齿突骨折与迟发性寰枢椎脱位课件.ppt

《齿突骨折与迟发性寰枢椎脱位课件.ppt》由会员分享，可在线阅读，更多相关《齿突骨折与迟发性寰枢椎脱位课件.ppt（34页珍藏版）》请在淘文阁 - 分享文档赚钱的网站上搜索。

1、齿突骨折与迟发性寰枢齿突骨折与迟发性寰枢椎脱位椎脱位第1页，此课件共34页哦PrefacelDens axis Atlantoaxial stability Most important axial bone structurelOdontoid fracture Atlantoaxial instability Secondary SCI第2页，此课件共34页哦Odontoid fracture 710%of cervical spine fracturecause SCI instantly Respiratory dysfunction Even deathSpecial structu

2、res and functionHigh ununion rate after fracture第3页，此课件共34页哦Odontoid fracturel lLack of effective treatmentl lNot treated Unstable factors exist Atlas lost the restriction of Dens axis and ligamentsDelayed atlantoaxial dislocation第4页，此课件共34页哦Clinical informationMale 41 cases Female 15 casesAge range

3、 1558 yrs Average 37.5 yrs 1120 yrs 5 cases 2131yrs 16 cases 31 40yrs 23 cases 4150yrs 7 cases 5058yrs 5 cases第5页，此课件共34页哦Injury causesAccidental falls 15 cases building work accident 12 cases drop from bed 3 cases Motor vehicle accident 11 casesSports-related injury 13 cases water dive 7 casesTumbl

4、e on ground 7 casesWeight hurt 10 cases第6页，此课件共34页哦Course of diseasesTime from injury to treatment shortest 4 weeks longest 26 months 13M 23 cases 4 6M 15 cases 79M 11 cases 1012M 4 cases 1 yrs 3 cases第7页，此课件共34页哦Treatment coursenot treated after injury 12 casesno diagnosis when admitted 7 casesskul

5、l traction 23W stabilized by collars 16 casesonly collars stabilization 21 cases第8页，此课件共34页哦Local featuresUncomfortable and pain of neck and nape 37 cases Middle or bilateral area of the occipitocervical Middle or bilateral area of the occipitocervical Possible feeling of hyperesthesia or pain at fi

6、elds dominated by great occipital or great auricular nerve dominated by great occipital or great auricular nerveSkull and neck motor limitation 21 casesTilt stiffness of head and neck 14 cases第9页，此课件共34页哦Motor functionNormal gait,no motor limitation work properly 16 casesWeakness of legs,clumsy acti

7、on,but can walk weakness of hands grasping function not affected 21 casesunstable gait need support,weakness of upper limbs,capable of grasping,13 casesincapable of standing and walking stay in bed 6 cases第10页，此课件共34页哦Neurologic examinationnormal or almost normal 9 casesSymmetric tendon reflexes No

8、pathological reflexNo paresthesia or hyperesthesia appearances of upper of upper cervical nerve injurypain,anaesthesia of GAN and GON 15 casespain,anaesthesia of GAN and GON 15 casestendon hyperreflex,muscle hypertension muscle force decrease 23 grades 32 casesHoffman抯抯抯抯 sign positive 19 casessign

9、positive 19 casesBabinskiBabinski抯抯抯抯 sign positive 8 cases Both 6 casessign positive 8 cases Both 6 cases第11页，此课件共34页哦Radiological examinationRoutine X-ray programhead-neck AP lateraldynamic lateral filmsopen mouth viewAll case showed odontoid fractureAccording to Anderson-D扐扐lonzo classificatonTyp

10、e 47 cases Type 9 cases第12页，此课件共34页哦Dislocation statusno displacement 8 casesForeward displacement 4mm 14cases 57mm 20 cases 810mm 8 cases 1112mm 3 casesDorsal displacement 3 casesDynamic reducible dislocation 14casesflexiondislocation extensionreduction第13页，此课件共34页哦MRI examination 41 casesNo signif

