Fracturas de la apófisis odontoides: Revisión de nuestra casuística, implicaciones terapéuticas y nueva clasificación
Odontoid fractures. A review and new classification
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"apellidos" => "Ferrer" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147399707657?idApp=UINPBA00004B" "url" => "/11301473/0000001000000006/v1_201305151018/S1130147399707657/v1_201305151018/es/main.assets" ] "es" => array:13 [ "idiomaDefecto" => true "titulo" => "Fracturas de la apófisis odontoides: Revisión de nuestra casuística, implicaciones terapéuticas y nueva clasificación" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "426" "paginaFinal" => "438" ] ] "autores" => array:2 [ 0 => array:3 [ "autoresLista" => "S. Martín-Ferrer, J. Rimbau, M<span class="elsevierStyleSup">a</span>.C. Joly" "autores" => array:3 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Martín-Ferrer" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Rimbau" ] 2 => array:2 [ "nombre" => "M<span class="elsevierStyleSup">a</span>.C." "apellidos" => "Joly" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicios de Neurocirugía. Hospital Universitario “Dr. J. Trueta”. Girona" ] ] ] 1 => array:3 [ "autoresLista" => "J. Teruel, J. Pont" "autores" => array:2 [ 0 => array:3 [ "nombre" => "J." "apellidos" => "Teruel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Pont" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicios de Radiología. Hospital Universitario “Dr. J. Trueta”. Girona" "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Odontoid fractures. A review and new classification" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras Clave" "identificador" => "xpalclavsec156812" "palabras" => array:5 [ 0 => "Fracturas del axis" 1 => "Fracturas de la apófisis odontoides" 2 => "Osteosíntesis anterior del axis" 3 => "Clasificación fracturas odontoides" 4 => "Atornillado anterior de la odontoides" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key Words" "identificador" => "xpalclavsec156813" "palabras" => array:5 [ 0 => "Axis fractures" 1 => "Odontoid fractures" 2 => "Antelior spinal fusion" 3 => "Anterior screw fixation" 4 => "Odontoid fractures classification" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">De los 111 casos de fracturas del axis atendidos en nuestro servicio desde 1988 a 1998, 58 presentaban fracturas de la apófisis odontoides. De éstos, 51 pacientes fueron intervenidos quirúrgicamente mediante la técnica del atornillado anterior. En este grupo, hemos conseguido demostrar radiológicamente la existencia de una buena consolidación ósea en 48 pacientes (92.3%). De todos los casos, en 38 se demuestra una buena alineación (73%) y en 14 (26.9%) algún grado de desalineación de la consolidación ósea. Las edades del grupo fueron de los 13 años de edad del más joven, hasta los 86 del de mayor edad. Hemos observado en la serie gran disparidad de desplazamientos de la odontoides al ingreso en el hospital. Sólo 15 pacientes (25.8%) no tenían fracturas desplazadas a su ingreso. Los restantes 43 casos presentaban diversos grados de desplazamientos anterior (27.5%) o posterior (46.5%). En diez casos se ha presentado algún tipo de complicación (19.2%), Yno hemos observado mortalidad directa respecto al procedimiento.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A partir de los resultados analizados de los casos, la mayoría con controles superiores a los tres años del procedimiento, concluimos que ninguno de los factores que habitualmente se citan como determinantes en la decisión de la elección de la técnica quirúrgica apropiada para el tratamiento de este tipo de fracturas (edad, dirección y grado de desplazamiento, fracturas asociadas, clasificación de las fracturas, o estado neurológico) ha sido un obstáculo ni técnico ni funcional para obtener una correcta consolidación de la fractura. A partir de los datos obtenidos creemos que los únicos factores que contraindican el atornillado anterior en todos los casos de fracturas de la odontoides, son el trazo de la fractura y la ruptura del ligamento transverso del atlas. A nuestro entender no existen fracturas estables de la base de la odontoides. Unicamente la localización de la fractura ha condicionado la actitud terapéutica en nuestra serie. Consecuentemente se propone que la clasificación de las fracturas de la apófisis odontoides se limite a las del ápex y de la base. Las primeras pueden ser tratadas conservadoramente. Las segundas, siempre inestables, deben ser tratadas mediante su atornillado anterior como primera opción terapéutica.</p>" ] "en" => array:2 [ "titulo" => "Summary" "resumen" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">From the 111 cases of fractures of the Axis treated in our service from 1989 to 1998, 58 presented with Odontoid fractures. In this group of patients, 51 cases underwent an anterior screw placement of the Odontoid. We have been able to demonstrate a good osseous consolidation after the anterior screw placement in 48 cases (92.3%). From these cases, in 38 (73%) a good alineation is demonstrated and in 14 (26.9%) sorne degree of distorsion is seen with respect to the original position. In the group, the youngest patient was 13 year-old and the older was 86 year-old. On admission, we have observed a great variety of different displacements of the fractured odontoids while only 15 patients (25.8%) had lined-up fractures. The 43 remaining cases presented different degrees of anterior displacement (27.5%) or posterior (46.5%). There were surgical complications or functional impairment of the segment in 9 cases (17.3%) in controls, and we have not observed direct mortality with respect to the procedure yet a patient died lately in the same hospitalization from other causes.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">From the results here analyzed of the 45 patients with at least a 3-year controls from the procedure, we conclude that none of the factors habitually reported as determinant in the decision about which is the most suitable surgical technique for the treatment of the odontoid fractures (age, direction and degree of displacement, type of fracture according to Anderson and d’Alonzo), has been a technical or functional obstacle to obtain an adequate consolidation of the fracture.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">From these data, we believe that only the oblique fractures and those with an associated rupture of the transverse ligament of the axis, are the single contraindications of anterior screw placement. In our opinion stable fractures of the base of the odontoid do not existo Only the localization of the fracture has condicioned our therapeutical decisions in our series. Consequently we propose that the classification of odontoid fractures remains limited to the apex fractures and fractures of the base. The apex former can be treated by conservative means but the last, always unstable, must be treated by anterior screwing as the first therapeutical choice.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Martín-Ferrer, S.; Rimbau, J.; Joly, M.C.; Teruel, J.; Pont, J.: Fracturas de la apófisis odontoides: revisión de nuestra casuística, implicaciones terapéuticas y nueva clasificación. 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