PDF(Pubmed)
Abstract：
Traumatic posterior atlantoaxial dislocation combined with Jefferson fracture and odontoid process fracture with vertebral artery injury is rare. The management of such injury raises controversial issues and is still open to debate. A 74-year-old Chinese male presented with sustained neck pain and stiffness after falling from height. The patient was neurologically intact. Preoperative radiographs demonstrated a Jefferson burst fracture with a posterior dislocation of the atlantoaxial joints and odontoid process Anderson and D\'alonzo type II fracture. A computed tomography angiography (CTA) showed an occluded left vertebral artery. Coil embolization in the proximal portion of the occluded vertebral artery was performed to prevent further cerebral infarction due to distal embolization of the thrombus. Then a second stage occipito-cervical fusion was performed to reconstruct cervical spine stability. A systematic screening of blunt trauma vertebral artery injuries through CTA is required when dealing with upper cervical fracture. For cases with vertebral artery occlusion secondary to cervical spine injury, endovascular treatment preceding cervical spine surgery is a feasible and a safe treatment.
摘要：
外伤性寰枢椎后脱位合并Jefferson骨折和齿状突骨折合并椎动脉损伤少见。这种伤害的管理引发了有争议的问题，目前仍有待讨论。一名74岁的中国男性从高处跌落后出现持续的颈部疼痛和僵硬。患者神经完整。术前X光片显示Jefferson爆裂骨折，寰枢关节后脱位，齿状突Anderson和D'alonzoII型骨折。计算机断层扫描血管造影（CTA）显示左椎动脉闭塞。在闭塞的椎动脉的近端部分进行线圈栓塞，以防止由于血栓的远端栓塞而进一步的脑梗死。然后进行第二阶段枕颈融合以重建颈椎稳定性。处理上颈椎骨折时，需要通过CTA对钝性椎动脉损伤进行系统筛查。对于颈椎损伤继发椎动脉闭塞的病例，颈椎手术前的血管内治疗是一种可行且安全的治疗方法。
