CT Classification Of Atlas Fracture And Its Reliminary Clinical Application Sutdy

Objective:With the combination of the morphology, stability of atlas fracture and its CT features, this research aims at proposing the hypothesis of the CT classification of atlas fracture and preliminary exploring its application of clinical treatment.Methods:Thirty patients with a diagnosis of atlas fracture in The First Affiliated Hospital of Guangxi Medical University, from January 2013 to September 2015 were analyzed retrospectively. Based on domestic and international document literature and clinic data on atlas fracture morphology, stability and its CT features, a hypothesis of CT classification of atlas fracture was proposed to cover all kinds of atlas fracture. Atlas fracture can be classified into unstable fracture and stable fracture. Stable fracture can be divided into the following:fracture with don’t involve atlantoaxial joint or atlantooccipital joint, undisplaced atlas fracture and don’t involve atlantooccipial dislocation. Unstable fracture can be divided into:atlantooccipial dislocation and atlantoaxial dislocation. Axial instability fracture relates to articular surface fractures or displaced fracture. Based on CT features, it can be further classified into type A fracture (sagittal displaced fracture), type B fracture (displaced fracture of coronary artery) and type C fracture (displaced fracture of sagittal and coronal). These three kinds of axial instability fracture can be divided into three different subgroups:A1, A2, A3, B1, B2, B3, C1, C2 and C3. Thirty patients with a diagnosis of atlas fracture were reclassified according to CT classification method and surgery method was recorded. All patients were followed up after the surgery.Results:1. Statistical results of CT classification of 30 patients with atlas fracture were as follows:there were 2 cases of stable fracture among which five cases were type A (type Al,2 cases; type A2,1 case; type A3,2 cases), seventeen cases were type B (type B1,13 cases; type B2,2 cases,type B3,2 cases) and six cases were type C (type C1,2 cases; type C2,1 case; type C3,3 cases).2. A treatment for the 30 patients with atlas fracture was:conservative treatment (2 cases) and surgery (28 cases). There were 17 cases under treatment of posterior reduction and fixation of Cland 11 cases under treatment of posterior approach with fixation of C1-C2. Among the 17 type B patients with atlas fracture,15 were under treatment of posterior reduction and fixation of Clinternal fixation, and 2 were under treatment of posterior approach with fixation of C1-C2. Among the 5 type A patients with atlas fracture,1 were under treatment of posterior reduction and fixation of C1,4 were under treatment of a posterior approach with fixation of C1-C2. Among the 6 type C patients with atlas fracture, one was under treatment of posterior reduction and fixation of C1, and 5 were under treatment of a posterior approach with fixation of C1-C2.3. The type of spinal cord injury was classified as:27cases were grade E, and 3 cases were grade D according to Frankel. After half a year of surgery, only one patient did not recovered well because of the combining of lower cervical spine injuries, while the remained recovered to normal.Conclusion:The classification of atlas fracture based on morphology and CT has significance to treatment and surgery method of the atlas fracture. Based on this classification method, if the appropriate surgical plans were chosen by combining imaging manifestations to determine morphology and classification before the operation; the different types of fracture were reduced and fixed during the operation, the surgical operation can be completed smoothly and achieve good effect.