TY  - JOUR
T1  - Kraniyoservikal bileşkenin travmatik yaralanmaları: 51 olgunun retrospektif analizi
TT  - Traumatic ınjuries of the craniocervical junction: Retrospective analysis of 51 patients
AU  - Karataş, Derya
AU  - Uygur, Saygı
AU  - Koyuncu, Ömer Ruşen
AU  - Tekeli Barut, Irmak
AU  - Doruk, Efekan
AU  - Başar, Furkan
AU  - Dağtekin, Ahmet
PY  - 2023
DA  - August
Y2  - 2023
JF  - Mersin Üniversitesi Sağlık Bilimleri Dergisi
JO  - Mersin Univ Saglık Bilim Derg
PB  - Mersin Üniversitesi
WT  - DergiPark
SN  - 1308-0830
SP  - 280
EP  - 289
VL  - 16
IS  - 2
LA  - tr
AB  - Amaç: Kraniyoservikal bileşke gerek embriyolojik gerek anatomik gerekse biyomekanik açıdan karmaşık bir yapıya sahiptir. Alt servikal omurgaların yer aldığı diğer bölgelerden önemli farklılıklar gösterir. Bu kompleks yapı bu bölgedeki yaralanmaların gerek sınıflaması gerekse  yapılacak cerrahi yaklaşımlar için oldukça büyük önem taşımaktadır. Kraniyoservikal bileşke yaralanmalarının değerlendirilmesi ve tedavi seçeneklerinin ortaya konulması amaçlanmıştır. Yöntem: Ocak 2021-Ocak 2023 tarihleri arasında kraniyoservikal bileşke yaralanması tespit edilmiş ve retrospektif olarak değerlendirilmiş olan 51 adet hasta çalışmaya dahil edilmiştir. Hastaların 30’u erkek, 21’i kadın, yaş ortalaması 52.7 (18-94) ve ortalama takip süresi 12.5 ay olarak tespit edildi. Hastalarımızda 3 oksipital kondil 2 oksipital kondil/atlas kombine, 14 atlas, 9 C1/C2 kombine, 13 odontoid, 6 asılmış adam ve 4C2’nin diğer sınıflandırılamayan kırığı tespit edilmiştir. Bulgular: Oksipital kondil, oksipital kondil/atlas kombine, atlas ve C1/C2 kombine kırıklarının tamamı konservatif olarak tedavi edilmiştir. Odontoid kırığı olan hastalardan Tip 1 ve 3 kırığı olanlar konservatif tedavi edilmiştir. Tip 2 kırığı olan 3 hastaya cerrahi endikasyon belirlenmiş ve bu hastaların ikisi cerrahi olarak tedavi edilmiştir. Takipte atlas kırığı olan bir hastada baziler invaginasyon gelişmiş ve cerrahi tedaviyi kabul etmeyen bu hastada kaynamama tespit edilmiştir. Sonuç: Karmaşık anatomik ve biyomekanik bir yapıya sahip olan kraniyoservikal bileşke yaralanmalarında mevcut sınıflama sistemleri hala hastaların yönetimi açısından yetersiz kalabilmektedir. Hastaların takip ve tedavisine karar verirken detaylı radyolojik inceleme ile ligamantöz ve kemik yapının, ayrıca kişisel füzyon ile ilgili klinik durumların ayrıntılı olarak değerlendirilmesinin önemi akılda tutulmalıdır.
KW  - Kraniyoservikal bileşke yaralanmaları
KW  - oksipital kondil kırıkları
KW  - atlas kırıkları
KW  - aksis kırıkları
KW  - odontoid kırıkları
N2  - Aim: The craniocervical junction have a complex construction from the anatomical and biomechanical perspective. It is significantly different from other regions involving lower cervical spine. This complex structure is of great importance for both the classification of injuries in this region and the surgical approaches to be made. The aim is to evaluate the craniocervical junction injuries and to discuss treatment options. Method: Between January 2021 and January 2023 51 patients with traumatic craniocervical injury were identified and evaluated retrospectively. Of these patients, 30 were male and 21 were female, with a mean age of 52.7 (18-94) and average follow-up time was 12.5 months. In our patients, three occipital condyles, 2 condyles/atlas combined, 14 atlas, 9 C1/C2 combined (5 odontoids, 4 hangman’s fractures), 13 odontoids, 6 hangman’s fractures, and 4 unclassified C2 fractures were identified. Results: All occipital condyle, occipital condyle/atlas combined, atlas and C1/C2 combined fractures were treated conservatively. Among the patients with odontoid fractures, those with Type 1 and 3 fractures were treated conservatively. Surgery was indicated in 3 patients with type 2 fractures and two patients with Type 2 odontoid fractures were operate. One patient with atlas fracture had basillar invagination during the follow-up. This patient along with the patient who rejected operation did not have fusion during follow-up. Conclusion: Current classification systems based on the injuries of craniocervical junction which have a complex anatomical and biomechanical structure, may still be insufficient for the management of patients. When deciding on the follow-up and treatment of patients, the importance of detailed radiological examination and evaluation of ligamentous and bone structure, as well as clinical conditions related to personal fusion should be kept in mind.