11、icant abnormal 8 casesSpinal cord compression 33 casesl l SC signals increasing 5cases第14页，此课件共34页哦Treatment All received operationBefore operation Skull traction routinely1W later X rays observe reduction trend possible reductionkeep traction until restored impossible reductiongive up tractionl lRe

12、ducible dislocation need no continuous traction receive operation directly第15页，此课件共34页哦Atlanoaxial posterior structure bone graft and wire fixationModified Gallie method 17 cases Modified Brooks method 14 casesAutogenous iliac bone Autogenous iliac bone clip to be clip to be 揟揟?shape?shapeThe convex

13、 of bone graft is inserted into the gap The convex of bone graft is inserted into the gap between between the posterior arch of atlas and the base of C2 lamina and spinous Distance=810 mm Inter-arches&Over-surface bone graft+Wire fixation第16页，此课件共34页哦Atlas posterior arch resection +Occipital-cervica

14、l fusionResect each side of the dislocated atlas posterior arch 10mm beside the posterior tubercleAutogenous iliac grafts between the occipital and the base of C2 spinous processes Total 25 cases第17页，此课件共34页哦ResultsNo death caseNo death caseAll be followed-upAll be followed-upAverage follow-up time

15、3yrs and 6MShortest 11M Longest 10yrs and 8M第18页，此课件共34页哦Assessment arcording tospinal cord function and imageExcellent:no abnormal feelingNormal or near normal of limbs Bone graft unionNormal or near normal of limbs Bone graft unionNo significant difficulty of head and neck motionGood:feel goodUnco

16、mfortable on head or neck occasionallySometimes weakness of extremities,normal gait Sometimes weakness of extremities,normal gait Neurologic examinationNeurologic examination hypersensitive of tendon reflex hypersensitive of tendon reflex pathologic reflex may exist pathologic reflex may exist第19页，此

17、课件共34页哦Better:symptoms and signs improved Limbs motor deficit,unstable gaitno-change:no change of symptoms and signs or feelings Bone grafts un-union 第20页，此课件共34页哦Results of treatmentAtlantoaxial fusionAtlantoaxial fusionExcellent 14 cases Good 11 casesBetter 4 cases No change 2 cases*1 case bone gr

18、aft ununion and displacedOccipitocervical fusion Occipitocervical fusion Excellent 12 cases Good 8 casesBetter 3 cases No change 2 cases*bone graft ununion and displaced第21页，此课件共34页哦DiscussionDiscussion:Features of Odontoid fracture and delayed atlantoaxial dislocationOdontoid fracture Atlas-axis lo

19、ss restriction of bone structure Results in instability between atlas and axisEspecially Anderson-D扐扐lozon typeor type fracture Many cases died instantly for severe cervical spinal cord injury and respiratory failure第22页，此课件共34页哦Main causes of early mis-diagnosisSurvivals of odontoid fracture only c

20、omplicated with mild dislocation or no dislocation of atlasclinical symptoms are mild not enough to take patient抯抯 attentionthe illegible radiography show overlapping of bone structure between atlas and axis第23页，此课件共34页哦Pathological changesIntensive related factorsIntensive related factorsTraumatic

21、force formTraumatic force strengthAnatomic structure第24页，此课件共34页哦Anatomy about odontoidThe apical ligament and the alar ligamentThe apical ligament and the alar ligament extend from the tip and the two sides of the dens body weaving with anterior atlanto-occipital membraneThe posterior part of alar

22、ligament attaches to The posterior part of alar ligament attaches to the anterior rim of occipital foramen magnum and the occipital condyles Odontoid jointed with the posterior side of atlas anterior arch,Odontoid jointed with the posterior side of atlas anterior arch,keeping stable with the strong

23、transverse ligament and alar keeping stable with the strong transverse ligament and alar ligament which restrict the motor range of odontoidligament which restrict the motor range of odontoid第25页，此课件共34页哦Anatomy about odontoidSagittal diameter of C1 canal=30 mmDiameter of cord=10 mmDiameter of dens=

