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1頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月PrefaceDensaxis

AtlantoaxialstabilityMostimportantaxialbonestructureOdontoidfracture

AtlantoaxialinstabilitySecondarySCI第2頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月Odontoidfracture7~10%ofcervicalspinefracturecause

SCIinstantlyRespiratorydysfunctionEvendeathSpecialstructuresandfunctionHighununionrateafterfracture第3頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月OdontoidfractureLackofeffectivetreatmentNottreatedUnstablefactorsexistAtlaslosttherestrictionofDensaxisandligamentsDelayedatlantoaxialdislocation第4頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月ClinicalinformationMale41casesFemale15casesAgerange15~58yrsAverage37.5yrs11~20yrs5cases21~31yrs16cases31~40yrs23cases41~50yrs7cases50~58yrs5cases第5頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月InjurycausesAccidentalfalls15casesbuildingworkaccident12casesdropfrombed3casesMotorvehicleaccident11casesSports-relatedinjury13caseswaterdive7casesTumbleonground7casesWeighthurt10cases第6頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月CourseofdiseasesTimefrominjurytotreatment

shortest4weekslongest26months1~3M23cases4~6M15cases7~9M11cases10~12M4cases>1yrs3cases第7頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月Treatmentcoursenottreatedafterinjury12casesnodiagnosiswhenadmitted7casesskulltraction2~3Wstabilizedbycollars16casesonlycollarsstabilization21cases第8頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月LocalfeaturesUncomfortableandpainofneckandnape37casesMiddleorbilateralareaoftheoccipitocervicalPossiblefeelingofhyperesthesiaorpainatfieldsdominatedbygreatoccipitalorgreatauricularnerveSkullandneckmotorlimitation21casesTiltstiffnessofheadandneck14cases第9頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月MotorfunctionNormalgait,nomotorlimitationworkproperly16casesWeaknessoflegs,clumsyaction,butcanwalkweaknessofhandsgraspingfunctionnotaffected21casesunstablegaitneedsupport,weaknessofupperlimbs,capableofgrasping,13casesincapableofstandingandwalkingstayinbed6cases第10頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月Neurologicexaminationnormaloralmostnormal

9casesSymmetrictendonreflexesNopathologicalreflexNoparesthesiaorhyperesthesiaappearancesofuppercervicalnerveinjurypain,anaesthesiaofGANandGON15casestendonhyperreflex,musclehypertensionmuscleforcedecrease2~3grades32casesHoffman抯signpositive19casesBabinski抯signpositive8casesBoth6cases第11頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月RadiologicalexaminationRoutineX-rayprogramhead-neckAPlateraldynamiclateralfilmsopenmouthviewAllcaseshowedodontoidfractureAccordingtoAnderson-D扐lonzoclassificatonTypeⅡ47casesTypeⅢ9cases第12頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月Dislocationstatusnodisplacement8casesForewarddisplacement≤4mm14cases5~7mm20cases8~10mm8cases11~12mm3casesDorsaldisplacement3casesDynamicreducibledislocation14casesflexion—dislocationextension—reduction第13頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月MRIexamination41casesNosignificantabnormal8casesSpinalcordcompression33casesSCsignalsincreasing5cases第14頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月Treatment

AllreceivedoperationBeforeoperation—Skulltractionroutinely1WlaterXrays—observereductiontrendpossiblereduction—keeptractionuntilrestoredimpossiblereduction—giveuptractionReducibledislocationneednocontinuoustraction

receiveoperationdirectly第15頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月Ⅰ—Atlanoaxialposteriorstructure

bonegraftandwirefixationModifiedGalliemethod17casesModifiedBrooksmethod14casesAutogenousiliacbone—cliptobe揟?shapeTheconvexofbonegraftisinsertedintothegapbetweentheposteriorarchofatlasandthebaseofC2laminaandspinousDistance=8~10mm

Inter-arches&Over-surfacebonegraft+Wirefixation第16頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月Ⅱ—Atlasposteriorarchresection

+Occipital-cervicalfusionResecteachsideofthedislocatedatlasposteriorarch10mmbesidetheposteriortubercleAutogenousiliacgraftsbetweentheoccipitalandthebaseofC2spinousprocesses

