Levine A M, Edwards C C
Section of Spinal Surgery, University of Maryland, Baltimore.
J Bone Joint Surg Am. 1991 Jun;73(5):680-91.
Thirty-four patients who had fractures of the atlas (the first cervical vertebra) were reviewed at an average follow-up of 4.5 years. Seventeen patients had bilateral fracture of the posterior arch of the first cervical vertebra. Eight were treated with immobilization in a cervical orthosis, with no long-term problems secondary to the injury. Nine of these patients had additional fractures in the first and second cervical vertebral complex, complicating the management of the fractures of the posterior arch. Two of the nine patients died, and the treatment of the other seven was dependent on the additional fractures. A second group of six patients had a fracture in the area of the lateral mass, with one fracture just anterior to or within the anterior portion of the lateral mass of the first cervical vertebra and a second fracture posterior to the lateral mass of the first cervical vertebra on the same side; resultant asymmetrical displacement of the lateral masses was seen on the open-mouth roentgenogram that was made for each patient. A third group of eleven patients sustained a Jefferson, or burst, fracture of the first cervical vertebra. These patients had either four fractures (two in the anterior arch and two in the posterior arch) or three fractures (one in the anterior arch and two in the posterior arch). Spreading of the lateral masses was relatively symmetrical on the open-mouth roentgenogram. Patients who had fractures with displacement of two to seven millimeters were treated with immobilization in a halo vest. Patients who had fractures with severe spreading of the lateral masses (more than seven millimeters) were treated with reduction of the lateral masses by axial traction until healing of the arch had occurred. No atlanto-axial instability was evident in any patient at follow-up.
对34例寰椎（第一颈椎）骨折患者进行了回顾性研究，平均随访时间为4.5年。17例患者为第一颈椎后弓双侧骨折。8例采用颈椎矫形器固定治疗，未出现与损伤相关的长期问题。其中9例患者在第一和第二颈椎复合体还有其他骨折，使后弓骨折的治疗变得复杂。这9例患者中有2例死亡，其他7例患者的治疗取决于额外的骨折情况。第二组6例患者在侧块区域骨折，1例骨折位于第一颈椎侧块前部前方或内部，另1例骨折位于同一侧第一颈椎侧块后方；在为每位患者拍摄的开口位X线片上可见侧块不对称移位。第三组11例患者发生了第一颈椎的Jefferson骨折或爆裂骨折。这些患者有4处骨折（前弓2处，后弓2处）或3处骨折（前弓1处，后弓2处）。在开口位X线片上，侧块的分离相对对称。移位2至7毫米的骨折患者采用头环背心固定治疗。侧块严重分离（超过7毫米）的骨折患者采用轴向牵引使侧块复位，直至弓部愈合。随访时，所有患者均未出现寰枢椎不稳。
