Axis odontoid fracture
Introduction
Introduction to the odontoid fracture The odontoid process fracture is a serious injury involving the stability of the atlantoaxial region, and the incidence is about 10% of the cervical spine injury. Due to its special anatomical structure, the incidence of non-healing is also high, and the presence of instability factors may lead to acute delayed cervical spinal cord compression and life-threatening. basic knowledge Sickness ratio: 0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: comminuted fracture
Cause
Causes of axonal fractures
(1) Causes of the disease
Often caused by external forces in the head and neck from different directions.
(two) pathogenesis
The odontoid fracture is caused by the external force of the head and neck in different directions. Among them, due to the violent flexion of the head and neck (more common), the axial odontoid fracture caused by the extension and rotation is often accompanied by atlantoaxial dislocation, in the process. Simple odontoid fractures caused by sudden suspension of violence are relatively rare, accounting for about 8% of the total number of cervical spine fractures. Therefore, clinical observation should be taken to prevent missed diagnosis.
Prevention
Prevention of axial odontoid fracture
First, practice and strengthen the body: should actively continue to exercise for a long time, increase the time in outdoor activities, breathe more fresh air, promote systemic blood circulation and metabolism. You can choose to walk, jog, tai chi, health exercises and other items. Multiple activities can make the calcium in the blood more in the bones, thus improving the hardness of the bone and effectively reducing the occurrence of fractures.
Second, more sun: Sun can promote the synthesis of vitamin D, and calcium metabolism depends on the role of vitamin D; ultraviolet light in the sun can promote the formation and absorption of calcium in the body, maintain normal calcium and phosphorus metabolism, increase calcium in bones And improve the hardness of the bone.
Third, the first disease prevention: the elderly should not go to places where there are many people and cars, rain, snow or water on the ground, do not go out when icing, so as not to fall and fracture. Do not climb ladders or climb high activities. It is not advisable to walk on steep slopes. Because the elderly have weak limbs, they are slow to respond and fall easily. When you go out, you should slow down slowly. If you have symptoms such as vertigo, deafness, and dizziness, try to reduce your outing. You must help to walk or handcuffs when you go out. Before going to the toilet at night, you should sit on the edge of the bed for a while, so that the muscle strength of the leg is excited and prevent the occurrence of temporary hypotension when the position changes. When you take a shower, prepare a small stool and sit on your pants and shoes to prevent falling.
Fourth, diet adjustment: Eat more vegetables, protein and vitamin-rich diet, can prevent the occurrence and development of osteoporosis. The early diet of the fracture should be light, in order to facilitate the swelling of the sputum, the late should be partial taste, choose the right diet to adjust the liver and kidney, which is conducive to the healing of the fracture and the recovery of function.
V. Close observation: When suffering from injury, if you suspect a fracture, you should go to the hospital for treatment. The necessary temporary fixing measures should be taken during the transfer. The upper limb fracture is applied with a wooden board to fix the arm, and the length of the board should exceed the upper and lower joint surfaces of the fracture site. The fractured arm can also be attached to the chest. Lower extremity fractures can be tied together with long planks. The length of the board should be up to the underarm, the lower part should exceed the heel, or the affected limb can be tied together with another limb. Spinal fractures should be moved from double to parallel on the board. The cervical spine should be padded with sandbags on both sides of the head to restrict head movement before being sent to the hospital. If there is bleeding, temporarily wrap the wound with a cleaning cloth and then ligation with a tourniquet. Generally, the tourniquet ligation time does not exceed 1 hour each time, and the tourniquet can be relaxed for 1 to 2 minutes every hour to see the blood flow out, which can prevent limb ischemia and necrosis due to excessive ligation time. After the fracture is fixed by plaster or other methods, the changes in skin color and swelling at the end of the injured limb should be closely observed within 24 hours. If the swelling is intensified, the skin should be treated immediately, relax or remove the plaster to prevent limb ischemia, poor reflux and necrosis due to the tight fixation of the plaster. The fixed period of the fracture should be reviewed regularly according to the doctor's advice.
Sixth, functional exercise: Actively exercise uninjured joints under the guidance of a doctor, one hundred times per hour per day, to avoid joint stiffness, contracture and muscle atrophy. Self-massage by light massage can promote local blood circulation and facilitate fracture recovery. (The above information is for reference only, please consult your doctor for details.)
