Chen Yun-Lin, Jiang Wei-Yu, Lu Wen-Jie, Hu Xu-Dong, Wang Yang, Ma Wei-Hu
Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, China.
Zhejiang Chinese Medical University, School of Medicine, Hangzhou, China.
Asian Spine J. 2025 Feb;19(1):3-9. doi: 10.31616/asj.2024.0162. Epub 2025 Feb 24.
A retrospective study.
This study aimed to observe the computed tomography (CT) characteristics of atlas fracture and propose a new CT classification system, evaluate its reliability and repeatability, and discuss its clinical significance.
The treatment and classification of atlas fracture remain controversial. At present, no classification method has been standardized for atlas fracture. Injury to the transverse atlantal ligament (TAL) and lateral mass displacement is still controversial.
Seventy-five patients with atlas fracture were included from January 2015 to December 2020. Based on the anatomy of the fracture line, atlas fractures were divided into three types. Each type was divided into two subtypes according to the fracture displacement. Unweighted Cohen kappa coefficients were applied to evaluate the reliability and reproducibility.
According to the new classification, 17 cases of type A1, 12 of type A2, seven of type B1, 13 of type B2, 12 of type C1, and 14 of type C2 were identified. The K-values of the interobserver and intraobserver reliability were 0.846 and 0.912, respectively, for the new classification. The K-values of interobserver reliability for types A, B, and C were 0.843, 0.799, and 0.898, respectively. The K-values of intraobserver reliability for types A, B, and C were 0.888, 0.910, and 0.935, respectively. The mean K-values of the interobserver and intraobserver reliability for subtypes were 0.687 and 0.829, respectively.
The new classification of atlas fractures can cover nearly all atlas fractures. This system is the first to evaluate the severity of fractures based on the C1 articular facet and fracture displacement and strengthen the anatomy ring of the atlas. It is concise, easy to remember, reliable, and reproducible.
一项回顾性研究。
本研究旨在观察寰椎骨折的计算机断层扫描（CT）特征，提出一种新的CT分类系统，评估其可靠性和可重复性，并探讨其临床意义。
寰椎骨折的治疗和分类仍存在争议。目前，尚无针对寰椎骨折的标准化分类方法。寰椎横韧带（TAL）损伤和侧块移位仍存在争议。
纳入2015年1月至2020年12月期间的75例寰椎骨折患者。根据骨折线的解剖结构，将寰椎骨折分为三种类型。每种类型根据骨折移位情况分为两个亚型。应用非加权Cohen kappa系数评估可靠性和可重复性。
根据新分类，A1型17例，A2型12例，B1型7例，B2型13例，C1型12例，C2型14例。新分类的观察者间和观察者内可靠性的K值分别为0.846和0.912。A、B、C型的观察者间可靠性K值分别为0.843、0.799和0.898。A、B、C型的观察者内可靠性K值分别为0.888、0.910和0.935。亚型的观察者间和观察者内可靠性的平均K值分别为0.687和0.829。
寰椎骨折的新分类几乎可以涵盖所有寰椎骨折。该系统首次基于C1关节面和骨折移位评估骨折严重程度，并强化了寰椎的解剖环。它简洁、易记、可靠且可重复。
