Amling M, Wening V J, Pösl M, Grote H J, Hahn M, Delling G
Abteilung Osteopathologie, Universität Hamburg.
Chirurg. 1994 Nov;65(11):964-9.
Fractures of the dens are seen especially in young adolescents but also in individuals after the sixth decade of life. The etiology of these fractures and the occurrence of non-union after initial treatment is still discussed controversially. To address these issues, the axis was removed from thirty-seven autopsy cases for histomorphometric analysis. The base of the dens is a region of least resistance for fractures due to its reduced trabecular bone volume, a poorer trabecular interconnection and a cortical thickness one third that of the axis. In all of the cases, trabeculae disconnected from the trabecular lattice, and in 30% microcallus formations were demonstrated in the base of the dens. In osteoporotics the microarchitectural differences of cancellous bone between the base of the dens and the other regions of the axis are increased markedly. The obtained data suggest that the bone structure of the axis is responsible for the location, the distribution and the frequency of fractures of the odontoid process. The deficiency of bone mass within the base also offers a new explantation for the occurrence of non-unions even after treatment of fractures of the base of the dens.
齿突骨折在青少年中尤为常见，但在60岁以上人群中也有发生。这些骨折的病因以及初始治疗后不愈合的发生率仍存在争议。为了解决这些问题，从37例尸检病例中取出枢椎进行组织形态计量学分析。齿突基部由于小梁骨体积减少、小梁连接较差且皮质厚度仅为枢椎的三分之一，是骨折的阻力最小区域。在所有病例中，小梁与小梁网络分离，30%的病例在齿突基部可见微骨痂形成。在骨质疏松症患者中，齿突基部与枢椎其他区域的松质骨微结构差异明显增大。所得数据表明，枢椎的骨骼结构决定了齿突骨折的位置、分布和频率。齿突基部骨量不足也为即使在齿突基部骨折治疗后仍发生不愈合提供了新的解释。
