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Click to edit Master title style,Click to edit Master text styles,Second Level,Third Level,Fourth Level,Fifth Level,Odontoid Fracture and Delayed Atlantoaxial Dislocation,Chang Zheng Hospital Shanghai,Jia Lianshun,Preface,Dens axis,Atlantoaxial stability,Most important axial bone structure,Odontoid fracture,Atlantoaxial instability,Secondary SCI,Odontoid fracture,710%of cervical spine fracture,cause,SCI instantly,Respiratory dysfunction,Even death,Special structures and function,High ununion rate after fracture,Clinical information,Male 41 cases Female 15 cases,Age range 1558 yrs Average 37.5 yrs,1120 yrs 5 cases 2131yrs 16 cases,31 40yrs 23 cases 4150yrs 7 cases,5058yrs 5 cases,Injury causes,Accidental falls 15 cases,building work accident 12 cases,drop from bed 3 cases,Motor vehicle accident 11 cases,Sports-related injury 13 cases,water dive 7 cases,Tumble on ground 7 cases,Weight hurt 10 cases,Course of diseases,Time 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,Treatment course,not treated after injury 12 cases,no diagnosis when admitted 7 cases,skull traction 23W,stabilized by collars 16 cases,only collars stabilization 21 cases,Motor function,Normal gait,no motor limitation,work properly,16 cases,Weakness of legs,clumsy action,but can walk,weakness of hands,grasping function not affected,21 cases,unstable gait need support,weakness of upper limbs,capable of grasping,13 cases,incapable of standing and walking,stay in bed,6 cases,Radiological examination,Routine X-ray program,head-neck AP lateral,dynamic lateral films,open mouth view,All case showed odontoid fracture,According to Anderson-D扐lonzo classificaton,Type 47 cases Type 9 cases,MRI examination,41 cases,No significant abnormal 8 cases,Spinal cord compression 33 cases,SC signals increasing 5cases,Treatment,All received operation,Before operation Skull traction routinely,1W later X rays,observe reduction trend,possible reductionkeep traction until restored,impossible reductiongive up traction,Reducible dislocation need no continuous traction,receive operation directly,Atlanoaxial posterior structure bone graft and wire fixation,Modified Gallie method 17 cases,Modified Brooks method 14 cases,Autogenous iliac bone,clip to be 揟?shape,The convex of bone graft is inserted into the gap,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,Atlas posterior arch resection +Occipital-cervical fusion,Resect each side of the dislocated,atlas posterior arch,10mm beside the posterior tubercle,Autogenous iliac grafts between,the occipital and the base,of C2 spinous processes,Total 25 cases,Results,No death case,All be followed-up,Average follow-up time 3yrs and 6M,Shortest 11M Longest 10yrs and 8M,Better:symptoms and signs improved,Limbs motor deficit,unstable gait,no-change:no change of symptoms,and signs or feelings,Bone grafts un-union,Results of treatment,Atlantoaxial fusion,Excellent 14 cases Good 11 cases,Better 4 cases No change 2 cases*,*1 case bone graft ununion and displaced,Occipitocervical fusion,Excellent 12 cases Good 8 cases,Better 3 cases No change 2 cases*,*bone graft ununion and displaced,Main causes of early mis-diagnosis,Survivals of odontoid fracture only complicated with mild dislocation,or no dislocation of atlas,clinical symptoms are mild,not enough to take patient抯 attention,the illegible radiography show overlapping of bone structure,between atlas and axis,Pathological changes,Intensive related factors,Traumatic force form,Traumatic force strength,Anatomic structure,Anatomy about odontoid,Sagittal diameter of C1 canal=30 mm,Diameter of cord=10 mm,Diameter of dens=10 mm,Safe space for cord=10 mm,Considerable buffering space is available,Mechanism of odontoid fracture,Skull flexion injury is one of the major causes,Traumatic forces head bended suddenly,Odontoid,Anterior arch of C1,Transverse ligament,Impacting forward together,Transverse shear force Vertical compress force,Separate the connection between odontoid and C2 body,Odontoid fracture,Outside shear force Outside tear force,Mechanism of delayed atlas dislocation,Unstable status caused by odontoid fracture,Skull has trends of inclining forward and moving continuously,Atlas move forward progressively with dens axis,Delayed atlas dislocation,Direct operative decompression,Moving forward equably or Moving forward rotately,Potential risks of SCI,Contributed factors,odontoid,ligaments around,articular capsule,Diagnosis of,odontoid fracture&atlas dislocation,Historyinjury,treatment course,local and neurologic examination,image examination,routine X-rays films,Skull-neck AP films Open-mouth films Lateral flexion and extension films,X-ray tomography CT MRI,Differentiate with the odontoid dysplasia and its deformity complication,Facilitate choosing the treatment plan and assessing prognosis,Discussion,Treatment,Odontoid fract
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