齒突骨折幻燈

1、樞椎骨折樞椎骨折 1、齒狀突骨折2、外傷型樞椎滑脫 （hangman骨折）一、解剖二、分型三、治療齒狀突血供齒狀突較為固定的動(dòng)脈血供有3組動(dòng)脈組成：前升動(dòng)脈（anterior ascending artery）后升動(dòng)脈（posterior ascending artery）裂穿動(dòng)脈（水平動(dòng)脈 cleft perforators）Risk factors for nonunion age 50 years 5 mm displacement 2 mm gap angulations 10 degrees fx comminution delay in treatment (Lack of mai

2、ntaining an acceptable reduction and fracture alignment with an external immobilization device)Persistent Persistent ossiculumossiculum terminaleterminale 永久永久末端小骨末端小骨Os odontoideum Os odontoideum 齒狀突小骨 It was originally thought to be a congenital lesion due to failure of the center of ossification

3、of the dens to fuse with the body of C2, it may actually represent an unremembered and/or unrecognised fracture through the C2/dens growth plate before the age of 5 or 6. There may be associated instability and chronic symptoms. The level of mobility is below the transverse atlantal ligament and the

4、refore results in abnormal mobility of the dens with respect to C2型型： A 型 非粉碎性橫行骨折，移位1mm； C 型 顯著粉碎性骨折型：淺型； 深型治療： I型、深I(lǐng)II型采用牽引、Halo-vest支架、頭頸胸石膏等保守治療 II型、淺III型骨折采用手術(shù)治療齒狀突骨折前路螺釘固定術(shù)：標(biāo)準(zhǔn)拉力螺釘技術(shù)、空心螺釘技術(shù)適應(yīng)癥：齒狀突基底部橫行骨折II型、淺III型禁忌癥：齒狀突骨折骨不連、骨質(zhì)疏松的老年II性型骨折、I型及III型骨折優(yōu)點(diǎn)：保留C1/C2活動(dòng)功能；便于護(hù)理和制動(dòng)不足：不能用于基底部斜型骨折、技術(shù)難度大，在短頸、

5、胸椎畸形患者中應(yīng)用困難；椎管狹窄者易損傷脊椎被視為禁用；術(shù)后吞咽困難前路C1/2螺釘固定適應(yīng)癥：齒狀突II型骨折不能耐受俯臥位手術(shù)者；前路齒狀突螺釘固定失敗者；C1/2不穩(wěn)；不穩(wěn)定性Jefferson骨折優(yōu)點(diǎn)：不許俯臥位；同一手術(shù)入路可行齒狀突螺釘固定不足：外傷型樞椎滑脫（hangman骨折）型系雙側(cè)椎弓根骨折，C2/3關(guān)節(jié)穩(wěn)定，椎間隙完整，較少伴發(fā)脊髓損傷型為在前者基礎(chǔ)上暴力進(jìn)一步加大，不僅骨折呈分離狀，且多伴有成角畸形；前縱韌帶或后縱韌帶斷裂，或是二者同時(shí)斷裂；頸2椎體后下緣可被后縱韌帶撕脫出現(xiàn)撕脫性骨折。且骨折端分離程度較前者為大，一般超過(guò)3mm，或成角大于11型較型損傷為重,如圖4所示,不僅前縱韌帶和后縱韌帶同時(shí)斷裂,且雙側(cè)關(guān)節(jié)突前方骨折的錯(cuò)位程度更為明顯,甚至呈現(xiàn)椎節(jié)脫位狀。此時(shí),一般伴有椎間盤及纖維環(huán)斷裂,并在頸2有三個(gè)部位的損傷：（1）椎弓根或椎板骨折。（2）雙側(cè)關(guān)節(jié)突半脫位或脫位。（3）前縱韌帶及后縱韌帶斷裂，致使頸2椎體半脫位或脫位后路C2椎弓根螺釘