Traumatic posterior atlantoaxial dislocation based on imaging of the anterior arch-odontoid process-transverse ligament complex: a retrospective cohort study.

IF 2.9 2区 医学 Q2 CLINICAL NEUROLOGY
Tingfei Yan, Deshuang Qi, Haoyu Ni, Bingyong Xie, Jianchao Chang, Li Zhang, Peiwen Song, Cailiang Shen, Haisong Yang, Guodong Shi, Haiming Yu, Fulong Dong
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引用次数: 0

Abstract

Objective: Traumatic posterior atlantoaxial dislocation (TPAD) is uncommon, and related research is very limited. By analyzing the imaging characteristics of the anterior arch-odontoid process-transverse ligament complex in patients, the authors classify the outcomes of TPAD and elucidate its mechanisms of injury.

Methods: This is a retrospective review of CT and MRI data on patients with TPAD treated at two clinical centers from June 2014 to March 2024. Through analysis and statistics on injuries to the anterior arch, odontoid process, and transverse ligament complex, the authors proposed a new classification method based on different injuries to these structures on imaging. Additionally, they discuss the role of hyperflexion and hyperextension injuries in the formation of TPAD.

Results: The different injuries to the anterior arch-odontoid process-transverse ligament complex on imaging were classified into four types of TPAD: fracture-free TPAD (type I), odontoid process fracture TPAD (type II), anterior arch fracture TPAD (type III), and compound fracture TPAD (type IV); the latter three types are referred to as "fracture-associated TPAD." Considering the significant role of the transverse ligament in injuries, these four fracture types were further divided into two subtypes based on transverse ligament integrity (i.e., intact or injured). Among the 41 patients included in the study, there were 2 cases of fracture-free TPAD (i.e., 1 type Ia case and 1 type Ib case) and 39 cases of fracture-associated TPAD (i.e., 31 cases of odontoid process fracture TPAD, including 18 type IIa cases and 3 type IIb cases; 5 cases of anterior arch fracture TPAD, including 3 type IIIa cases and 2 type IIIb cases; and 3 cases of compound fracture TPAD, including 2 type IVa cases and 1 type IVb case).

Conclusions: Based on the imaging classification method for different injuries to the anterior arch-odontoid process-transverse ligament complex, TPAD injuries demonstrate a higher degree of alignment, facilitating a comprehensive understanding of these injuries. Hyperflexion and hyperextension are the primary mechanisms in TPAD injuries, with the integrity of the transverse ligament playing a crucial role and guiding treatment principles.

基于前弓-齿状突-横韧带复合体成像的外伤性后寰枢脱位:一项回顾性队列研究。
目的:外伤性寰枢后脱位(TPAD)较为少见,相关研究非常有限。通过分析患者前弓-齿状突-横韧带复合体的影像学特征,对TPAD的预后进行分类,并阐明其损伤机制。方法:回顾性分析2014年6月至2024年3月在两个临床中心治疗的TPAD患者的CT和MRI资料。通过对前弓、齿状突和横韧带复合体损伤的分析和统计,提出了一种基于影像学上不同损伤的分类方法。此外,他们还讨论了过屈和过伸损伤在TPAD形成中的作用。结果:前弓-齿状突-横韧带复合体在影像学上的损伤不同,可分为无骨折型TPAD (I型)、齿状突骨折型TPAD (II型)、前弓骨折型TPAD (III型)和复合骨折型TPAD (IV型)四种类型;后三种类型被称为“骨折相关性TPAD”。考虑到横韧带在损伤中的重要作用,根据横韧带的完整性(即完整或损伤),将这四种骨折类型进一步分为两种亚型。纳入研究的41例患者中,无骨折型TPAD 2例(即Ia型1例,Ib型1例),骨折相关TPAD 39例(即齿状突骨折型TPAD 31例,其中IIa型18例,IIb型3例;TPAD前弓骨折5例,其中IIIa型3例,IIIb型2例;复合骨折TPAD 3例,其中IVa型2例,IVb型1例)。结论:基于对前弓-齿状突-横韧带复合体不同损伤的影像学分类方法,TPAD损伤表现出较高的对齐程度,有助于对这些损伤的全面认识。过屈和过伸是TPAD损伤的主要机制,横韧带的完整性起着至关重要的作用,并指导治疗原则。
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来源期刊
Journal of neurosurgery. Spine
Journal of neurosurgery. Spine 医学-临床神经学
CiteScore
5.10
自引率
10.70%
发文量
396
审稿时长
6 months
期刊介绍: Primarily publish original works in neurosurgery but also include studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology.
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