“斯宾塞法则”与狄克曼寰枢横韧带损伤分类的再探讨：基于寰椎骨折非手术治疗的临床转归对寰枢稳定性预测的差异。
"Rule of Spence" and Dickman's Classification of Transverse Atlantal Ligament Injury Revisited: Discrepancy of Prediction on Atlantoaxial Stability Based on Clinical Outcome of Nonoperative Treatment for Atlas Fractures.
机构信息
Department of Spine Surgery, Center for Orthopedics, Daping Hospital, Army Medical University.
出版信息
Spine (Phila Pa 1976). 2019 Mar 1;44(5):E306-E314. doi: 10.1097/BRS.0000000000002877.
UNLABELLED
Detailed clinical information of 13 adult patients with acute atlantal fractures underwent nonoperative treatment was retrospectively studied. "Rule of Spence" was found inaccurate in predicting either integrity of transverse atlantal ligament (TAL) or atlantoaxial stability, whereas Dickman's classification of TAL injury was more superior to "rule of Spence" on both prediction.
STUDY DESIGN
A retrospective study.
OBJECTIVE
To evaluate the prediction accuracy of "Rule of Spence" and Dickman's classification of the transverse atlantal ligament (TAL) injury on clinical outcomes (mainly focused on atlantoaxial stability) of atlas fractures treated nonoperatively.
SUMMARY OF BACKGROUND DATA
TAL is regarded as primary stabilizer of the atlantoaxial complex. Atlas fractures are categorized as unstable and stable according to TAL injury or not. "Rule of Spence" and Dickman's classification have been widely used to evaluate the integrity of TAL indirectly or directly. However, there is controversy about how to interpret and apply these image measures appropriately in treatment decision making, and comparing the two measures in same cohort has been lack.
METHODS
From January 2013 to December 2015, 13 adult patients with atlas fractures, treated nonoperatively at acute posttraumatic phase and followed up for at least 2 years, were enrolled in the study. Lateral mass offset (LMO) and TAL injury were measured by radiography. Atlantoaxial stability, pain in occipital region, limitation of cervical motion, neurological dysfunction, and quality of daily life were evaluated as clinical outcomes.
RESULTS
LMO less than 6.9 mm was inaccurate either to exclud TAL injury (4/8, 50% failed) or to predict clinical outcomes (2/8, 25% failed), whereas LMO greater than 6.9 mm was accurate to determine TAL injury (5/5, 100% succeeded) but not to predict atlantoaxial stability (4/5, 80% failed). Two cases with Dickman's classification type I injury (100%) failed to restore C1-2 stability and six of seven type II (85.7%) succeeded. Three patients were indicated for fusion surgery due to instability, and one due to traumatic arthritis. Overall clinical outcomes were satisfactory as pain and quality of life were considered.
CONCLUSION
Dickman's classification of TAL injury is of higher superiority to "Rule of Spence" in term of the accuracy of predicting atlantoaxial stability of nonoperatively treated atlas fractures.
LEVEL OF EVIDENCE
未加标签
对 13 例接受非手术治疗的急性寰枢椎骨折成年患者的详细临床资料进行了回顾性研究。“斯宾塞规则”在预测横韧带（TAL）完整性或寰枢关节稳定性方面均不准确，而迪克曼的 TAL 损伤分类在这两方面的预测上均优于“斯宾塞规则”。
研究设计
回顾性研究。
目的
评估“斯宾塞规则”和迪克曼的 TAL 损伤分类对非手术治疗寰椎骨折的临床结果（主要集中在寰枢关节稳定性）的预测准确性。
背景资料总结
TAL 被认为是寰枢复合体的主要稳定器。根据 TAL 损伤与否，寰椎骨折分为不稳定和稳定。“斯宾塞规则”和迪克曼的分类已被广泛用于间接或直接评估 TAL 的完整性。然而，在治疗决策中如何正确解释和应用这些影像学指标存在争议，并且在同一队列中比较这两种指标的研究还很缺乏。
方法
2013 年 1 月至 2015 年 12 月，共纳入 13 例成人寰椎骨折患者，在急性创伤后阶段接受非手术治疗，并至少随访 2 年。通过 X 线测量横突间距（LMO）和 TAL 损伤。评估寰枢关节稳定性、枕部疼痛、颈椎活动受限、神经功能障碍和日常生活质量作为临床结果。
结果
LMO 小于 6.9mm 既不能排除 TAL 损伤（4/8，50%失败），也不能预测临床结果（2/8，25%失败），而 LMO 大于 6.9mm 则准确确定 TAL 损伤（5/5，100%成功）但不能预测寰枢关节稳定性（4/5，80%失败）。2 例迪克曼 I 型损伤（100%）未能恢复 C1-2 稳定性，7 例 II 型中的 6 例（85.7%）成功。由于不稳定，3 例患者需要进行融合手术，1 例由于创伤性关节炎。由于疼痛和生活质量得到改善，总体临床结果令人满意。
结论
在预测非手术治疗寰椎骨折的寰枢关节稳定性方面，迪克曼的 TAL 损伤分类比“斯宾塞规则”具有更高的准确性。
证据水平
4 级。
Zotero 插件