ATLAS Dotaz Zobrazit nápovědu

INTRODUCTION AND OBJECTIVES: The objective of the study was: (1) to describe changes in the shape of the atlas during growth, including gender and side differences; (2) to assess the dimension essential for identification of the optimal entry point; (3) to determine the age limit for a safe insertion of 3.5-mm screws into the lateral masses according to our own limiting parameters. MATERIALS AND METHODS: Dimensions of the atlas were measured on 200 CT scans of the craniocervical junction in individuals aged 0-18 years and on 34 anatomical specimens of the first cervical vertebra (aged 2.5-18 years). Both series were divided according to the gender and age. The values measured on CT scans were used for statistical comparison of data in boys and girls and comparison of the right and left sides. RESULTS: The atlas reaches its maximum growth rate between 0 and 2 years of age, then the growth decelerates and continues until the age of 18 years. The proportion of dimensions of C1 vertebral foramens changes with age. The youngest children show a relatively greater distance from the left to the right medial pedicle; around the age of 5 the values get even and subsequently the distance from the inner wall of anterior to posterior arch gets relatively greater. The transverse foramen has a slightly oval shape throughout the period of growth. Statistically significant differences between boys and girls were observed primarily between 12 and 18 years of age. CONCLUSION: The study has proved adequate size of lateral masses for insertion of 3.5-mm screws in all patients from the age of 5 years. In younger children, the patient´s anatomy should be respected and the surgical technique tailored accordingly.

Klíčová slova
Anatomía del atlas pediátrico, Atlas developmental changes, C1 entry point, Cambios en el desarrollo del atlas, Lateral mass screw, Pediatric atlas anatomy, Punto de entrada C1, Tornillo de masa lateral,
MeSH
atlas (obratel) * anatomie a histologie diagnostické zobrazování chirurgie MeSH
dítě MeSH
fraktury páteře * diagnostické zobrazování chirurgie MeSH
kojenec MeSH
kostní šrouby MeSH
lidé MeSH
mladiství MeSH
novorozenec MeSH
počítačová rentgenová tomografie * MeSH
předškolní dítě MeSH
Check Tag
dítě MeSH
kojenec MeSH
lidé MeSH
mladiství MeSH
mužské pohlaví MeSH
novorozenec MeSH
předškolní dítě MeSH
ženské pohlaví MeSH
Publikační typ
časopisecké články MeSH
práce podpořená grantem MeSH

Článek

Applied anatomy of screw placement via the posterior arch of the atlas and anatomy-based refinements of the technique

METHODS: Four formalin-fixed specimens and 40 macerated atlas vertebras were used to describe the relevant ...

European journal of orthopaedic surgery & traumatology. 2016 Oct ; 26 (7) : 793-803. [epub] 20160422

Eur J Orthop Surg Traumatol
ISSN 1432-1068 | 1633-8065
Zdroj

PURPOSE: To present a method of posterior arch and lateral mass screw (PALMS) insertion and to prove its feasibility. METHODS: Four formalin-fixed specimens and 40 macerated atlas vertebras were used to describe the relevant anatomy. The height of the posterior arch was measured on 42 consecutive patients using standard CT of the cervical spine. The operative technique and the special CT reconstructions used for preoperative planning are described. Eight patients underwent posterior fixation using this technique. RESULTS: We described the relevant anatomy and important anatomical landmarks of the posterior arch of the atlas. PALMS placement was modified according to these anatomical findings. Fifteen PALMSs were placed in eight patients using this technique without vascular or neural injury. CONCLUSION: It is feasible to place PALMS using the described technique. CT angiography is of crucial importance for preoperative planning using the described special reconstructions. The arch posterior to the lateral mass (APLM) is defined as the bone stock situated posterior to the lateral mass, respecting its convergence. The ideal entry point for a PALMS is on the APLM above the center of the converging lateral mass. A complete or incomplete ponticulus posticus and a retrotransverse foramen or groove can be used as an accessory landmark to refine the entry point.

