Orthopaedic Service, Don Gnocchi Foundation of Rome, Rome, Italy.
World Neurosurg. 2011 Feb;75(2):314-9. doi: 10.1016/j.wneu.2010.09.004.
Computed tomography (CT) scan and X-ray study on consolidation time of C2 neural arch fractures treated conservatively were examined.
A prospective study was undertaken: 28 conservatively treated fractures of the neural arch of the axis (11 hanged-man type I, 5 type II, and 12 miscellaneous fractures) were monitored during the period of orthosis by means of CT scan and plain X-rays performed on admission, and then at intervals between 2 and 120 days afterward. In patients treated with a halo vest (20 cases), a CT scan of the skull was performed to make sure that the pins were correctly positioned and to evaluate the osteolytic processes at the pin-bone interface.
Two patients died as a result of other severe brain or thoracoabdominal injuries, and the remaining 26 fractures healed in an average time of 109 days (range 90-120). The process of bone consolidation was documented in detail by CT, which showed how the newly formed osteofibrous tissue (iso-hypodense) progressively filled the interfragmentary space. In 2 cases of cranial pin loosening, CT demonstrated an osteolytic rim at the interface, which prompted early removal of the halo system. At clinical follow-up (mean 32 months; range 24-84), functional status was evaluated: all of the patients were neurologically intact with the exception of one, who presented with persistent paresthesias. The most frequent disturbance was cervical pain (12 cases, 46%).
CT with two- and three-dimensional reconstructed images has been shown to be the most reliable method for clarifying the evolution of bone consolidation and to show any osteolytic processes at the pin-bone interface during halo vest immobilization. Follow-up results of our series suggest that surgical treatment would not have improved the quality of life in these patients.
对保守治疗的 C2 神经弓骨折的 CT 扫描和 X 射线研究进行了检查。
进行了一项前瞻性研究：对 28 例保守治疗的枢椎神经弓骨折（11 例绞刑架 I 型，5 例 II 型，12 例杂合骨折）在支具治疗期间通过 CT 扫描和入院时及之后 2 至 120 天的平片进行监测。在使用 halo vest 治疗的 20 例患者中，进行颅骨 CT 扫描以确保针正确定位，并评估针骨界面的溶骨过程。
两名患者因其他严重脑或胸腹损伤而死亡，其余 26 例骨折平均愈合时间为 109 天（范围 90-120 天）。CT 详细记录了骨愈合过程，显示了新形成的纤维骨组织（等低密）如何逐渐填充骨折间隙。在 2 例颅骨针松动的病例中，CT 显示界面处有溶骨性边缘，促使早期移除 halo 系统。临床随访（平均 32 个月；范围 24-84 个月）评估了功能状态：除 1 例患者持续出现感觉异常外，所有患者的神经功能均完整。最常见的干扰是颈痛（12 例，46%）。
CT 具有二维和三维重建图像，是澄清骨愈合演变并显示 halo vest 固定期间针骨界面任何溶骨过程的最可靠方法。我们系列的随访结果表明，手术治疗不会改善这些患者的生活质量。
