Información del artículo
Introducción
Las fracturas del axis son las más comunes del raquis cervical y ofrecen un interés especial por sus características anatómicas. Los principales problemas de estas fracturas vienen dados por la posible inestabilidad residual y el riesgo vital de los pacientes lesionados. Pueden dividirse en cuatro grupos, con la incidencia que se cita entre paréntesis: a) fracturas de la apófisis odontoides (49,4%); b) fracturas del arco vertebral (37,4%); c) fracturas del cuerpo vertebral (10,6%), y d) fracturas del macizo lateral (1,6%).
Revisión de la bibliografíaEn este artículo hemos revisado los conceptos más actuales del tratamiento de este tipo de lesiones.
ConclusionesEsixten una serie de aspectos que influyen en el pronóstico de estos factores: edad del paciente, tipo de fractura, desplazamiento inicial, tiempo hasta el tratamiento, intensidad de la tracción, consecución o no de la estabilidad y posibles lesiones asociadas.
Palabras clave:
axis
fracturas
diagnóstico
tratamiento
Introduction
Fractures of the axis are the most frequent fractures of the cervical spine and are of special interest due to their anatomical characteristics. The main concern is that the residual instability associated with these fractures is life threatening. Fractures of the axis can be classified into 4 groups: a) fractures of the dens or odontoid process (incidence 49.4%); b) fractures of the vertebral arch, (incidence 37.4%); c) fractures of the vertebral body, (incidence 10.6%) and d) fractures of the lateral masses, (incidence 1.6%).
Literature reviewIn this article we review the current treatments for these fractures.
ConclusionsThere are a series of variables that affect prognosis: age of the patient, type of fracture, initial slippage, time to treatment, intensity of traction, achievement of stability and possible associated lesions.
Key words:
axis
fractures
diagnosis
treatment
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Bibliografía
[1.]
S.D. Korres, K. Stamos, C. Kosmidis.
Traumatic lesions of the upper cervical spine.
Cervical Spine I, pp. 244-247
[2.]
D.S. Korres, G. Kyritsis, J. Kouvaras, G. Sapkas, E.l. Velikas.
Double level fractures of the cervical spine.
Int Orthop (SICOT), 11 (1987), pp. 105-108
[3.]
R. Louis.
Chirurgie atlanto-axoidenne par voie transorale.
Rev Chir Orthop, 69 (1983), pp. 381-391
[4.]
R. Roy-Camille, G. Saillant, T.H. Judet, P. Mamoudy, J.M. Feron.
Arthrodèse atloido-axoidienne par voie laterale.
Rev Chir Orthop, 68 (1982), pp. 139-142
[5.]
D.A. Bednar, J. Parikh, J. Hummel.
Management of type II odontoid process fractures in geriatric patients: a prospective study of sequential cohorts with attention to survivorship.
J Spinal Dis, 8 (1995), pp. 166-169
[6.]
M. Blauth, U. Schmidt, D. Otte, C. Krettek.
Fractures of the odontoid process in small children.
Eur Spine J, 5 (1996), pp. 63-70
[7.]
T. Odent, J. Langlais, C. Glorion, B. Kassis, J. Bataill, J.C. Pouliquen.
Fractures of the odontoid process: a report of 15 cases in children younger than 6 years.
J Pediatr Orthop, 19 (1999), pp. 51-54
[8.]
L.D. Anderson, R.T. d’Allonzo.
Fractures of the odontoid process of the axis.
J Bone Joint Surg Am, 56A (1974), pp. 1663-1674
[9.]
P. Mouradian.
Fractures of the odontoid process.
Acta Orthop Scand, 77 (1979), pp. 61-95
[10.]
B. Althoff, P. Bardholm.
Fractures of the odontoid process.
Acta Orthop Scand, 77 (1979), pp. 61-95
[11.]
R. Klemola, A. Karttunen, M. Laine.
Nontraumatic dens fracture in a patient with lymphangiomatosis: radiographic, CT, and MR findings.