Klíčová slova
Atlantoaxial fixation, Atlas, Atlas anatomy, Atlas pedicle screw, Posterior arch screw,
MeSH
arteria vertebralis diagnostické zobrazování MeSH
arteriae carotides diagnostické zobrazování MeSH
atlas (obratel) anatomie a histologie chirurgie MeSH
CT angiografie MeSH
dospělí MeSH
fraktury páteře patologie chirurgie MeSH
fúze páteře přístrojové vybavení metody MeSH
implantace protézy metody MeSH
kostní šrouby * MeSH
krční obratle anatomie a histologie zranění chirurgie MeSH
lidé středního věku MeSH
lidé MeSH
mrtvola MeSH
počítačová rentgenová tomografie MeSH
protézy - design MeSH
studie proveditelnosti MeSH
výsledek terapie MeSH
Check Tag
dospělí MeSH
lidé středního věku MeSH
lidé MeSH
mužské pohlaví MeSH
Publikační typ
časopisecké články MeSH
hodnotící studie MeSH

Článek

K diferenciální diagnostice ventrální luxace atlantu
[Differential diagnosis of anterior dislocation of atlas]

MARUSIAK, J
Autor MARUSIAK, J

Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca. 1957 Mar ; 24 (2) : 134-7.

Acta Chir Orthop Traumatol Cech
ISSN 0001-5415
Zdroj

Klíčová slova
ATLAS AND AXIS/dislocation *, SPONDYLITIS/differential diagnosis *,
MeSH
atlas (obratel) zranění MeSH
axis zranění MeSH
diferenciální diagnóza * MeSH
dislokace kloubu * MeSH
lidé MeSH
spondylitida diagnóza MeSH
Check Tag
lidé MeSH
Publikační typ
časopisecké články MeSH

Článek

Poranĕní atlasu
[Injuries of the atlas]

PURPOSE OF THE STUDY: Injuries of atlas account for 1-2% of all injures of the spine and for 7% of the ...

Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca. 2003 ; 70 (5) : 274-8.

Acta Chir Orthop Traumatol Cech
ISSN 0001-5415
Zdroj

PURPOSE OF THE STUDY: Injuries of atlas account for 1-2% of all injures of the spine and for 7% of the injuries of the cervical spine. Fractures of atlas occur either as isolated fractures or in combination with the injury of the axis or occipital condyles. The aim of the work is to evaluate a group of patients with the injury of the atlas treated both conservatively and surgically. MATERIAL: Between January 1996 and October 2001 we treated at the Orthopaedic Department of 3rd Medical Faculty, Carles University in Prague 10 patients with the injury of atlas. Between November 2001 and December 2002 we treated at the Orthopaedic Department and Spondylosurgical Department of the Medical Faculty Motol another 5 patients with the injury of atlas. In 10 cases the fracture of atlas was isolated (anterior arch--once, 4 time Jefferson fracture, twice--fracture of massa lateralis), in 5 cases the fracture was associated with the injury of epistropheus (dens type II/posterior arch--twice, dens type II/Jefferson fracture--once, dens type II/massa lateralis--once, hangman fracture type II/posterior atlas arch--once). Teh group of patients included 9 men and 6 women of the average age of 46.6 years (range, 27-85 years). Eight patients were treated conservatively, 7 patients surgically. The most frequent cause of the injury was fall on the head or a severe downward violence in 7 cases, car accident in 4 cases, other causes vere identified in 4 cases. Neurological deficit upon admission was found out only in one patient (Frankel D). METHODS: In isolated injuries of the anterior or posterior arch of atlas we always proceeded conservatively. The cervical spine was fixed for 12 weeks in the Philadelphia collar. One isolated fracture of massa lateralis was also treated conservatively for 12 weeks in the Philadelphia collar. Another case of the same type of fracture was treated surgically by C1-C2 by the Magerl technique supplemented on the intact side by the Gallie wire loop. Two stable Jefferson fractures were treated by the halo vest applied for 12 weeks. Two unstable fractures were handled surgically, once by C1-C2 by the Magerl technique and once by C0-C2 occipitocervical fixation. C1-C2 associated injuries were treated in four cases surgically, three times by a direct dens fixation and once by C1-C2 fixation after Magerl supplemented with the Gallie wire loop. A patient with the associated hangman fracture type II and fracture of the posterior atlas arch refused the surgery and therefore was treated by the halo fixation for 12 weeks. Philadelphia collar was applied to the patients operated on. RESULTS: In the group of the conservatively treated, 3 patients complained of pain in the upper part of cervical spine and head requiring from time to time the administration of analgesics. All fractures healed within 12 weeks and the functional radiographs showed stable C0-C2 segments. As for complications, during the conservative treatment in one case a pyogenic secretion was recorded around the fixation elements of the halo apparatus requiring its removal after 8 weeks. The patient was further treated by a pelot fixation. In one case it was necessary to adjust twice the halo apparatus due to re-dislocation of the hangman fracture (associated hangman fracture of type II and posterior atlas arch). In spite of this the injury healed in C2-C3 subluxation, however, the fracture of atlas healed in a favourable anatomical position. In the group of the operated on, 2 patients complained of pain in the upper cervical spine requiring from time to time the administration of analgesics and one patient complained of a marked limitation of the range of motion by 50% (C0-C2 occipitocervical fixation). Also in this group stable C0-C2 segments were found out 12-14 weeks after the surgery. DISCUSSION: In our group of 15 patients the fracture healed, i.e. stable C0-C1 and C1-C2 segments, in all patients treated both conservatively and surgically. In the group of conservatively treated patients there occurred in one case re-dislocation of the fracture. However, the patient refused the surgery repeatedly. Apart from these case we found in neither group any severe complication. The ratio of conservative and surgical treatment was 8:7. CONCLUSION: Based on our own experience and the literary data we believe that suitable for the treatment of stable injuries of the atlas is conservative treatment, i.e. fixation in the Philadelphia collar for 12 weeks. In unstable injuries or intraarticular injures with dislocation we prefer surgical fixation of C1-C2 or C0-C2 in dependence on the type of injury. All associated injuries are indicated for surgical treatment.

