Ifthekar Syed, Ahuja Kaustubh, Mittal Samarth, Sarkar Bhaskar, Deep Gagan, Thomas Watson, Kandwal Pankaj
Department of Orthopaedics, AIIMS Rishikesh, Rishikesh, Uttarakhand 249203 India.
Department of Trauma and Emergency, AIIMS Rishikesh, Rishikesh, 249203 Uttarakhand India.
Indian J Orthop. 2020 Aug 13;55(3):673-679. doi: 10.1007/s43465-020-00227-y. eCollection 2021 Jun.
Injuries involving upper cervical spine are serious and fatal injuries which are associated with alteration of normal occipital-cervical anatomy. These injuries may result in permanent neurologic deficits or neck deformity if not treated in a timely and appropriate manner.
To evaluate the outcomes of neglected upper cervical spine injuries treated by various methods.
Retrospective study.
Twelve patients attending ER or OPD with a history of neck trauma and who were diagnosed with fractures and fracture dislocations C1 and C2 were included in the study. Fresh injuries sustained within a week were excluded from study. The outcomes were measured in terms of improvement in VAS, ODI Scores and correction of the neck deformity. Surgical parameters like duration of surgery and blood loss were also observed.
Eleven males and one female. The mean age was 40.9 ± 16.9 (07-67 years). Eleven patients underwent posterior instrumentation, while one patient was treated anteriorly. The mean delay in presentation was 28 ± 8.67 days (15-42 days). The mean duration of surgery was 188.3 ± 34.35 min (120-240 min), average blood loss was 350 ± 111.8 ml (150-600 ml). The mean VAS improved from 8.45 ± 0.89 to 3.9 ± 0.51 ( < 0.05). The mean ODI Pre-operatively was 88.45 ± 5.89 which improved to 31.9 ± 4.01 ( < 0.05). The neck deformity/torticollis was corrected in all the patients.
Neglected upper cervical spine injuries are difficult to treat and a posterior approach is helpful in reducing the subluxations indirectly and to obtain a posterior fusion.
涉及上颈椎的损伤是严重的致命伤，与正常枕颈解剖结构的改变相关。若未得到及时、恰当的治疗，这些损伤可能导致永久性神经功能缺损或颈部畸形。
评估采用多种方法治疗的被忽视的上颈椎损伤的疗效。
回顾性研究。
本研究纳入了12例因颈部外伤就诊于急诊科或门诊且被诊断为C1和C2骨折及骨折脱位的患者。一周内的新鲜损伤被排除在研究之外。通过视觉模拟评分法（VAS）、颈椎功能障碍指数（ODI）评分的改善情况以及颈部畸形的矫正来衡量疗效。还观察了手术时间和失血量等手术参数。
11例男性，1例女性。平均年龄为40.9±16.9岁（7 - 67岁）。11例患者接受了后路内固定术，1例患者接受了前路治疗。平均就诊延迟时间为28±8.67天（15 - 42天）。平均手术时间为188.3±34.35分钟（120 - 240分钟），平均失血量为350±111.8毫升（150 - 600毫升）。平均VAS评分从8.45±0.89改善至3.9±0.51（P<0.05）。术前平均ODI为88.45±5.89，术后改善至31.9±4.01（P<0.05）。所有患者的颈部畸形/斜颈均得到矫正。
被忽视的上颈椎损伤难以治疗，后路手术有助于间接复位半脱位并实现后路融合。