Emerg Radiol, 8 (2001), pp. 119-122
[12.]
L.P. Fisher, J.P. Carret, G.P. Gonon, Y. Sayfi.
Arterial vascularizationof the axis.
Bull Assoc Anat (Nancy), 60 (1976), pp. 335-346
[13.]
W.W. Parke.
The vascular relations of the upper cervical vertebrae.
Orthop Clin North Am, 9 (1978), pp. 879-889
[14.]
R. Roy-Camille, P.H. Lepresie, Ch.r. Mazel.
Les fractures de I’ odontoide. «Rachis cervical superieur».
pp. 99-118
[15.]
G. Mourgues, L.P. de Fischer.
Fractures de l’apophyse odontoide (dens) de l’axis.
Rev Chir Orthop, 67 (1981), pp. 783-790
[16.]
A.T. Bergenheim, A. Forssell.
Vertical odontoid fracture.
J Neurosurg, 74 (1991), pp. 665-667
[17.]
E.C. Benzel, B.L. Hart, P.A. Ball, N.G. Baldwin, W.W. Orrison, M. Espinosa.
Fractures of C2 vertebral body.
J Neurosurg, 81 (1994), pp. 206-212
[18.]
J.A. Glaser, R. Whitehill, W.G. Stamp, J.A. Jane.
Complications associated with halo – vest. A review of 245 cases.
J Neurosurg, 65 (1986), pp. 762-769
[19.]
M.N. Hadley, C.A. Dickman.
Acute axis fractures: a review of 229 cases.
J Neurosurg, 71 (1989), pp. 642-647
[20.]
J.S. Harrop, A.l. Vaccaro, G.J. Przybylski.
Acute respiration compromise assiociated with flexed cervical traction after C2 fractures.
Spine, 26E (2001), pp. 50-54
[21.]
D. Wolter, B. Reimann.
Possibilities and limits of the therapy of cervical spine injurieswith the halo.
Unfallchir, 15 (1989), pp. 83-94
[22.]
U. Vieweg, R. Schultheib.
A review of halo vest treatment of upper cervical spine injuries.
Arch Ortop Trauma Surg, 121 (2001), pp. 50-55
[23.]
A. Brooks, N. Tennessee, E. Jenkins.
Atlanto-axial arthrodesis by the wedge compression method.
J Bone Joint Surg Am, 60A (1978), pp. 279-284
[24.]
B. Jeanneret, F. Magerl.
Primary posterior fusion C 1-2 in odontoid fractures: Indications, technique and results of transarticular screw fixation.
J Spinal Dis, 5 (1992), pp. 464-475
[25.]
G. Dutoit.
Lateral atlanto-axial arthodesis: A screw fixation technique.
S Afr J Surg, 14 (1976), pp. 9-12
[26.]
R. Streli.
Dens transfixation plate.
Cervical spine I, pp. 239-243
[27.]
M. Aebi, C. Etter, M. Coscia.
Fractures of the odontoid proccess. Treatment with anterior screw fixation.
Spine, 14 (1989), pp. 1065-1070
[28.]
R. Roy-Camille, G. Saillant, P.H. Lepresle, P. Leonard.
Fractures recentes de I’ odontoide.
Presse Med, 12 (1983), pp. 2233-2236
[29.]
D.S. Korres.
The cervical spine. Traumatology and pathology. Athens: Ed.
Litsas, (1999),
[30.]
N. Schwarz.
Fractures of the odontoid in children.
Eur J Trauma, 27 (2001), pp. 49-57
[31.]
N.S. Blockey, D.W. Purser.
Fractures of the odontoid process of the axis.
J Bone Joint Surg Br, 38 (1956), pp. 794-817
[32.]
M.L.S. Apuzzo, J.S. Heiden, M.H. Weiss, T.T. Ackerson, J.P. Harvey, T. Kurze.
