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首页> 外文期刊>Journal of neurosurgical sciences >Therapeutic indications in upper cervical spine instability. Considerations on 58 cases.
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Therapeutic indications in upper cervical spine instability. Considerations on 58 cases.

机译：上颈椎的治疗适应症不稳定。 关于58例的考虑因素。

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BACKGROUND: The particular biomechanics of the upper cervical spine require, when trauma occurs, careful evaluation of the stability of the lesions, in order to guarantee the best possible therapeutic and prognostic approach. To date, there has been no uniformity of opinion in merit, especially with reference to treatment of odontoid fractures. It is necessary for this reason as much as for the opportune standardisation of the patients' classification parameters to establish what is meant by stability and which lesions are to be held as being unstable in the upper cervical spine. METHODS: All the cases of upper cervical spine instability treated in our Unit from '94 to date have been reviewed. Four fractures to the first cervical vertebra, 29 to the odontoid process, 9 isolated fractures in the C2 body, 12 hangman fractures, 7 fractures of the articular processes, 2 to the occipital condyles and 4 C1-C2 dislocations without fractures were localised. Using precise prognostic indexes as our classification criteria, 56 of the 58 patients observed were addressed towards either conservative treatment or directly towards surgical treatment. In particular, 29 patients were conservatively treated with a collar or Halo-Vest. Twenty-seven surgical operations were carried out: 14 screw fixations, 6 anterior fixations using plates and screws, 4 rear ones using metal wire or wire with bone graft, 3 odontectomy operations associated with posterior fixation. RESULTS: In the follow-up, using a range of between three months to six years, good fusion with spine stabilisation was achieved in all the patients treated. In particular, surgery was carried out as the first therapeutic indication in 25 cases, obtaining excellent results. Surgery was necessary in only 2 cases after the failure of external stabilisation. CONCLUSIONS: The judgement passed on instability in traumatic lesions in the upper cervical spine represents the decisive factor in the choice of the therapeutic option. Instead of always opting for conservative treatment, in the case of C1-C2 fractures-luxations, and going ahead with surgery only when there is instability or non-fusion of the segments resulting after successive monitoring, we believe that the definition and standardisation of the prognostic factors is opportune, in order to provide patients with a specific solution, in such a way as to reduce the failure percentage of the first treatment and optimise the healing time.
机译：背景：当发生创伤时，颈椎的特定生物力学需要，仔细评估病变的稳定性，以保证最佳的治疗和预后方法。迄今为止，在优点中没有统一意见，特别是参考Odontoid骨折的治疗。因此，有必要适用于患者分类参数的适当标准化，以确定稳定性的含义，并且在上部颈椎中不稳定存在病变。方法：已审查从'94迄今为止在我们的单位中处理的上颈椎鼻脊柱不稳定的所有病例。四个骨折到第一个颈椎，29〜29〜Odontoid方法，C2体中的9个分离骨折，12个刽子手骨折，7个骨折的关节过程，2至枕骨髁和4个C1-C2脱位没有骨折的末端。使用精确的预后指标作为我们的分类标准，观察到的58名患者中的56名朝向保守治疗或直接针对外科治疗。特别是，29名患者保守用衣领或卤状背心治疗。进行了二十七种外科手术：14个螺钉固定，6个前固定，使用板和螺钉，4个后部使用金属线或骨覆盖件，3个与后固定相关的神经切除术。结果：在随访中，在三个月至六年之间，所有患者治疗的患者都达到了良好的融合。特别是，在25例中，进行手术作为第一次治疗指示，获得优异的结果。外部稳定失败后，只有2例需要手术。结论：上颈椎创伤性病变中通过的判断代表了治疗选择选择的决定性因素。在C1-C2裂缝的情况下，只有在连续监测之后仍有不稳定或不融合时，才能继续手术，才能继续进行手术，而不是始终选择保守治疗。预后因素是适当的，为了为患者提供特定的解决方案，以降低第一次治疗的失效百分比并优化愈合时间。

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