Kraniyoservikal bileşkenin travmatik yaralanmaları: 51 olgunun retrospektif analizi

Yıl 2023, Cilt: 16 Sayı: 2, 280 - 289, 17.08.2023

Derya Karataş , Saygı Uygur Ömer Ruşen Koyuncu Irmak Tekeli Barut Efekan Doruk Furkan Başar Ahmet Dağtekin

Öz

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.

Anahtar Kelimeler

Kraniyoservikal bileşke yaralanmaları, oksipital kondil kırıkları, atlas kırıkları, aksis kırıkları, odontoid kırıkları

Destekleyen Kurum

Destekleyen kurum yoktur

Traumatic ınjuries of the craniocervical junction: Retrospective analysis of 51 patients

Öz

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.

Anahtar Kelimeler

Craniocervical junction injury, occipital condyle fractures, atlas fractures, axis fractures, odontoid fractures

Kaynakça

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