齒突骨折與遲發(fā)性寰樞椎脫位

齒突骨折與遲發(fā)性寰樞椎脫位第一頁，共三十四頁，編輯于2023年，星期二PrefaceDensaxis

AtlantoaxialstabilityMostimportantaxialbonestructureOdontoidfracture

AtlantoaxialinstabilitySecondarySCI第二頁，共三十四頁，編輯于2023年，星期二Odontoidfracture7~10%ofcervicalspinefracturecause

SCIinstantlyRespiratorydysfunctionEvendeathSpecialstructuresandfunctionHighununionrateafterfracture第三頁，共三十四頁，編輯于2023年，星期二OdontoidfractureLackofeffectivetreatmentNottreatedUnstablefactorsexistAtlaslosttherestrictionofDensaxisandligamentsDelayedatlantoaxialdislocation第四頁，共三十四頁，編輯于2023年，星期二ClinicalinformationMale41casesFemale15casesAgerange15~58yrsAverage37.5yrs11~20yrs5cases21~31yrs16cases31~40yrs23cases41~50yrs7cases50~58yrs5cases第五頁，共三十四頁，編輯于2023年，星期二InjurycausesAccidentalfalls15casesbuildingworkaccident12casesdropfrombed3casesMotorvehicleaccident11casesSports-relatedinjury13caseswaterdive7casesTumbleonground7casesWeighthurt10cases第六頁，共三十四頁，編輯于2023年，星期二CourseofdiseasesTimefrominjurytotreatment

shortest4weekslongest26months1~3M23cases4~6M15cases7~9M11cases10~12M4cases>1yrs3cases第七頁，共三十四頁，編輯于2023年，星期二Treatmentcoursenottreatedafterinjury12casesnodiagnosiswhenadmitted7casesskulltraction2~3Wstabilizedbycollars16casesonlycollarsstabilization21cases第八頁，共三十四頁，編輯于2023年，星期二LocalfeaturesUncomfortableandpainofneckandnape37casesMiddleorbilateralareaoftheoccipitocervicalPossiblefeelingofhyperesthesiaorpainatfieldsdominatedbygreatoccipitalorgreatauricularnerveSkullandneckmotorlimitation21casesTiltstiffnessofheadandneck14cases第九頁，共三十四頁，編輯于2023年，星期二MotorfunctionNormalgait,nomotorlimitationworkproperly16casesWeaknessoflegs,clumsyaction,butcanwalkweaknessofhandsgraspingfunctionnotaffected21casesunstablegaitneedsupport,weaknessofupperlimbs,capableofgrasping,13casesincapableofstandingandwalkingstayinbed6cases第十頁，共三十四頁，編輯于2023年，星期二Neurologicexaminationnormaloralmostnormal

9casesSymmetrictendonreflexesNopathologicalreflexNoparesthesiaorhyperesthesiaappearancesofuppercervicalnerveinjurypain,anaesthesiaofGANandGON15casestendonhyperreflex,musclehypertensionmuscleforcedecrease2~3grades32casesHoffman抯signpositive19casesBabinski抯signpositive8casesBoth6cases第十一頁，共三十四頁，編輯于2023年，星期二RadiologicalexaminationRoutineX-rayprogramhead-neckAPlateraldynamiclateralfilmsopenmouthviewAllcaseshowedodontoidfractureAccordingtoAnderson-D扐lonzoclassificatonTypeⅡ47casesTypeⅢ9cases第十二頁，共三十四頁，編輯于2023年，星期二Dislocationstatusnodisplacement8casesForewarddisplacement≤4mm14cases5~7mm20cases8~10mm8cases11~12mm3casesDorsaldisplacement3casesDynamicreducibledislocation14casesflexion—dislocationextension—reduction第十三頁，共三十四頁，編輯于2023年，星期二MRIexamination41casesNosignificantabnormal8casesSpinalcordcompression33casesSCsignalsincreasing5cases第十四頁，共三十四頁，編輯于2023年，星期二Treatment

AllreceivedoperationBeforeoperation—Skulltractionroutinely1WlaterXrays—observereductiontrendpossiblereduction—keeptractionuntilrestoredimpossiblereduction—giveuptractionReducibledislocationneednocontinuoustraction

receiveoperationdirectly第十五頁，共三十四頁，編輯于2023年，星期二Ⅰ—Atlanoaxialposteriorstructure

bonegraftandwirefixationModifiedGalliemethod17casesModifiedBrooksmethod14casesAutogenousiliacbone—cliptobe揟?shapeTheconvexofbonegraftisinsertedintothegapbetweentheposteriorarchofatlasandthebaseofC2laminaandspinousDistance=8~10mm

Inter-arches&Over-surfacebonegraft+Wirefixation第十六頁，共三十四頁，編輯于2023年，星期二Ⅱ—Atlasposteriorarchresection

+Occipital-cervicalfusionResecteachsideofthedislocatedatlasposteriorarch10mmbesidetheposteriortubercleAutogenousiliacgraftsbetweentheoccipitalandthebaseofC2spinousprocesses