Total25cases第17頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月ResultsNodeathcaseAllbefollowed-upAveragefollow-uptime3yrsand6MShortest11MLongest10yrsand8M第18頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月Assessmentarcordingto

spinalcordfunctionandimageExcellent:noabnormalfeelingNormalornearnormaloflimbsBonegraftunionNosignificantdifficultyofheadandneckmotionGood:feelgoodUncomfortableonheadorneckoccasionallySometimesweaknessofextremities,normalgaitNeurologicexaminationhypersensitiveoftendonreflexpathologicreflexmayexist第19頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月Better:symptomsandsignsimprovedLimbsmotordeficit,unstablegaitno-change:nochangeofsymptomsandsignsorfeelingsBonegraftsun-union第20頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月ResultsoftreatmentAtlantoaxialfusionExcellent14casesGood11casesBetter4casesNochange2cases**1casebonegraftununionanddisplacedOccipitocervicalfusionExcellent12casesGood8casesBetter3casesNochange2cases**bonegraftununionanddisplaced第21頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月DiscussionⅠ:FeaturesofOdontoidfracture

anddelayedatlantoaxialdislocationOdontoidfractureAtlas-axislossrestrictionofbonestructureResultsininstabilitybetweenatlasandaxisEspeciallyAnderson-D扐lozontypeⅡortypeⅢfractureManycasesdiedinstantlyforseverecervicalspinalcordinjuryandrespiratoryfailure第22頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月Maincausesofearlymis-diagnosisSurvivalsofodontoidfractureonlycomplicatedwithmilddislocationornodislocationofatlasclinicalsymptomsaremildnotenoughtotakepatient抯attentiontheillegibleradiographyshowoverlappingofbonestructurebetweenatlasandaxis第23頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月PathologicalchangesIntensiverelatedfactorsTraumaticforceformTraumaticforcestrengthAnatomicstructure第24頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月AnatomyaboutodontoidTheapicalligamentandthealarligamentextendfromthetipandthetwosidesofthedensbodyweavingwithanterioratlanto-occipitalmembraneTheposteriorpartofalarligamentattachestotheanteriorrimofoccipitalforamenmagnumandtheoccipitalcondylesOdontoidjointedwiththeposteriorsideofatlasanteriorarch,keepingstablewiththestrongtransverseligamentandalarligamentwhichrestrictthemotorrangeofodontoid第25頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月AnatomyaboutodontoidSagittaldiameterofC1canal=30mmDiameterofcord=10mmDiameterofdens=10mmSafespaceforcord=10mmConsiderablebufferingspaceisavailable第26頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月MechanismofodontoidfractureSkullflexioninjuryisoneofthemajorcausesTraumaticforcesheadbendedsuddenlyOdontoidAnteriorarchofC1TransverseligamentImpactingforwardtogetherTransverseshearforceVerticalcompressforceSeparatetheconnectionbetweenodontoidandC2bodyOdontoidfractureOutsideshearforceOutsidetearforce第27頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月MechanismofdelayedatlasdislocationUnstablestatuscausedbyodontoidfractureSkullhastrendsofincliningforwardandmovingcontinuouslyAtlasmoveforwardprogressivelywithdensaxisDelayedatlasdislocationDirectoperativedecompressionMovingforwardequablyorMovingforwardrotatelyPotentialrisksofSCIContributedfactorsodontoidligamentsaroundarticularcapsule第28頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月DiscussionⅡ

ClinicalfeaturesofodontoidfractureLocalsymptomsneckandnapepainearly—restrictedtouppercervicalspinemotordysfunctionofheadandneckespeciallytherotationfunctionNeurologicsymptomsmildatearlystage,easytobeoverlookeddelayedspinalcordcompression

paralysis,respirationfailureNerverootcompressionnimbleness,painandstiffnessofoccipital-cervicalarea第29頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月Diagnosisof

odontoidfracture&atlasdislocationHistory—injury,treatmentcourselocalandneurologicexaminationimageexaminationroutineX-raysfilmsSkull-neckAPfilmsOpen-mouthfilmsLateralflexionandextensionfilmsX-raytomographyCTMRIDifferentiatewiththeodontoiddysplasiaanditsdeformitycomplicationFacilitatechoosingthetreatmentplanandassessingprognosis第30頁(yè)，課件共34頁(yè)，創(chuàng)作于2023年2月DiscussionⅢTreatmentOdontoidfractureself-healingdifficultCanhardlyhealatthedisplacedsiteNon-operationtreatmentsareineffectiveSurgicaltreatmentisthefirstchoiceOperativeprocedurechoiceaccordingtopathologicchangesandclinic