Krüger Antonio, Oberkircher Ludwig, Frangen Thomas, Ruchholtz Steffen, Kühne Christian, Junge Andreas
Department of Trauma, Hand and Reconstructive Surgery, Philipps University, Marburg, Germany.
Department of Trauma and Hand Surgery, Hospital of the Brothers of Mercy, Trier, Germany.
J Craniovertebr Junction Spine. 2013 Jul;4(2):49-55. doi: 10.4103/0974-8237.128525.
Occipital condyle fractures (OCFs) are considered to be rare injuries. OCFs are now diagnosed more often because of the widespread use of computed tomography. Our aim is to report the incidence, treatment and long term outcome of 8 patients with OCFs.
All patients presenting with multiple trauma from 1993 to 2006 were analyzed retrospectively. Characteristics and course of the treatment were evaluated. Follow-up was performed after 11,7 years (range 5,9 to 19,3 years).
Nine cases of OCF in 8 patients were identified. All injuries resulted from high velocity trauma. The average scores on the ISS Scale were 39,6 (24-75) and 7,3 (3-15) on the GCS. According to Anderson's classification, 5 cases of Type III and 4 cases of Type I fractures were identified. According to Tuli's classification, 5 cases of Type IIA and 4 cases of Type I were found. Indications for immobilization with the halo-vest were type III injuries according to Anderson's classification or Tuli's type IIA injuries, respectively. Patients with Tuli's type I injuries were treated with a Philadelphia collar for 6 weeks. In one patient with initial complete tetraplegia and one with incomplete neurological deficits the final follow-up neurologic examination showed no neurological impairment at all (Frankel-grade A to E, respectively B to E). At follow-up, 3 patients were asymptomatic. Four patients suffered from mild pain when turning their head, pain medication was necessary in one case only.
OCF's are virtually undetectable using conventional radiography. In cases of high velocity, cranio-cervical trauma or impaired consciousness, high resolution CT-scans of the craniocervical junction must be performed. We suggest immobilization using a halo device for type III injuries according to Anderson's classification or Tuli's type IIa injuries, respectively. Patients with Tuli's type I injuries should be treated with a Philadelphia collar.
枕髁骨折(OCF)被认为是罕见的损伤。由于计算机断层扫描的广泛应用,现在OCF的诊断更为常见。我们的目的是报告8例OCF患者的发病率、治疗方法及长期预后。
回顾性分析1993年至2006年所有多发伤患者。评估治疗的特点及过程。随访时间为11.7年(范围5.9至19.3年)。
在8例患者中发现9例OCF。所有损伤均由高速创伤导致。损伤严重度评分(ISS)平均为39.6(24 - 75),格拉斯哥昏迷评分(GCS)平均为7.3(3 - 15)。根据安德森分类法,发现5例Ⅲ型骨折和4例Ⅰ型骨折。根据图利分类法,发现5例ⅡA型骨折和4例Ⅰ型骨折。分别根据安德森分类法的Ⅲ型损伤或图利分类法的ⅡA型损伤,使用头环背心固定。图利Ⅰ型损伤患者使用费城颈托治疗6周。1例最初完全性四肢瘫患者和1例不完全性神经功能缺损患者,最终随访神经学检查均未显示神经功能障碍(分别从Frankel A级恢复到E级,另一例从B级恢复到E级)。随访时,3例患者无症状。4例患者转头时轻度疼痛,仅1例需要止痛药物。
使用传统X线摄影几乎无法检测出OCF。对于高速颅脑 - 颈椎创伤或意识障碍患者,必须进行颅颈交界区的高分辨率CT扫描。我们建议分别根据安德森分类法的Ⅲ型损伤或图利分类法的Ⅱa型损伤,使用头环装置固定。图利Ⅰ型损伤患者应使用费城颈托治疗。