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Reposition von Verrenkungen und Verrenkungsbrüchen der unteren Halswirbelsäule

Reduction of traumatic dislocations and facet fracture-dislocations in the lower cervical spine

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Zusammenfassung:

Hintergrund

Traumatische Verrenkungen und Verrenkungsbrüche der unteren (C2/C3–C7/Th1) Halswirbelsäule (HWS) sind häufig mit schwerwiegenden neurologischen Begleitverletzungen vergesellschaftet. Repositionskenntnisse und ein schlüssiges Weiterbehandlungskonzept sind die Voraussetzung für ein gutes Behandlungsergebniss dieser Halswirbelsäulenverletzungen.

Patienten und Methoden

117 operativ behandelte Patienten des eigenen Krankengutes der Jahre 1973–1997 erfüllten eines oder mehrere der Einschlusskriterien: einseitig verhakte Verrenkung (48%), beidseitig verhakte Verrenkung (23%), einseitig reitende Verrenkung (14%), beidseitig reitende Verrenkung (12%), ein- oder beidseitig verhakte/reitende Verrenkung mit Gelenkfortsatzfraktur (3%).

Ergebnisse

Die Segmente C5/6 und C6/7 (jeweils n=43) waren am häufigsten betroffen. 65% der Patienten hatten initial neurologische Ausfälle, d. h. 35% komplette oder inkomplette Tetraplegien, 2% Paraplegien und 28% radikuläre Läsionen.

Schlussfolgerung

Aufgrund der deutlichen Zeitabhängigkeit sowohl des Repositionserfolges als auch des Erholungspotenzials beim Vorhandensein neurologischer Ausfälle, sollte die geschlossene Reposition (z. B. mit Hilfe eines Haloringes) von Verrenkungen und/oder Verrenkungsbrüchen der unteren HWS so rasch wie möglich vorgenommen werden.

Abstract

Background

Traumatic facet dislocations and facet-fracture dislocations in the lower cervical spine (C2/C3 to C7/T1) are frequently associated with devastating neurological symptoms. A good outcome can only be achieved if the operator has wide and sound knowledge of reduction techniques and the best possible strategy is devised for the subsequent treatment of these severe lesions.

Patients and methods

Between 1973 and 1997 a total of 117 of our patients met at least one of the following inclusion criteria: unilateral locked facet dislocation (48%), bilateral locked facet dislocations (23%), unilateral “perched” facet subluxation (14%), bilateral perched facet subluxation (12%), uni- or bilateral dislocation/perched subluxation with facet fractures (3%).

Results

Most of the lesions were located at the levels of C5/C6 and C6/7 (n=46 for each). Associated neurological deficits were present initially in 65% of patients: 35% had complete or incomplete spinal cord injuries (tetraplegia), 2% were paraplegic, and 28% had cervical radiculopathies.

Conclusions

Closed reduction (e.g. with the aid of a halo ring) should be carried out as soon as possible after lower cervical spine dislocation or facet-fracture dislocation, as both the success rate of reduction and the potential for recovery from neurological deficits are clearly higher when reduction is achieved within the first 4 h after the initial injury.

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Authors and Affiliations

  1. Unfallchirurgische Klinik, Medizinische Hochschule Hannover

    U. Lange

  2. Universitätsklinik für Unfallchirurgie und Sporttraumatologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020 , Innsbruck, Österreich

    M. Reinhold, C. Knop, R. Rosenberger, R. Schmid & M. Blauth

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  1. M. Reinhold
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Correspondence to M. Reinhold.

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Reinhold, M., Knop, C., Lange, U. et al. Reposition von Verrenkungen und Verrenkungsbrüchen der unteren Halswirbelsäule. Unfallchirurg 109, 1064–1072 (2006). https://doi.org/10.1007/s00113-006-1188-0

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