Axis vertebral body fracture
Introduction
Introduction to axial vertebral fracture There are few reports of pivotal vertebral fractures. In fact, this injury is not uncommon, but it is scattered in the reports of Hangman fractures and odontoid fractures. Some of the atypical Hangman fractures are actually fractures of the vertebral body, and the type III odontoid fracture classified by Anderson-DAlonzo is defined as a vertebral fracture rather than a odontoid fracture. The clinical manifestations of the vertebral body fractures vary according to the type of fracture. Patients with type I fractures have a higher probability of accompanying nerve damage, because the anterior part of the vertebral body is displaced forward together with the atlas, and the posterior vertebral body The lateral fracture fragments remain in place, which may cause the spinal cord to be compressed. However, there are reports of severe neurological function and only severe neck pain. Patients with type II fractures are generally not accompanied by symptoms of nerve damage, only local symptoms. Neck pain, stiffness. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: cerebrospinal fluid leakage
Cause
Cause of axillary vertebral fracture
Type I fracture (55%):
The fracture line is a vertical axis fracture of the vertebral body, and the mechanism includes:
(1) A little less stretch than the violence that caused a Hangman fracture, and a violent effect with a small axial load causes a vertical fracture of the dorsal portion of the central body;
(2) The main axial compression load plus stretching violence acts on the top of the forehead, causing vertical fracture of the dorsal part of the vertebral body plus C23 intervertebral disc anterior fracture, C2 vertebral body anterior inferior margin avulsion fracture, with C1 and C2 major vertebrae Overextension of the body;
(3) Flexion violence plus axial load acts on the top of the occipital, causing vertical fracture of the dorsal side of the C2 vertebral body, intervertebral disc rupture, C2 complex (most of the vertebral body of the atlas and the central vertebra) and anterior longitudinal ligament tear;
(4) Flexion and distraction violence can cause posterior fracture of the vertebral body, partial rupture of the intervertebral disc and flexion of the C2 complex;
(5) An acute overextension and rotational violence, as Schneider et al. briefly described a similar fracture that occurred as the knot of the sling was placed under the ear.
Type II fracture (35%):
The fracture line is a vertical axis fracture in the sagittal direction, that is, a lateral vertebral block fracture or an atlantoaxial articular process fracture. The injury mechanism is that the axial compression and lateral flexion are transmitted through the occipital condyle to the atlas lateral mass and then transmitted to the pivot. Lateral vertebral block, causing a compression fracture.
Type III fracture (20%):
The fracture line is a horizontal vertebral body fracture, that is, a odontoid type III fracture, which will not be described here.
Prevention
Prevention of vertebral body fracture
Pay attention to the safety of production and life, ensure personal safety, avoid trauma is the key to the prevention and treatment of this disease, and also pay special attention to prevent spinal cord injury during treatment, so as not to cause unnecessary complications.
Complication
Complications of pivotal vertebral fracture Complications cerebrospinal fluid leakage
In this case, patients with type I fractures have a higher probability of accompanying nerve damage, because the anterior portion of the vertebral body is displaced forward along with the atlas, and the fragments of the posterior aspect of the vertebral body remain in place. This causes the risk of spinal cord compression, but there are also reports of severe neurological function and only severe neck pain. Patients with type II fractures are generally not accompanied by symptoms of neurological damage, only local symptoms, neck pain, and stiffness.
Other complications of the disease include: spinal cord, vertebral artery injury and cerebrospinal fluid leakage.
Symptom
Symptoms of pivotal vertebral fractures Common symptoms Severe pain Neck stiffness Neck pain Spinal cord compression
The clinical manifestations of the vertebral body fractures vary according to the type of fracture. Patients with type I fractures have a higher probability of accompanying nerve damage, because the anterior part of the vertebral body is displaced forward together with the atlas, and the posterior vertebral body The lateral fracture fragments remain in place, which may cause the spinal cord to be compressed. However, there are reports of severe neurological function and only severe neck pain. Patients with type II fractures are generally not accompanied by symptoms of nerve damage, only local symptoms. Neck pain, stiffness.
Examine
Examination of vertebral fractures
The examination of this disease mainly includes X-ray examination, CT and MRI examination:
(1) In the ordinary X-ray examination, the cervical lateral radiograph and the sagittal section are very useful for the diagnosis of type I fracture. The lateral radiograph can show the fracture line through the dorsal aspect of the vertebral body, most of the front of the vertebral body and The atlas is displaced forward with an angular deformity of flexion or extension, and the posterior and posterior parts of the vertebral body are still in place, in the normal position above the C3 vertebral body. The fracture can clearly show the fracture line and the fracture block. In the case of displacement, the open slice and the coronal slice are very valuable for the diagnosis of type II fracture, which can show the lateral block collapse, the atlanto-lateral block enters the superior articular surface, and the type III fracture is the first in this chapter. Section.
(2) CT, especially CT three-dimensional reconstruction, is very important for understanding the comprehensive information of fractures.
(3) MRI's good resolution of soft tissue makes it widely used in spinal cord injury; similarly, in patients with axial vertebral fractures, MRI can clearly show spinal cord injury and compression.
Diagnosis
Diagnosis and diagnosis of axial vertebral fracture
Diagnosis should be based on accurate, detailed medical history, physical examination and a combination of multiple imaging findings to determine the violent point of action, the mechanism of injury, and comprehensive information on the fractures of the vertebral body and surrounding bone and soft tissue.
The disease needs to be differentiated from atlas vertebral arch fracture and upper cervical deformity, and can be identified by CT scan.
In addition, for some of the small vertebral body sagittal fractures and posterior rim fractures, only the positive lateral radiographs are easily missed. Therefore, for the suspicious patients, the orthostatic and lateral flexion and extension X-ray films should be taken. Scholars pointed out that the clearest means of observing the fracture of the vertebral body is the thin layer reconstruction of CT, which is very helpful for the differential diagnosis of this disease.
