Kwon Jae Hyun, Chinthala Anoop Sai, Arnold Jonathan C, Witten Andrew J, Bohnstedt Bradley N
Department of Neurological Surgery, Indiana University School of Medicine, 355 W. 15th St., Suite 5100, Indianapolis, IN 46202, USA.
J Clin Med. 2024 Dec 15;13(24):7639. doi: 10.3390/jcm13247639.
Occipital condyle fractures (OCFs) can be seen in around 4-19% of patients who suffer from cervical spine trauma. Anderson and Montesano system type III OCFs, which are avulsion fractures, are potentially unstable and operative. This study evaluates the management of type III OCFs at our institution over a 22-year period. This retrospective study reviewed all cases of type III OCFs at our institution from July 2001 to March 2023, identified via imaging reports. Using the in-house radiology imaging informatics system "Doris" (Dig Our Radiology Information System), reports containing the terms subluxation, avulsion, unstable, or type 3/III with occipital condyle, occipital condylar, occipital fx, or occipital fracture were collected. We also searched for Montesano type III/3 fracture. Electronic medical records were used to collect clinical and demographic data. Patients evaluated by the neurosurgical team with at least 1 month of follow-up were included in the analysis. A total of 563 patients were identified with type III OCFs. A total of 56 patients met the inclusion criteria. The majority (91%, 51/56) were treated conservatively with cervical orthosis. A small subset (8.9%, 5/56) underwent occipito-cervical fusion. Three had concomitant unstable C1 fractures, while the other two had significant coronal deformity associated with their type III OCF. At our institution, type III OCFs are predominantly managed with cervical orthosis. Only those with an associated malalignment of the occipito-cervical joint underwent fusion. These findings suggest that most type III OCFs can be treated conservatively with orthosis once stability is confirmed with an upright radiograph.
枕髁骨折（OCFs）在颈椎创伤患者中约占4%-19%。安德森和蒙特萨诺III型OCFs为撕脱性骨折，具有潜在不稳定性，通常需要手术治疗。本研究评估了我院22年间III型OCFs的治疗情况。这项回顾性研究对我院2001年7月至2023年3月期间所有III型OCFs病例进行了回顾，这些病例通过影像学报告确定。利用内部放射学成像信息系统“多丽丝”（挖掘我们的放射学信息系统），收集了包含半脱位、撕脱、不稳定或枕髁、枕髁、枕骨骨折或枕骨骨折的3/III型等术语的报告。我们还搜索了蒙特萨诺III/3型骨折。使用电子病历收集临床和人口统计学数据。纳入分析的患者为经神经外科团队评估且随访至少1个月的患者。共确定563例III型OCFs患者。共有56例符合纳入标准。大多数患者（91%，51/56）采用颈椎矫形器保守治疗。一小部分患者（8.9%，5/56）接受了枕颈融合术。其中3例伴有不稳定的C1骨折，另外2例伴有与III型OCF相关的明显冠状位畸形。在我院，III型OCFs主要采用颈椎矫形器治疗。只有那些伴有枕颈关节排列不齐的患者才接受融合术。这些发现表明，一旦通过直立位X线片确认稳定，大多数III型OCFs可以采用矫形器保守治疗。