Complication
Complications of axillary odontoid fracture Complications, comminuted fractures
It is not uncommon for the odontoid process to be clinically common. It is the most common complication of odontoid fracture. The odontoid incontinence is particularly prone to the type II fracture of the fracture line through the odontoid waist, mainly due to the dislocation of this type of fracture. Because the ligament of the odontoid ligament and the wing ligament can separate the fracture, and the pushing of the posterior transverse ligament can also shift it. In addition, the tissue attached to the waist of the odontoid has two pairs from the front. The ligament is attached to the side of the neck 1 side. As a result, when the odontoid fracture occurs at the base of the odontoid, these ligaments can separate the head end of the fracture from the vertebral body end of the neck 2, and the neck 1~ It is also a factor that does not connect to the fracture site of the extension and flexion of the neck 2 joint.
Symptom
Symptoms of axonal fractures Common symptoms Forced postural comminuted fractures can not turn neck and neck pain Local tenderness Spinal cord compression
It is similar to the clinical symptoms and signs of the mild cases of atlantoaxial dislocation. It is mainly caused by neck pain, local tenderness, limited mobility (especially cervical spine activity) and forced position of both hands. Concussion and other injuries, without associated cases of atlantoaxial dislocation, generally no symptoms of cervical spinal cord compression; but in the process of movement and diagnosis, if improper operation may also cause adverse consequences, should be noted.
Simple odontoid fractures can generally be divided into the following three types:
1. Type I: Type I odontoid fracture is not common, which may be the result of avulsion of the ligament, because the cusp ligament and two oblique ligaments attach to the tip of the odontoid, this part Most of the fractures are stable, and the fracture line is mostly obliquely torn, and the incidence rate is about 5%. The stability can be confirmed from the lateral flexion of the flexion and flexion. Since most of the fractures are not displaced, Therefore, the complications are less and the prognosis is better.
2. Type II: It is more common in the odontoid waist fracture, accounting for about 70% of the simple odontoid fracture. Most of the fractures are caused by the lateral flexion of the head. This type of fracture can also be caused by the extension of the extension. There is very little violence, because the blood supply is not good, the healing rate is about 1/4 of this type, so the proportion of surgery is higher.
3. Type III: The fracture line is located at the base of the odontoid type III fracture, the incidence rate is about 25%; mainly due to flexion and violence of the head and neck; the fracture line often extends and the upper part of the vertebral body and bone Atlantoaxial joint, but the fracture here is relatively stable, such as no healing, the prognosis is generally better.
Recently, some scholars have proposed type IV, that is, on the basis of type III, when there is a comminuted fracture at the fracture line, it is of this type; it is difficult to treat and the prognosis is not ideal.
Examine
Examination of the odontoid fracture
Imaging examination plays an important role in the diagnosis and classification. Conventional X-ray and tomography can obtain clear images (opening is particularly important); CT and MRI examinations not only help to show the fracture line, but also the transverse The state of the ligament is easy to observe. When reading the film, attention should be paid to the degree of fracture displacement. If the displacement exceeds 5 mm, the healing is delayed.
In addition, according to the widening of the neck and pharyngeal space (that is, the distance between the posterior pharyngeal wall and the third cervical vertebrae, which is normally within 4 mm), according to X-ray film, CT scan MRI and other imaging examinations, diagnosis No difficulty.
Diagnosis
Diagnosis and diagnosis of axonal fracture
The main basis for the diagnosis of axial odontoid fractures are:
1. The history of trauma should be asked in detail.
2. The clinical manifestations are mainly neck symptoms, and attention to the head and neck forced position.
3. Imaging examination plays an important role in the diagnosis and classification. Conventional X-ray and tomography can obtain clear images (opening is particularly important); CT and MRI examinations not only help to show the fracture line, but also The state of the transverse ligament of the vertebra is easy to observe. When reading the film, attention should be paid to the degree of fracture displacement. If the displacement exceeds 5 mm, the healing is delayed.
In addition, according to the widening of the neck and pharyngeal space (that is, the distance between the posterior pharyngeal wall and the third cervical vertebrae, which is normally within 4 mm), the diagnosis is based on X-ray film, CT scan and MRI imaging examination. There is no difficulty in getting on.
Differential diagnosis
In addition to the identification of other injuries in the upper cervical segment, it is mainly differentiated from congenital odontoid hypoplasia.
