Chan Kyle Samuel, Shlobin Nathan A, Dahdaleh Nader S
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Craniovertebr Junction Spine. 2022 Jul-Sep;13(3):233-244. doi: 10.4103/jcvjs.jcvjs_61_22. Epub 2022 Sep 14.
Atlas fractures are a common craniocervical injury, often resulting from trauma. However, diagnosis and management of atlas fractures continues to be the subject of controversy. We aimed to characterize the factors related to diagnosis of atlas fractures, delineate important considerations in selecting the optimal management for a patient with an atlas fracture, and compare outcomes of surgical and conservative management.
We performed a systematic review using PubMed, Embase, and Scopus to identify articles that analyzed diagnosis and management of isolated atlas fractures published between 2013 and 2020. Titles and abstracts were screened. Studies meeting prespecified inclusion criteria were reviewed in full.
Of 305 resultant articles, 13 were included. C1:C2 ratio and lateral mass displacement (LMD) were used to predict transverse atlantal ligament (TAL) injury. Surgery promoted high fusion rates overall. Stable atlas fractures achieved high fusion rates with conservative management, while spinal fusion promoted greater fusion rates than halo vest immobilization management for unstable fractures. Visual Analog Scale scores, range of motion, and/or LMD improved after surgery. LMD increased for unilateral sagittal split fractures with TAL injury after conservative treatment.
Stable atlas fractures can be sufficiently treated conservatively. Unstable atlas fractures can be managed both conservatively and surgically, while surgery is associated with favorable outcomes for unstable isolated atlas fractures. Future studies are necessary to further guide risk stratification and treatment approaches in management of the patients with isolated atlas fractures.
寰椎骨折是一种常见的颅颈损伤，常由外伤引起。然而，寰椎骨折的诊断和治疗仍是一个有争议的话题。我们旨在确定与寰椎骨折诊断相关的因素，阐述为寰椎骨折患者选择最佳治疗方案时的重要考虑因素，并比较手术治疗和保守治疗的效果。
我们使用PubMed、Embase和Scopus进行了一项系统综述，以识别2013年至2020年间分析孤立性寰椎骨折诊断和治疗的文章。对标题和摘要进行了筛选。对符合预先设定纳入标准的研究进行了全文审查。
在305篇检索到的文章中，纳入了13篇。C1:C2比值和侧块移位（LMD）用于预测寰椎横韧带（TAL）损伤。总体而言，手术促进了较高的融合率。稳定的寰椎骨折采用保守治疗可获得较高的融合率，而对于不稳定骨折，脊柱融合术比头环背心固定治疗能促进更高的融合率。术后视觉模拟评分、活动范围和/或LMD有所改善。保守治疗后，伴有TAL损伤的单侧矢状劈裂骨折的LMD增加。
稳定的寰椎骨折可以通过保守治疗得到充分治疗。不稳定的寰椎骨折可以采用保守治疗和手术治疗，而手术治疗对于不稳定的孤立性寰椎骨折具有良好的效果。未来有必要进行进一步的研究，以进一步指导孤立性寰椎骨折患者管理中的风险分层和治疗方法。