MeSH
atlas (obratel) diagnostické zobrazování zranění chirurgie MeSH
dospělí MeSH
fraktury páteře diagnostické zobrazování chirurgie MeSH
lidé středního věku MeSH
lidé MeSH
radiografie MeSH
senioři nad 80 let MeSH
senioři MeSH
Check Tag
dospělí MeSH
lidé středního věku MeSH
lidé MeSH
mužské pohlaví MeSH
senioři nad 80 let MeSH
senioři MeSH
ženské pohlaví MeSH
Publikační typ
časopisecké články MeSH

Článek

Izolované zlomeniny atlasu
[Isolated fractures of the atlas]

PURPOSE OF THE STUDY: To present the current tends in the diagnosis and management of isolated atlas ...

Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca. 2004 ; 71 (1) : 50-5.

Acta Chir Orthop Traumatol Cech
ISSN 0001-5415
Zdroj

PURPOSE OF THE STUDY: To present the current tends in the diagnosis and management of isolated atlas fractures based on the retrospectively evaluated group of patients with this trauma. MATERIAL: In the period from 1995 to 2002, we treated 486 injuries to the cervical spine at our department. Out of these, 19 patients sustained an isolated fracture of the first cervical vertebra. This group consisted of 12 men and seven women; the average age was 46.6 years. Neurological findings in 18 patients were classified as Frankel E and, in one, as Frankel A. The causes of injury included a fall from height in five patient, a fall in the street in five pedestrians, a car accident in five patients, a dive into shallow water in three and a shooting injury in one patient. METHODS: We treated 16 patients conservatively, using a halo-vest in eight patients and a Philadelphia collar also in eight patients. In two patients with unstable atlas injury, we carried out C1-C2 transarticular stabilization according to Magerl. In the patient who had been shot, we removed the bullet transorally. RESULTS: All patients healed completely without signs of instability. One patient with postraumatic pentaplegia, who died within 24 h of surgery due to septic shock, had not been included in the follow-up. Two patients reported neck pain at rest, three after exercise and 13 were without any pain. The patient after C1-C2 transarticular stabilization had a significant restriction of the range of motion in the cervical spine; the rest of the patients were without limitation. None of the patients showed any deterioration of neurological findings during the treatment, nor was any post-traumatic atlantoaxial instability recorded after the therapy was completed. DISCUSSION: Isolated fractures of the atlas account for 1 to 2% of all spinal fractures. Many fractures may remain unnoticed and, therefore, it is important to X-ray patients with a symptomatic injury to the cervical spine in three standard projection planes (anteroposterior, lateral and transoral). When a fracture of the atlas is suspected, it is necessary to examine them by computed tomography to obtain a more accurate presentation of fracture lines. Views on the method of treating isolated fractures of the atlas, particularly unstable ones, are not consistent. CONCLUSIONS: Isolated fractures of the first cervical vertebra, in terms of therapy, are stable and unstable. Stable fractures heal within 8 to 12 weeks. A Philadelphia collar or halo-vest provide sufficient immobilization. Surgical stabilization or a halo-vest immobilization for a period of 12 weeks are recommended in unstable injuries that are characterized by the lateral mass displacement of more than 7 mm or extension of the space before the dens (predental space) by more than 3 mm, or in which magnetic resonance imaging demonstrated injury to the transverse ligament. After the halo-vest removal, it is necessary to perform functional examination of the cervical spine for detection of potential atlantoaxial instability.