Occipital neck joint injury
Introduction
Introduction to occipital neck injury This type of injury is very rare in the clinic. There were only 8 cases reported in the world before 1981. There were almost no survivors after the occipital neck () joint injury. Because most of the patients died immediately on the scene, a few patients died within a few days. Most of the survivors were of the type of fracture (injury). The treatment was mainly light weight (1~1.5kg) bone traction, in order to maintain their position. And warn everyone to be careful: this is a severe cervical spine injury. Often accompanied by nerve damage including brain damage, brain stem injury or high cervical spinal cord injury. These nerve injuries are often accompanied by loss of consciousness and loss of spontaneous breathing, requiring permanent artificial respiration, often associated with skull base fractures or upper cervical fractures. Conventional radiographs are difficult to diagnose, and the presence of such lesions should be considered when epidural and suboccipital hematoma are found. MRI can confirm the diagnosis. basic knowledge The proportion of sickness: 0.2% - 0.4% Susceptible people: no specific population Mode of infection: non-infectious Complications:
Cause
Causes of occipital neck injury
(1) Causes of the disease
The most common cause of upper cervical spine injury is traffic accidents, followed by high altitude falls and sports injuries, including snorkeling or high diving.
(two) pathogenesis
Anatomically, the occipital-cervical joint is horizontal and easily causes dislocation, but there are not only a strong ligamentous tissue around it, but also the surrounding muscles are well developed, so in general, the chance of fracture dislocation here is Rarely, on the contrary, the atlantoaxial joint of the next vertebra is easily damaging, but if the lateral violence on the skull is sudden and rapid, so that the shear stress is concentrated at the occipital and neck joints, Causes displacement of this pair of elliptical joints.
The cause of injury to the neck and joint dislocation is more common in traffic accidents. It occurs in traffic accidents where the pedestrian collides with the car, especially when the child runs on the road and collides with the opposite car. Low, the head is the first to be violently impacted and cause acute dislocation of the occipital and ankle joints, and most of them die in the accident. This is mainly because the displacement exceeds the maximum buffer space in the spinal canal and the medulla oblongata The formation of oppression, such as only causing subluxation, but has not caused fatal compression of the medulla, the patient may survive, but this lucky person is very rare after all, in addition, the pre-hospital treatment level for this injury survival rate It has a key influence. On the other hand, it should be noted that this injury is easily accompanied by skull base and atlas fractures and brain trauma, etc., should be noted during the examination.
In addition, the fracture of the occipital condyle caused by the axial compression force can also cause the occipital condyle fracture and the anterior and posterior arch fracture of the neck. This level of injury has a high mortality rate. For this kind of injury, it is not advisable to choose surgical fixation. Prevent aggravation of injuries.
Prevention
Occipital neck injury prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Complications of occipital neck injury Complications
Often can be complicated by quadriplegia and life center crisis.
Symptom
Symptoms of occipital and neck joint injuries Common symptoms Loss of consciousness Forced position Electric shock of limbs can not turn neck compensation
The clinical classification of occipital neck () joint damage is mainly divided into the following two types.
1. Complete dislocation mainly causes quadriplegia and life center crisis, mostly accompanied by brain stem injury, and died at the time of injury or short-term. The cause of death after admission is mainly due to the disappearance of spontaneous breathing, resulting in respiratory and circulatory system functions. Depletion, and immediately after the injury, the injury is the brain stem or the medulla, and the life center is involved. This case can also be combined with the occipital condyle fracture. The author has encountered 5 cases of complete dislocation of the occipital neck () joint injury. The longest surviving is no more than one month.
2. The occipital neck () instability type, that is, trauma only causes partial ligaments and muscle groups to be damaged. This type is mainly characterized by: neck pain, limited mobility, forced position and tenderness at the junction of the neck and neck, etc. The electric shock of the extremities (more often in the position of the body position) or sudden quadriplegia, this type can also be seen in congenital cervical fusion disease (such as Klippel-Feil syndrome) and other factors caused by compensatory stress induced neck and neck Unstable.
Examine
Examination of occipital neck injury
1. X-ray film can show the widening of the anterior vertebral shadow. X-ray film is mainly used to exclude other types of upper neck injury and for measuring the distance between the occipital teeth. Under normal circumstances, the pillow of an adult The tooth spacing is 4 to 5 mm, and more than 6 mm indicates subluxation or dislocation of the occipital ankle joint.
2. CT or MRI is decisive for diagnosis and can show signs of occipital condyle fracture.
Diagnosis
Diagnosis and diagnosis of occipital and neck joint injuries
History
Have a clear history of trauma.
2. Clinical symptoms
Mainly for the local injury symptoms of the occipital neck segment, accompanied by neurological dysfunction above the cervical spinal cord, varying in severity, mild manifestations of spinal cord irritation symptoms and signs; severe loss of consciousness and spontaneous breathing disappeared, and permanent respiratory reliance phenomenon.
3. Imaging examination
(1) X-ray film: It can show the widening of the vertebral shadow. The X-ray film is mainly used to exclude other types of upper neck injury and to measure the distance between the occipital teeth (Fig. 3). Under normal conditions. Under the adult, the interdental distance of the pillow is 4 ~ 5mm, more than 6mm indicates the subluxation or dislocation of the occipital ankle joint.
(2) CT or MRI: It has a decisive effect on the diagnosis and can show the occipital condyle fracture sign.
Generally not confused with other diseases.
