance imaging demonstrated injury to the transverse ligament. After the halo-vest removal, it is necessary to perform functional examination of the cervical spine for detection of potential atlantoaxial instability.
基于对一组经回顾性评估的此类创伤患者的研究，阐述孤立性寰椎骨折诊断与治疗的当前趋势。
1995年至2002年期间，我们科室共治疗了486例颈椎损伤患者。其中，19例患者发生了第一颈椎孤立性骨折。该组包括12名男性和7名女性；平均年龄为46.6岁。18例患者的神经学表现被归类为Frankel E级，1例为Frankel A级。损伤原因包括5例患者高处坠落、5例行人街道摔倒、5例患者车祸、3例浅水区跳水以及1例患者枪伤。
我们对16例患者进行了保守治疗，8例患者使用头环背心，8例患者使用费城颈托。对于2例不稳定寰椎损伤患者，我们根据马格勒（Magerl）法进行了C1 - C2经关节稳定术。对于枪伤患者，我们经口取出了子弹。
所有患者均完全愈合，无不稳定迹象。1例创伤后四肢瘫患者在术后24小时内死于感染性休克，未纳入随访。2例患者静息时颈部疼痛，3例运动后疼痛，13例无任何疼痛。C1 - C2经关节稳定术后的患者颈椎活动范围有明显受限；其余患者无活动受限。治疗期间所有患者神经学表现均无恶化，治疗完成后也未记录到任何创伤后寰枢椎不稳定情况。
孤立性寰椎骨折占所有脊柱骨折的1%至2%。许多骨折可能未被注意到，因此，对有症状的颈椎损伤患者进行三个标准投照平面（前后位、侧位和经口位）的X线检查很重要。当怀疑有寰椎骨折时，有必要通过计算机断层扫描进行检查，以更准确地显示骨折线。关于孤立性寰椎骨折，尤其是不稳定骨折的治疗方法，观点并不一致。
就治疗而言，第一颈椎孤立性骨折有稳定型和不稳定型。稳定型骨折在8至12周内愈合。费城颈托或头环背心可提供足够的固定。对于以侧块移位超过7毫米或齿突前间隙（齿突前间隙）增宽超过3毫米为特征的不稳定损伤，或磁共振成像显示横韧带损伤的不稳定损伤，建议进行手术稳定或佩戴头环背心固定12周。头环背心去除后，有必要对颈椎进行功能检查，以检测潜在的寰枢椎不稳定情况。
