von Gumppenberg S, Claudi B
Chirurgische Klinik und Poliklinik der Technischen Universität, München.
Aktuelle Traumatol. 1989 Apr;19(2):57-60.
A differentiated therapeutic approach is necessary in discoligamentous or osseous lesions of the cervical spine. Whereas lesions with neurological disturbances are stabilised by operation almost in all cases--and extensive lesions of the lower cervical spine (C3 to C7) quite frequently--, conservative treatment is the order of the day in sequels to trauma at the upper cervical spine (C1 and C2) as well as in mild lesions of all sections of the cervical vertebral column. Fractures of the dens of Types II and III (after Anderson and d'Alonzo) are the exception, since they are now being stabilized by surgery on a large scale. The advantages of the halo-fixateur therapy compared against extension and immobilization in Minerva gypsum are that secondary correction of positioning is possible; that functionally disturbing and extended spondylodeses are avoided; that care of the polytraumatized patient is facilitated; that X-ray films are easy to assess; and that the period of hospitalization is greatly reduced. Successful treatment is possible only of the possible complications are known. Failures are possible if the head screws become loose, if there are pin-trac infections, if dislocations and fractures are redislocated, and if there are points of pressure beneath the jacket.
对于颈椎的椎间盘韧带或骨性病变,需要采取差异化的治疗方法。几乎在所有情况下,伴有神经功能障碍的病变都通过手术进行稳定治疗——下颈椎(C3至C7)的广泛病变更是如此——而上颈椎(C1和C2)创伤后遗症以及颈椎各节段的轻度病变则以保守治疗为主。II型和III型齿突骨折(根据安德森和达隆佐分类)为例外情况,因为目前这类骨折大多通过手术进行稳定治疗。与在密涅瓦石膏中进行伸展和固定相比,头环固定器疗法的优点在于可以进行二次定位矫正;避免了功能上造成干扰的广泛脊柱融合术;便于护理多发伤患者;X线片易于评估;以及大大缩短了住院时间。只有了解可能出现的并发症,才有可能成功治疗。如果头部螺钉松动、出现针道感染、脱位和骨折再次移位,以及头环下方存在压迫点,就可能导致治疗失败。