Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
World Neurosurg. 2021 Feb;146:e1345-e1350. doi: 10.1016/j.wneu.2020.11.172. Epub 2020 Dec 9.
Atlas fracture occurs in 3%-13% of all cervical spinal injuries and is often associated with other injuries. The factors associated with concomitant transverse ligament disruption and vertebral artery injury remain underexamined.
We retrospectively reviewed 97 consecutive cases of atlas fractures. We analyzed demographic and clinic characteristics, including mechanism of injury, fracture type, and associated injuries. We identified factors independently associated with vertebral artery injury and/or transverse ligament disruption.
On multivariable analysis, vertebral artery injury was independently, positively associated with injury to the transverse ligament (odds ratio [OR], 8.51 [1.17, 61.72], P = 0.034), associated facial injury (OR, 7.78 [1.05, 57.50]; P = 0.045), intoxication at presentation (OR, 51.42 [1.10, 2408.82]; P = 0.045), and negatively associated with type 3 fractures (OR, 0.081 [0.0081, 0.814]; P = 0.033). There was a trend toward a positive association with a violence mechanism of injury (OR, 33.47 [0.75, 1487.89]; P = 0.070). Transverse ligament injury was independently associated with other injuries to the spine (OR, 13.07362 [2.43, 70.28]; P = 0.003), atlantodental interval (OR, 2.63 [1.02, 6.75]; P = 0.045), lateral mass displacement (OR, 1.78 [1.32, 2.39]; P < 0.001), and male sex (OR, 7.07 [1.47, 34.06]; P = 0.015). There was a trend toward a positive association with injury to the vertebral artery (OR, 5.13 [0.96, 27.35]; P = 0.056).
Among patients with atlas fractures, vertebral artery injury and transverse ligament disruption are associated with each other. Mechanism of injury, fracture type, and intoxication at the time of injury were associated with vertebral artery injury, and atlantodental interval and lateral mass displacement are associated with magnetic resonance imaging-confirmed injury to the transverse ligament.
寰椎骨折占所有颈椎脊柱损伤的 3%-13%，常伴有其他损伤。与横韧带断裂和椎动脉损伤相关的因素仍未得到充分研究。
我们回顾性分析了 97 例连续的寰椎骨折病例。我们分析了人口统计学和临床特征，包括损伤机制、骨折类型和相关损伤。我们确定了与椎动脉损伤和/或横韧带断裂相关的独立因素。
多变量分析显示，椎动脉损伤与横韧带损伤独立正相关（比值比 [OR]，8.51 [1.17，61.72]，P=0.034），与面部损伤（OR，7.78 [1.05，57.50]；P=0.045）、受伤时中毒（OR，51.42 [1.10，2408.82]；P=0.045）相关，与 3 型骨折负相关（OR，0.081 [0.0081，0.814]；P=0.033）。损伤机制为暴力与椎动脉损伤呈正相关趋势（OR，33.47 [0.75，1487.89]；P=0.070）。横韧带损伤与脊柱其他损伤（OR，13.07362 [2.43，70.28]；P=0.003）、寰齿间距（OR，2.63 [1.02，6.75]；P=0.045）、侧块移位（OR，1.78 [1.32，2.39]；P<0.001）和男性（OR，7.07 [1.47，34.06]；P=0.015）独立相关。与椎动脉损伤呈正相关趋势（OR，5.13 [0.96，27.35]；P=0.056）。
在寰椎骨折患者中，椎动脉损伤和横韧带断裂相互关联。损伤机制、骨折类型和受伤时的中毒与椎动脉损伤有关，而寰齿间距和侧块移位与磁共振成像证实的横韧带损伤有关。
