Bransford Richard, Falicov Alexis, Nguyen Quynh, Chapman Jens
Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA.
J Neurosurg Spine. 2009 May;10(5):466-73. doi: 10.3171/2009.1.SPINE08708.
The object of this study was to describe an unusual fracture subtype within C-1 injuries with a propensity to result in late deformity and pain. Most patients with C-1 injuries are nonsurgically treated using external immobilization unless there is an injury of the transverse atlantal ligament. The authors describe an unusual variant involving a unilateral sagittal split with a high tendency to late deformity and pain. They also review the literature and treatment of C-1 fractures.
A retrospective review of 12,671 CT scans from a Level I trauma center over a 6-year period yielded 54 patients with C-1 fractures. Among these patients, 6 had an unusual unilateral lateral mass sagittal split, which resulted in a late cock-robin deformity in all survivors and thus a surgical deformity correction with occipital-cervical instrumented fusions. Patient charts and radiographs were reviewed, this fracture subtype is described, and its treatment discussed.
Radiographic studies in 6 patients with C-1 fractures demonstrated a unilateral sagittal split of the lateral mass but an intact transverse atlantal ligament. In the 3 surviving patients, a late cock-robin deformity, significant loss of neck rotation, and severe neck pain developed. Vertebral artery occlusion, as revealed on CT angiography, occurred in 1 patient. All patients were placed in traction and underwent successful occipital-cervical fusion and deformity correction. At the final follow-up, all patients had satisfactory pain relief and improved head alignment.
Patients with a unilateral sagittal split of the C-1 lateral mass have unstable injuries and must be carefully monitored, with a low threshold for surgical reconstruction or prolonged traction. Patients with late deformity can be successfully treated with occipital-cervical instrumented fusions.
本研究的目的是描述C1损伤中一种不寻常的骨折亚型，该亚型易导致晚期畸形和疼痛。大多数C1损伤患者采用外部固定进行非手术治疗，除非存在寰椎横韧带损伤。作者描述了一种不寻常的变异类型，即单侧矢状裂，其晚期畸形和疼痛的发生率很高。他们还回顾了C1骨折的文献及治疗方法。
对一家一级创伤中心6年期间的12671例CT扫描进行回顾性分析，共发现54例C1骨折患者。其中，6例存在不寻常的单侧侧块矢状裂，所有幸存者均出现晚期“知更鸟”畸形，因此接受了枕颈器械融合术以矫正畸形。回顾了患者病历和X线片，描述了这种骨折亚型，并讨论了其治疗方法。
6例C1骨折患者的影像学研究显示侧块单侧矢状裂，但寰椎横韧带完整。在3例存活患者中，出现了晚期“知更鸟”畸形、颈部旋转明显受限和严重颈部疼痛。1例患者CT血管造影显示椎动脉闭塞。所有患者均接受牵引治疗，并成功进行了枕颈融合和畸形矫正。在最后一次随访时，所有患者疼痛缓解满意，头部对线改善。
C1侧块单侧矢状裂的患者损伤不稳定，必须仔细监测，手术重建或延长牵引的阈值较低。晚期畸形患者可通过枕颈器械融合术成功治疗。
