两期手术治疗III型齿状突骨折伴C1-C2骨折脱位1例报告及处理综述。

IF 1.7 Q2 MEDICINE, GENERAL & INTERNAL
Annals of Medicine and Surgery Pub Date : 2024-10-16 eCollection Date: 2024-12-01 DOI:10.1097/MS9.0000000000002653
Khitamul Haq, Saleem Akhter, Muhammad A Waqas, Adedoyin E Alao, Abhik Halder, Bipin Chaurasia
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引用次数: 0

摘要

介绍及重要性:第二颈椎(C2)齿状突骨折分为三种类型,其中III型延伸至椎体。这些骨折通常由高能创伤引起,可引起严重的不稳定和神经问题。本病例报告讨论了一名43岁男性III型齿状突骨折并C1-C2骨折脱位,证明了传统神经外科技术在治疗此类复杂损伤中的有效性。病例介绍:一名43岁男性,在一次道路交通事故后表现为上颈椎疼痛和右上肢无力。影像学显示III型齿状突骨折伴后侧移位和寰枢关节(C1-C2)脱位。病人接受了两阶段的外科手术。第一阶段涉及经口减压,以解决后冲齿状突碎片和缓解脊髓压迫。第二阶段涉及后路颅颈固定,采用自体髂骨移植物进行稳定。患者术后好转,第3天出院,随访1个月病情稳定。临床讨论:治疗伴有C1-C2脱位的III型齿状突骨折具有挑战性,需要有策略的方法来确保脊柱的稳定性和神经系统的恢复。经口减压提供了直接有效的减压通道,而后路固定确保了坚固的稳定。自体髂骨移植物增强融合和长期稳定性。本病例说明了传统神经外科技术与现代外科原理的成功结合。结论:本病例强调了传统神经外科技术在治疗复杂齿状突骨折中的重要性。经口减压后颅颈后路固定的两阶段入路被证明是有效的,突出了这些技术在当代神经外科实践中取得积极结果的相关性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Two-stage surgical approach for type III odontoid fracture with C1-C2 fracture dislocation: a case report and management overview.

Introduction and importance: Odontoid fractures of the second cervical vertebra (C2) are categorized into three types, with type III extending into the body of the axis. These fractures, often resulting from high-energy trauma, can cause significant instability and neurological issues. This case report discusses a 43-year-old male with a type III odontoid fracture and C1-C2 fracture dislocation, demonstrating the effectiveness of traditional neurosurgical techniques in managing such complex injuries.

Case presentation: A 43-year-old male presented with upper cervical pain and right upper limb weakness following a road traffic accident. Imaging revealed a type III odontoid fracture with posterior displacement and atlanto-axial (C1-C2) joint dislocation. The patient underwent a two-stage surgical procedure. The first stage involved transoral decompression to address the retropulsed odontoid fragment and relieve spinal cord compression. The second stage involved posterior craniocervical fixation using an autologous iliac bone graft for stabilization. The patient showed postoperative improvement and was discharged on the third day, with a stable condition at a one-month follow-up.

Clinical discussion: Managing type III odontoid fractures with C1-C2 dislocation is challenging, requiring a strategic approach to ensure spinal stability and neurological recovery. Transoral decompression provides direct access for effective decompression, while posterior fixation ensures robust stabilization. The use of an autologous iliac bone graft enhances fusion and long-term stability. This case illustrates the successful integration of traditional neurosurgical techniques with modern surgical principles.

Conclusion: This case underscores the importance of traditional neurosurgical techniques in managing complex odontoid fractures. The two-stage approach of transoral decompression followed by posterior craniocervical fixation proved effective, highlighting the relevance of these techniques in achieving positive outcomes in contemporary neurosurgical practice.

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Annals of Medicine and Surgery
Annals of Medicine and Surgery MEDICINE, GENERAL & INTERNAL-
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