Total25cases第十七頁，共三十四頁，編輯于2023年，星期二ResultsNodeathcaseAllbefollowed-upAveragefollow-uptime3yrsand6MShortest11MLongest10yrsand8M第十八頁，共三十四頁，編輯于2023年，星期二Assessmentarcordingto

spinalcordfunctionandimageExcellent:noabnormalfeelingNormalornearnormaloflimbsBonegraftunionNosignificantdifficultyofheadandneckmotionGood:feelgoodUncomfortableonheadorneckoccasionallySometimesweaknessofextremities,normalgaitNeurologicexaminationhypersensitiveoftendonreflexpathologicreflexmayexist第十九頁，共三十四頁，編輯于2023年，星期二Better:symptomsandsignsimprovedLimbsmotordeficit,unstablegaitno-change:nochangeofsymptomsandsignsorfeelingsBonegraftsun-union第二十頁，共三十四頁，編輯于2023年，星期二ResultsoftreatmentAtlantoaxialfusionExcellent14casesGood11casesBetter4casesNochange2cases**1casebonegraftununionanddisplacedOccipitocervicalfusionExcellent12casesGood8casesBetter3casesNochange2cases**bonegraftununionanddisplaced第二十一頁，共三十四頁，編輯于2023年，星期二DiscussionⅠ:FeaturesofOdontoidfracture

anddelayedatlantoaxialdislocationOdontoidfractureAtlas-axislossrestrictionofbonestructureResultsininstabilitybetweenatlasandaxisEspeciallyAnderson-D扐lozontypeⅡortypeⅢfractureManycasesdiedinstantlyforseverecervicalspinalcordinjuryandrespiratoryfailure第二十二頁，共三十四頁，編輯于2023年，星期二Maincausesofearlymis-diagnosisSurvivalsofodontoidfractureonlycomplicatedwithmilddislocationornodislocationofatlasclinicalsymptomsaremildnotenoughtotakepatient抯attentiontheillegibleradiographyshowoverlappingofbonestructurebetweenatlasandaxis第二十三頁，共三十四頁，編輯于2023年，星期二PathologicalchangesIntensiverelatedfactorsTraumaticforceformTraumaticforcestrengthAnatomicstructure第二十四頁，共三十四頁，編輯于2023年，星期二AnatomyaboutodontoidTheapicalligamentandthealarligamentextendfromthetipandthetwosidesofthedensbodyweavingwithanterioratlanto-occipitalmembraneTheposteriorpartofalarligamentattachestotheanteriorrimofoccipitalforamenmagnumandtheoccipitalcondylesOdontoidjointedwiththeposteriorsideofatlasanteriorarch,keepingstablewiththestrongtransverseligamentandalarligamentwhichrestrictthemotorrangeofodontoid第二十五頁，共三十四頁，編輯于2023年，星期二AnatomyaboutodontoidSagittaldiameterofC1canal=30mmDiameterofcord=10mmDiameterofdens=10mmSafespaceforcord=10mmConsiderablebufferingspaceisavailable第二十六頁，共三十四頁，編輯于2023年，星期二MechanismofodontoidfractureSkullflexioninjuryisoneofthemajorcausesTraumaticforcesheadbendedsuddenlyOdontoidAnteriorarchofC1TransverseligamentImpactingforwardtogetherTransverseshearforceVerticalcompressforceSeparatetheconnectionbetweenodontoidandC2bodyOdontoidfractureOutsideshearforceOutsidetearforce第二十七頁，共三十四頁，編輯于2023年，星期二MechanismofdelayedatlasdislocationUnstablestatuscausedbyodontoidfractureSkullhastrendsofincliningforwardandmovingcontinuouslyAtlasmoveforwardprogressivelywithdensaxisDelayedatlasdislocationDirectoperativedecompressionMovingforwardequablyorMovingforwardrotatelyPotentialrisksofSCIContributedfactorsodontoidligamentsaroundarticularcapsule第二十八頁，共三十四頁，編輯于2023年，星期二DiscussionⅡ

ClinicalfeaturesofodontoidfractureLocalsymptomsneckandnapepainearly—restrictedtouppercervicalspinemotordysfunctionofheadandneckespeciallytherotationfunctionNeurologicsymptomsmildatearlystage,easytobeoverlookeddelayedspinalcordcompression

paralysis,respirationfailureNerverootcompressionnimbleness,painandstiffnessofoccipital-cervicalarea第二十九頁，共三十四頁，編輯于2023年，星期二Diagnosisof

odontoidfracture&atlasdislocationHistory—injury,treatmentcourselocalandneurologicexaminationimageexaminationroutineX-raysfilmsSkull-neckAPfilmsOpen-mouthfilmsLateralflexionandextensionfilmsX-raytomographyCTMRIDifferentiatewiththeodontoiddysplasiaanditsdeformitycomplicationFacilitatechoosingthetreatmentplanandassessingprognosis第三十頁，共三十四頁，編輯于2023年，星期二DiscussionⅢTreatmentOdontoidfractureself-healingdifficultCanhardlyhealatthedisplacedsiteNon-operationtreatmentsareineffectiveSurgicaltreatmentisthefirstchoiceOperativeprocedurechoiceaccordingtopathologicchangesandclinical