24、10 mmSafe space for cord=10 mmConsiderable buffering space is available第26页，此课件共34页哦Mechanism of odontoid fractureSkull flexion injury is one of the major causesTraumatic forces head bended suddenlyTraumatic forces head bended suddenlyOdontoid Anterior arch of C1 Transverse ligamentTransverse ligame

25、ntImpacting forward togetherImpacting forward togetherTransverse shear force Vertical compress forceSeparate the connection between odontoid and C2 bodySeparate the connection between odontoid and C2 bodyOdontoid fractureOdontoid fractureOutside shear force Outside tear forceOutside shear force Outs

26、ide tear force第27页，此课件共34页哦Mechanism of delayed atlas dislocationUnstable status caused by odontoid fractureUnstable status caused by odontoid fractureSkull has trends of inclining forward and moving continuouslySkull has trends of inclining forward and moving continuouslyAtlas move forward progress

27、ively with dens axisAtlas move forward progressively with dens axisDelayed atlas dislocation Delayed atlas dislocation Direct operative decompression Direct operative decompression Moving forward equably or Moving forward rotatelyMoving forward equably or Moving forward rotately Potential risks of S

28、CI Potential risks of SCI Contributed factors Contributed factors odontoid odontoid ligaments around ligaments around articular capsule articular capsule第28页，此课件共34页哦DiscussionDiscussion Clinical features of odontoid fractureLocal symptomsneck and nape painneck and nape pain early early restricted t

29、o upper cervical spinerestricted to upper cervical spinemotor dysfunction of head and neckmotor dysfunction of head and neck especially the rotation function especially the rotation functionNeurologic symptoms mild at early stage,easy to be overlookedmild at early stage,easy to be overlookeddelayed

30、spinal cord compressiondelayed spinal cord compression paralysis,respiration failure paralysis,respiration failure Nerve root compressionNerve root compression nimbleness,pain and stiffness of occipital-cervical area nimbleness,pain and stiffness of occipital-cervical area第29页，此课件共34页哦Diagnosis of o

31、dontoid fracture&atlas dislocationHistoryinjury,treatment courselocal and neurologic examinationimage examination routine X-rays films routine X-rays filmsSkull-neck AP films Open-mouth films Lateral flexion and extension filmsSkull-neck AP films Open-mouth films Lateral flexion and extension filmsX

32、-ray tomography CT MRIX-ray tomography CT MRIDifferentiate with the odontoid dysplasia and its deformity complicationDifferentiate with the odontoid dysplasia and its deformity complicationFacilitate choosing the treatment plan and assessing prognosisFacilitate choosing the treatment plan and assess

33、ing prognosis第30页，此课件共34页哦Discussion Discussion TreatmentOdontoid fracture self-healing difficultCan hardly heal at the displaced siteNon-operation treatments are ineffectiveSurgical treatment is the first choiceOperative procedure choice according to pathologic changes and clinical features第31页，此课件

34、共34页哦Atlantoaxial fusion an ideal methodConditionsReduction completely or almost restored after skull tractionAtlas is not dislocated or can restore while extension第32页，此课件共34页哦Occipital-cervical arthrodesis a common operative procedureRestricting the skull-neck motor function in some extent Indicat

35、ions those who needs posterior arch resection those who needs posterior arch resection obvious atlantoaxial dislocationposterior arch of atlas is the chief compressoratlas anterior dislocation is smallsevere symptoms of SCI exist第33页，此课件共34页哦Methods of rebuilding the stabilityModified Gallie and Bro

36、oks techniqueProcedures of wire technicalRevising and placing of bone graftsl lDistance between the posterior arch Distance between the posterior arch and laminae and spinous of C2 is 8mmwhen atlas is at neutral position under normal physical conditionl lRelatively constant keeping the ligament tension between atlas Relatively constant keeping the ligament tension between atlas and axis and the stability of joints related to dens axisand axis and the stability of joints related to dens axis第34页，此课件共34页哦