Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
J Neurosurg Spine. 2011 Aug;15(2):182-6. doi: 10.3171/2011.3.SPINE10756.
Horizontal fractures of the anterior arch of the atlas not associated with odontoid fractures have been regarded as stable fractures that can be simply treated with a cervical collar. The authors report that C-1 horizontal fractures also occur in association with severe distraction injuries of the craniocervical junction.
The authors retrospectively reviewed imaging studies obtained in all surviving patients in whom unstable distraction injuries of the craniocervical junction were diagnosed and in whom surgery was performed at their institution between 1995 and 2009. All patients who also had a C-1 horizontal fracture as a component of their spinal injury were included in the study.
Of 47 patients with unstable craniocervical distraction injuries, 5 patients had a horizontal fracture through the anterior ring of C-1: 1 patient had a primarily C1-2 distractive injury whereas 4 others had a grossly unstable injury across the occipitoatlantal junction (occipitoatlantal dissociation).
The finding of a C-1 horizontal fracture does not always reflect a benign injury and its presence should heighten the concern of a more severe and unstable injury at the craniocervical junction.
不伴有齿状突骨折的寰椎前弓横形骨折被认为是稳定性骨折，可简单采用颈托治疗。作者报告 C1 水平骨折也与颅颈交界区严重分离性损伤相关。
作者回顾性分析了在 1995 年至 2009 年于本院接受治疗的所有诊断为颅颈交界区不稳定分离性损伤且手术治疗的存活患者的影像学资料。所有合并 C1 水平骨折的患者均纳入研究。
47 例颅颈交界区不稳定分离性损伤患者中，5 例存在寰椎前弓水平骨折：1 例为单纯 C1-2 分离性损伤，而另外 4 例为枕骨寰枢关节（寰枢关节脱位）处严重不稳定损伤。
C1 水平骨折的存在并不总是反映良性损伤，其出现应使人们警惕颅颈交界区更严重、更不稳定的损伤。
