Scholz Matti, Schleicher Philipp, Kandziora Frank, Badke Andreas, Dreimann Marc, Gebhard Harry, Gercek Erol, Gonschorek Oliver, Hartensuer René, Jarvers Jan-Sven Gilbert, Katscher Sebastian, Kobbe Philipp, Koepp Holger, Korge Andreas, Matschke Stefan, Mörk Sven, Müller Christian W, Osterhoff Georg, Pécsi Ferenc, Pishnamaz Miguel, Reinhold Maximilian, Schmeiser Gregor, Schnake Klaus John, Schneider Kristian, Spiegl Ulrich Josef Albert, Ullrich Bernhard
Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main.
Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen.
Z Orthop Unfall. 2018 Dec;156(6):662-671. doi: 10.1055/a-0620-9170. Epub 2018 Jun 22.
In a consensus process with four sessions in 2017, the working group "upper cervical spine" of the German Society for Orthopaedics and Trauma Surgery (DGOU) formulated "Therapeutic Recommendations for the Diagnosis and Treatment of Upper Cervical Fractures", taking their own experience and the current literature into consideration. The following article describes the recommendations for axis ring fractures (traumatic spondylolysis C2). About 19 to 49% of all cervical spine injuries include the axis vertebra. Traumatic spondylolysis of C2 may include potential discoligamentous instability C2/3. The primary aim of the diagnostic process is to detect the injury and to determine potential disco-ligamentous instability C2/3. For classification purposes, the Josten classification or the modified Effendi classification may be used. The Canadian C-spine rule is recommended for clinical screening for C-spine injuries. CT is the preferred imaging modality and an MRI is needed to determine the integrity of the discoligamentous complex C2/3. Conservative treatment is appropriate in case of stable fractures with intact C2/3 motion segment (Josten type 2 and 2). Patients should be closely monitored, in order to detect secondary dislocation as early as possible. Surgical treatment is recommended in cases of primary severe fracture dislocation or discoligamentous instability C2/3 (Josten 3 and 4) and/or secondary fracture dislocation. Anterior cervical decompression and fusion (ACDF) C2/3 is the treatment of choice. However, in case of facet joint luxation C2/3 with looked facet (Josten 4), a primary posterior approach may be necessary.
在2017年举行的包含四次会议的共识制定过程中，德国骨科与创伤外科学会（DGOU）的“上颈椎”工作组参考自身经验和当前文献，制定了“上颈椎骨折诊断与治疗的治疗建议”。以下文章描述了枢椎环骨折（创伤性C2峡部裂）的建议。所有颈椎损伤中约19%至49%涉及枢椎。C2的创伤性峡部裂可能包括潜在的C2/3椎间盘韧带不稳定。诊断过程的主要目的是检测损伤并确定潜在的C2/3椎间盘韧带不稳定。为了进行分类，可使用约斯滕分类法或改良的埃芬迪分类法。推荐使用加拿大颈椎规则进行颈椎损伤的临床筛查。CT是首选的影像学检查方式，需要进行MRI检查以确定C2/3椎间盘韧带复合体的完整性。对于C2/3运动节段完整的稳定骨折（约斯滕2型和2型），保守治疗是合适的。应密切监测患者，以便尽早发现继发性脱位。对于原发性严重骨折脱位或C2/3椎间盘韧带不稳定（约斯滕3型和4型）和/或继发性骨折脱位，建议进行手术治疗。C2/3前路颈椎减压融合术（ACDF）是首选治疗方法。然而，对于伴有小关节绞锁的C2/3小关节脱位（约斯滕4型），可能需要采用一期后路手术入路。
