Nizare El Fatemi, Abdelali Bouchaouch, Fahd Derkaoui Hassani, Yassad Oudrhiri Mohammed, Rachid Gana, Rachid El Maaqili, Fouad Bellakhdar
Service de Neurochirugie, Hôpital Ibn Sina, CHU Rabat, Faculté de Médecine et de Pharmacie de Rabat, Université Mohammed V - Souissi, Maroc.
Pan Afr Med J. 2013 Jun 20;15:57. doi: 10.11604/pamj.2013.15.57.2316. eCollection 2013.
Traumatic injuries of the upper cervical spine are often encountered, and may be associated to severe neurological outcome. This is a retrospective study of 70 patients, admitted over a 14 years period (1996 to 2010), for management of upper cervical spine injuries. Data concerning epidemiology, radiopathology and treatment was reviewed, and clinical and radiological evaluation was conducted. Men are more affected than women, with traffic accidents being the major traumatic cause. A cervical spine syndrome of varied intensity was found in about 90% of patients; neurological deficit was noted in 10 patients (21%). Radiological analysis discovered varied and many combined lesions: C1-C2 dislocation (7 cases), C2-C3 dislocation (9 cases), C1 fracture (10 cases) and C2 fracture (44 cases) including 28 odontoid fractures. Orthopedic treatment was carried out exclusively for 31 patients, and surgical treatment for 38 patients. One patient died before surgery because of a polytraumatisme. Posterior approach was performed in 29 cases including hooks and rods in 18 patients, wiring in 9 cases, and 2 transarticular screw fixations. In 9 cases anterior approach was performed: 5 odontoid screwing and 4 cases of C2-C3 discectomy with bone graft. Nearly all patients were improved in post-operative. Elsewhere, the operating results were marked by a persistent neurological deficit in 2 cases, and infection in 2 cases controlled by medical treatment. Mean follow-up was 23 months and showed good clinical and radiological improvement. Early management of cervical spine injuries can optimize outcome. Treatment modalities are well codified; however controversy remains especially with type II odontoid fractures.
上颈椎创伤性损伤较为常见，可能导致严重的神经功能后果。这是一项对70例患者的回顾性研究，这些患者在14年期间（1996年至2010年）因上颈椎损伤入院接受治疗。回顾了有关流行病学、放射病理学和治疗的数据，并进行了临床和放射学评估。男性比女性更容易受到影响，交通事故是主要的创伤原因。约90%的患者存在不同程度的颈椎综合征；10例患者（21%）出现神经功能缺损。放射学分析发现了多种复杂的联合损伤：C1-C2脱位（7例）、C2-C3脱位（9例）、C1骨折（10例）和C2骨折（44例），其中包括28例齿状突骨折。31例患者仅接受了骨科治疗，38例患者接受了手术治疗。1例患者因多发伤在手术前死亡。29例采用后路手术，其中18例使用钩和棒，9例使用钢丝，2例采用经关节螺钉固定。9例采用前路手术：5例齿状突螺钉固定，4例C2-C3椎间盘切除并植骨。几乎所有患者术后病情都有所改善。此外，手术结果显示有2例持续存在神经功能缺损，2例感染经药物治疗得到控制。平均随访23个月，临床和放射学均有良好改善。颈椎损伤的早期处理可优化治疗结果。治疗方式已明确规范；然而，特别是对于II型齿状突骨折仍存在争议。
