环椎骨折手术 课件.pptVIP

阿尔茨海默症防治相关知识埃及的金字塔有建造方法动画艾司洛尔在神经外科重症中的应用二级二班防溺水等安全教育 阿尔茨海默症防治相关知识埃及的金字塔有建造方法动画艾司洛尔在神经外科重症中的应用二级二班防溺水等安全教育 环 椎 骨 折 Ring vertebral fractures 贺州广济医院骨二科 朱福良 环枢椎后面观 环枢椎前面观 环椎：位于枕骨下、周围韧带的保护作用，骨折相对发生较少 Sherk HH, Nicholson JT. Fractures of the atlas. J Bone Joint Surg (Am) 1970;52:1017–24 环椎骨折占：所有脊柱骨折的 1–2% 颈椎骨折 2 - 13% 严重的颈痛，但没有神经症状 Scharen S, Jeanneret B. Atlas fractures. Der Orthopade 1999;28(5):385–93. Sherk HH, Nicholson JT. Fractures of the atlas. J Bone Joint Surg (Am) 1970;52:1017–24. 1822 年 Sir Astley Cooper首先描述 Cooper A. A treatise on dislocations, and on fractures of joints. London, United Kingdom, Longman, Hurst Rees, Orme Browne, E. Cox and Son, 1822:542. 1920年Geoffrey Jefferson 报道环椎骨折 Jefferson G. Fracture of the altas vertebra: Report of four cases and a review of those previously reported. Br J Surg. 1920;7:407–422. 发生机制 轴向压力或过伸损伤 Jefferson G. Fracture of the altas vertebra: Report of four cases and a review of those previously reported. Br J Surg. 1920;7:407–422. Punjabi 、Sandler 报道过伸时轻度轴向压力就可以引起寰椎骨折 Punjabi MJD, Sandler A. Cervical spine kinematics and instability, in Clark CR, Ducker TB; Cervical Spine Research Society Editorial Committee (eds): The Cervical Spine. Philadelphia, Lippincott-Raven, 1998:55–57. 分型 单纯前弓骨折 单纯后弓骨折 (最常见) 合并前后弓粉碎性骨折 (Jefferson fracture) 单纯侧块骨折 横突骨折 Levine AM, Edwards CC. Traumatic lesions of the occipitoatlantoaxial complex. Clin Orthop Relat Res. 1989;239: 53–68. typically occur at the junction of the posterior arch and the lateral masses most vulnerable where the arch is thinned and where the vertebral artery courses 常发生在后弓与侧块连接处：骨细、颈动脉跨过 单纯后弓骨折，容易漏诊 Lateral mass fractures usually consist of a fracture line anterior and posterior to the joint surface . Openmouth radiograph demonstrates displacement of 1 C1 lateral mass on C2 with normal anatomic relationship of the contralateral side 可能导致枕骨髁向骨折间隙内半脱位 侧块不稳定容易导致斜颈畸形 经关节面的侧块骨折 Jefferson骨折。一个典型的四部分骨折，2骨折在前环和2骨折在在后环。 横韧带的完整性决定了骨折的稳定