Acute fractures of the odontoid process. Ananalysis of 45 cases.
Neurosurg, 48 (1978), pp. 85-89
[33.]
M.D. Ryan, T.K.F. Taylor.
Odontoid fractures.
J Bone Joint Surg Br, 64B (1982), pp. 416-421
[34.]
D.S. Korres, K. Stamos, A. Andreakos, C.h.r. Hardouvelis, A. Kouris.
Fractures of the dens and risk of pseudarthrosis.
Arch Ortho Trauma Surg, 108 (1989), pp. 373-376
[35.]
I.K. Evans, J.F. Raycroft.
Mal-union and myelopathy associated with type-III fractures of the odontoid process.
Proc 14th annual meeting of the C.S.R.S. No 35, (1986),
[36.]
R.C. Schneider, K.E. Livingston, A.J.E. Cave, G. Hamilton.
Hangman’s fracture of the Cervical Spine.
J Neurosurg, 22 (1965), pp. 141-153
[37.]
Mollan RAB.
Hangman fracture: Injury.
British J Acc Surg, 14 (1982), pp. 264
[38.]
B.C. Marar.
Fractures of the axis arch. Hangman fracture of the cervical spine.
Clin Orthop, 106 (1975), pp. 155-165
[39.]
J.r. Brashear HR, G.C. Venters, E.T. Preston.
Fractures of the neural arch of the axis.
J Bone Joint Surg Am, 57A (1995), pp. 879-887
[40.]
A. Levine, C. Edwards.
The management of traumatic spondylolisthesis of the axis.
J Bone Joint Surg Am, 67A (1985), pp. 217-226
[41.]
B. Effendi, D. Roy, B. Cornish, R.G. Dussanet, C.A. Lauring.
Fractures of the ring of the axis.
J Bone Joint Surg Br, 63B (1983), pp. 319-327
[43.]
R.W. Francis, J.W. Fielding, J.R. Hawkings, J. Pepin, R. Hensinger.
Traumatic spondylolisthesis of the axis.
J Bone Joint Surg Br, 63B (1981), pp. 313-318
[44.]
A.M. Levine.
Traumatic spondylolisthesis of the axis: «Hangman’s fracture». The Cervical Spine. 3rd ed. The CSRS committee.
pp. 429-448
[45.]
C.h.r. Mazel, R. Roy-Camille.
Tear drop fractures of C2-Pathogenesis and treatment. Abstracts of 7th Annual meeting of C.S.R.S.
Taormina, (1990),
[46.]
D.S. Korres, A. Zoubos, K. Kavadias, G. Babis, K. Balalis.
The tear drop or avulsed fracture of anterior inferior angle of the axis.
Eur Spine J, 3 (1994), pp. 151-154
[47.]
U.R. Hahnle, T.F. Wisniewski.
Shear fracture through the body of the axis vertebra.
Spine, 24 (1999), pp. 2278-2281
[48.]
I. Jakin, M. Sweet.
Transverse fracture through the body of the axis.
J Bone Joint Surg Br, 70B (1988), pp. 728-731
[49.]
D.S. Korres, T.H. Kormas, S. Spiridonos, I. Maroulakis.
A case of «chance» fracture of the axis. 7th annual Meeting of C.S.R.S.
Taormina, (1990),
[50.]
F. Signoret, J-M Feron, H. Bonfait, A. Patel.
Fractured odontoid with fractured superior articular process of the axis.
J Bone Joint Surg Br, 68B (1986), pp. 182-184
[51.]
V. Gleizes, F.P. Jacquot, F. Signoret, J.M. Feron.
Combined injuries in the upper cervical spine: Clinical and epidiological data over a 14 year period.
Eur Spine J, 9 (2000), pp. 386-392
[52.]
M.S. Abel, J.H. Teaghe.
Unilateral lateral mass compression fractures of the axis.
Skeletal Radiol, 4 (1979), pp. 92-98
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