成人急性寰枢椎联合骨折临床诊疗循证指南(2023版)

Evidence‑based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults(version 2023)

成人急性寰枢椎联合骨折具有较单纯寰椎或枢椎骨折更高的神经损伤发生率和早期病死率。目前,对于成人急性寰枢椎联合骨折的诊断和治疗方式选择仍存在争议且缺乏相关规范。非手术治疗存在较高的骨不融合率和并发症发生率,而手术治疗易导致椎动脉、脊髓和神经根损伤。对于成人急性寰枢椎联合骨折,目前我国尚无基于循证医学证据的诊疗指南。为给骨科医师提供关于成人急性寰枢椎联合骨折处理方面最新和最有效的信息,中国医师协会骨科医师分会脊柱创伤学组组织相关专家遵循循证医学原则,借鉴美国神经外科医师学会(AANS)/神经外科医师大会(CNS)在2013年发布的《成人急性寰枢椎联合骨折处理指南》,并基于有关成人急性寰枢椎联合骨折治疗的中英文文献,制订《成人急性寰枢椎联合骨折临床诊疗循证指南(2023版)》。针对影像学诊断、稳定性判断、治疗原则、治疗方式选择和相关并发症等问题提出基于循证医学证据的10条推荐建议,为成人急性寰枢椎联合骨折的诊疗提供参考。

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone.Currently,the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation.Non⁃operative treatments have a high incidence of bone nonunion and complications,while surgeries may easily lead to the injury of the vertebral artery,spinal cord and nerve root.At present,there are no evidence⁃based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.To provide orthopedic surgeons with the most up⁃to⁃date and effective information in treating acute combination fractures of the atlas and axis in adults,the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence‑based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults(version 2023)by referring to the"Management of acute combination fractures of the atlas and axis in adults"published by American Association of Neurological Surgeons(AANS)/Congress of Neurological Surgeons(CNS)in 2013 and the relevant Chinese and English literatures.Ten recommendations were made concerning the radiological diagnosis,stability judgment,treatment rules,treatment options and complications based on medical evidence,aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.