Cervical spine injuries associated with lateral mass and facet joint fractures: New classification and surgical treatment with pedicle screw fixation
Cervical spine injuries associated with lateral mass and facet joint fractures: New classification and surgical treatment with pedicle screw fixation
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DOI：
10.1007/s00586-004-0793-2
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发表时间：
2005-02-01
影响因子：
2.8
通讯作者：
Minami, A
中科院分区：
文献类型：
--
作者：
Kotani, Y;Abumi, K;Minami, A
为了明确损伤模式、初始脊柱不稳、颈椎侧块和小关节骨折的椎间盘韧带损伤程度，我们回顾性分析了影像学参数，并对这些损伤进行了新的分类。采用颈椎椎弓根螺钉内固定（CPS）进行手术治疗，并在至少2年的随访期内对总体神经学和影像学结局进行评价。侧块骨折分为以下四种亚型：分离、粉碎、劈裂和创伤性椎弓峡部裂。在X线片上评估主要损伤和相邻脊柱节段的矢状面和额状面排列。最初的椎间盘韧带损伤的磁共振成像的频率，损伤的亚型，并涉及脊髓水平进行了研究。77%的侧块骨折显示骨折椎体前移，而24%的侧块骨折观察到骨折椎体前移，甚至在头侧相邻椎体中也是如此。MRI显示76%的侧块骨折尾侧节段和24%的侧块骨折头侧节段的前纵韧带（ALL）和椎间盘信号改变。侧块骨折的亚型分析显示，分离型、劈裂型和创伤性腰椎滑脱的前移发生率较高，粉碎型和劈裂型的冠状面对线不良发生率较高（p < 0.05）。31例患者接受了使用颈椎椎弓根螺钉固定的手术治疗。CPS提供了上级的畸形矫正能力，没有假关节，以及良好的神经恢复。稳定节段的平均数量最小化，无严重并发症。对于分离、小关节骨折和侧块轻度粉碎性骨折，可考虑单节段后路固定。严重不稳定的劈裂型和粉碎型损伤伴冠状面对线不良可采用单纯的两节段后路CPS固定。骨折亚型的初步评估有助于成功地最小化稳定的脊柱节段。
To clarify the injury pattern, initial spinal instability, degree of discoligamentous injuries in cervical lateral mass and facet joint fractures, we retrospectively analyzed radiological parameters and introduced a new classification for these injuries. Surgical treatment was performed with cervical pedicle screw fixation (CPS), and overall neurological and radiological outcome was evaluated with a minimum follow-up period of 2 years. Lateral mass fractures were divided into the following four subtypes: separation, comminution, split, and traumatic spondylolysis. The sagittal and frontal alignments were evaluated at both mainly injured and adjacent spinal segments on radiographs. The initial discoligamentous injuries were investigated on magnetic resonance imaging in terms of their frequencies, subtype of injuries, and involved spinal levels. Anterior translation of fractured vertebra was demonstrated in 77% of lateral mass fractures, while 24% of anterior translation was observed, even in cephalad-adjacent vertebrae. On magnetic resonance imaging, signal changes in anterior longitudinal ligament (ALL) and intervertebral disc were demonstrated in 76% of caudal segments and 24% of cephalad segments adjacent to fractured vertebra of lateral mass fractures. The subtype analyses of lateral mass fractures demonstrated high rates of anterior translation in separation, split, and traumatic spondylolisthesis, as well as significant coronal malalignment in comminution and split types (p < 0.05). Thirty-one patients underwent surgical treatments using a cervical pedicle screw fixation. The CPS provided the superior capability of deformity correction without pseudoarthrosis, as well as excellent neurological recovery. The average numbers of stabilized segments were minimized without serious complications. In separation, facet joint fracture, and fractures with mild lateral mass comminution, the single level posterior fixation can be considered. The significant unstable injuries of split and comminution type with coronal malalignment can be treated with exclusive two-level posterior stabilization with CPS. The initial evaluation of fracture subtypes helps to successfully minimize the stabilized spinal segment.