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OdontoidFractureandDelayedAtlantoaxialDislocationChangZhengHospitalShanghaiJiaLianshunPrefaceDensaxis

AtlantoaxialstabilityMostimportantaxialbonestructureOdontoidfracture

AtlantoaxialinstabilitySecondarySCIOdontoidfracture7~10%ofcervicalspinefracturecause

SCIinstantlyRespiratorydysfunctionEvendeathSpecialstructuresandfunctionHighununionrateafterfractureClinicalinformationMale41casesFemale15casesAgerange15~58yrsAverage37.5yrs11~20yrs5cases21~31yrs16cases31~40yrs23cases41~50yrs7cases50~58yrs5casesInjurycausesAccidentalfalls15casesbuildingworkaccident12casesdropfrombed3casesMotorvehicleaccident11casesSports-relatedinjury13caseswaterdive7casesTumbleonground7casesWeighthurt10casesCourseofdiseasesTimefrominjurytotreatment

shortest4weekslongest26months1~3M23cases4~6M15cases7~9M11cases10~12M4cases>1yrs3casesTreatmentcoursenottreatedafterinjury12casesnodiagnosiswhenadmitted7casesskulltraction2~3Wstabilizedbycollars16casesonlycollarsstabilization21casesMotorfunctionNormalgait,nomotorlimitationworkproperly16casesWeaknessoflegs,clumsyaction,butcanwalkweaknessofhandsgraspingfunctionnotaffected21casesunstablegaitneedsupport,weaknessofupperlimbs,capableofgrasping,13casesincapableofstandingandwalkingstayinbed6casesRadiologicalexaminationRoutineX-rayprogramhead-neckAPlateraldynamiclateralfilmsopenmouthviewAllcaseshowedodontoidfractureAccordingtoAnderson-D扐lonzoclassificatonTypeⅡ47casesTypeⅢ9casesMRIexamination41casesNosignificantabnormal8casesSpinalcordcompression33casesSCsignalsincreasing5casesTreatment

AllreceivedoperationBeforeoperation—Skulltractionroutinely1WlaterXrays—observereductiontrendpossiblereduction—keeptractionuntilrestoredimpossiblereduction—giveuptractionReducibledislocationneednocontinuoustraction

receiveoperationdirectlyⅠ—Atlanoaxialposteriorstructure

bonegraftandwirefixationModifiedGalliemethod17casesModifiedBrooksmethod14casesAutogenousiliacbone—cliptobe揟?shapeTheconvexofbonegraftisinsertedintothegapbetweentheposteriorarchofatlasandthebaseofC2laminaandspinousDistance=8~10mm

Inter-arches&Over-surfacebonegraft+WirefixationⅡ—Atlasposteriorarchresection

+Occipital-cervicalfusionResecteachsideofthedislocatedatlasposteriorarch10mmbesidetheposteriortubercleAutogenousiliacgraftsbetweentheoccipitalandthebaseofC2spinousprocesses

Total25casesResultsNodeathcaseAllbefollowed-upAveragefollow-uptime3yrsand6MShortest11MLongest10yrsand8MBetter:symptomsandsignsimprovedLimbsmotordeficit,unstablegaitno-change:nochangeofsymptomsandsignsorfeelingsBonegraftsun-unionResultsoftreatmentAtlantoaxialfusionExcellent14casesGood11casesBetter4casesNochange2cases**1casebonegraftununionanddisplacedOccipitocervicalfusionExcellent12casesGood8casesBetter3casesNochange2cases**bonegraftununionanddisplacedMaincausesofearlymis-diagnosisSurvivalsofodontoidfractureonlycomplicatedwithmilddislocationornodislocationofatlasclinicalsymptomsaremildnotenoughtotakepatient抯attentiontheillegibleradiographyshowoverlappingofbonestructurebetweenatlasandaxisPathologicalchangesIntensiverelatedfactorsTraumaticforceformTraumaticforcestrengthAnatomicstructureAnatomyaboutodontoidSagittaldiameterofC1canal=30mmDiameterofcord=10mmDiameterofdens=10mmSafespaceforcord=10mmConsiderablebufferingspaceisavailableMechanismofodontoidfractureSkullflexioninjuryisoneofthemajorcausesTraumaticforcesheadbendedsuddenlyOdontoidAnteriorarchofC1TransverseligamentImpactingforwardtogetherTransverseshearforceVerticalcompressforceSeparatetheconnectionbetweenodontoidandC2bodyOdontoidfractureOutsideshearforceOutsidetearforceMechanismofdelayedatlasdislocationUnstablestatuscausedbyodontoidfractureSkullhastrendsofincliningforwardandmovingcontinuouslyAtlasmoveforwardprogressivelywithdensaxisDelayedatlasdislocationDirectoperativedecompressionMovingforwardequablyorMovingforwardrotatelyPotentialrisksofSCIContributedfactorsodontoidligamentsaroundarticularcapsuleDiagnosisof

odontoidfracture&atlasdislocationHistory—injury,treatmentcourselocalandneurologicexaminationimageexaminationroutineX-raysfilmsSkull-neckAPfilmsOpen-mouthfilmsLateralflexionandextensionfilmsX-raytomographyCTMRIDifferentiatewiththeodontoiddysplasiaanditsdeformitycomplicationFacilitatechoosingthetreatmentplanandassessingprognosisDiscussionⅢTreatmentOdontoidfractureself-healingdifficultCanhardlyhealatthedisplacedsiteNon-operationtreatmentsareineffectiveSurgicaltreatmentisthefirstchoiceOperativeprocedurechoiceaccordingtopathologicchangesandclinicalfeaturesAtlantoaxialfusion

anidealmethodConditionsReductioncompletelyoralmostrestoredafterskulltractionAtlasisnotdislocatedorcanrestorewhileextensionOccipital-cervicalarthrodesis

acommonoperativeprocedureRestrictingtheskull-neckmotorfunctioninsomeextentIndications—thosewhoneedsposteriorarchresectionobviousatlantoaxialdislocationposteriorarchofatlasisthechiefcompressoratlasanteriordislocationissmallseveresymptomsofSCIexistMethodsofrebuildingthestabilityModifiedGallieandBrookstechniqueProceduresofwiretechnicalRevisingandplacingofbonegraftsDistancebetweentheposteriorarchandlaminaeandspinousofC2is8mmwhenatlasisatneutralpositionundernormalphysicalconditionRelativelyconstantkeepingtheligamenttensionbetweenatlasandaxisandthestabilityofjointsrelatedtodensaxisAdvantages

oftheposteriorstructurefusioninter-archesbonegraftingover-surfacebone

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