CR  - Dagtekin A, Avcı E, Kara E, et al. Posterior cranial fossa morphometry in symptomatic adult Chiari I malformation patients: comparative clinical and anatomical study. Clinical neurology and neurosurgery. 2011;113(5):399-403.
CR  - Vigo V, Hirpara A, Yassin M, et al. Immersive surgical anatomy of the craniocervical junction. Cureus. 2020;12(9)
CR  - Dagtekin A, Avci E, Hamzaoglu V, et al. Management of occipitocervical junction and upper cervical trauma. Journal of Craniovertebral Junction & Spine. 2018;9(3):148.
CR  - Alves OL, Pereira L, Kim S-H, et al. Upper cervical spine trauma: WFNS spine committee recommendations. Neurospine. 2020;17(4):723.
CR  - Joaquim AF, Ghizoni E, Tedeschi H, et al. Upper cervical injuries: clinical results using a new treatment algorithm. Journal of Craniovertebral Junction & Spine. 2015;6(1):16.
CR  - Dickman CA. Traumatic injuries of the craniovertebral junction. Surgery of the craniovertebral junction. 1998;
CR  - Liao S, Jung MK, Hörnig L, Grützner PA, Kreinest M. Injuries of the upper cervical spine—how can instability be identified? International Orthopaedics. 2020;44:1239-1253
CR  - Julien TD, Frankel B, Traynelis VC, Ryken TC. Evidence-based analysis of odontoid fracture management. Neurosurgical focus. 2000;8(6):1-6.
CR  - Furtner J, Woitek R, Asenbaum U, Prayer D, Schueller-Weidekamm C. Occipitocervical junction: Aanatomy, craniometry and pathology. Der Radiologe. 2016;56(4):375-86; quiz 387.
CR  - Li G, Yang Y, Liu H, Hong Y, Rong X. Residual deformity after anterior cervical discectomy and fusion for unstable Hangman's fractures. World Neurosurgery. 2017;108:216-224.
CR  - Goel A, Jankharia B, Shah A, Sathe P. Three-dimensional models: an emerging investigational revolution for craniovertebral junction surgery. Journal of Neurosurgery: Spine. 2016;25(6):740-744.
CR  - Dickman CA, Greene KA, Sonntag V. Injuries involving the transverse atlantal ligament: classification and treatment guidelines based upon experience with 39 injuries. Neurosurgery. 1996;38(1):44-50.
CR  - Anderson PA, Montesano PX. Morphology and treatment of occipital condyle fractures. Spine. 1988;13(7):731-736.
CR  - Mueller FJ, Fuechtmeier B, Kinner B, et al. Occipital condyle fractures. Prospective follow-up of 31 cases within 5 years at a level 1 trauma centre. European Spine Journal. 2012;21:289-294.
CR  - Levine AM, Edwards C. Fractures of the atlas. JBJS. 1991;73(5):680-691.
CR  - Hadley MN, Browner C, Sonntag VK. Axis fractures: a comprehensive review of management and treatment in 107 cases. Neurosurgery. 1985;17(2):281-290.
CR  - Anderson LD, D'ALONZO RT. Fractures of the odontoid process of the axis. JBJS. 1974;56(8):1663-1674.
CR  - Grauer JN, Shafi B, Hilibrand AS, et al. Proposal of a modified, treatment-oriented classification of odontoid fractures. The Spine Journal. 2005;5(2):123-129.
CR  - Greene KA, Dickman CA, Marciano FF, Drabier JB, Hadley MN, Sonntag VK. Acute axis fractures: analysis of management and outcome in 340 consecutive cases. Spine. 1997;22(16):1843-1852.
CR  - Clark CR, White 3rd A. Fractures of the dens. A multicenter study. JBJS. 1985;67(9):1340-1348.
CR  - Goel A, Laheri V. Plate and screw fixation for atlanto-axial subluxation. Acta neurochirurgica. 1994;129:47-53.
CR  - Harms J, Melcher RP. Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine. 2001;26(22):2467-2471.
CR  - Effendi B, Roy D, Cornish B, Dussault R, Laurin C. Fractures of the ring of the axis. A classification based on the analysis of 131 cases. The Journal of bone and joint surgery British volume. 1981;63(3):319-327.
CR  - Levine AM, Edwards C. The management of traumatic spondylolisthesis of the axis. JBJS. 1985;67(2):217-226.
CR  - Lin B, Wu J, Chen Z-d, Zeng W, Liu Q, Dai L. Management of combined atlas-axis fractures: A  review of forty one cases. International Orthopaedics. 2016;40:1179-1186.
UR  - https://dergipark.org.tr/tr/pub/mersinsbd/issue//1310742
L1  - https://dergipark.org.tr/tr/download/article-file/3193073
ER  -