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)

作　　者：杜钰堃 黄大耿 田伟[3] 郝定均[2] 西永明[1] 贺宝荣[2] 陈伯华[1] 初同伟 董健[5] 董军 冯皓宇 范顺武[8] 冯世庆 高延征[10] 官众[11] 海涌[12] 贺利军 贺园 蒋电明 姜建元[15] 孔维庆 林斌 刘斌[17] 刘宝戈 李淳德[19] 李放 李锋[21] 吕国华[22] 李利[23] 廖琦[24] 李危石[25] 刘晓光 刘勇[27] 刘忠军[25] 鲁世保[28] 罗飞 李建毅 邱勇[30] 戎利民[31] 申勇[32] 沈慧勇[33] 舒钧[34] 宋跃明[35] 孙天胜 邵将[36] 田纪伟 王岩[23] 王哲 王征[23] 王向阳[39] 夏虹 闫景龙[41] 闫亮[2] 袁文 赵杰[43] 仉建国[44] 朱悦[45] 周许辉 赵明伟 中国医师协会骨科医师分会脊柱创伤学组 Du Yukun;Huang Dageng;Tian Wei;Hao Dingjun;Xi Yongming;He Baorong;Chen Bohua;Chu Tongwei;Dong Jian;Dong Jun;Feng Haoyu;Fan Shunwu;Feng Shiqing;Gao Yanzheng;Guan Zhong;Hai Yong;He Lijun;He Yuan;Jiang Dianming;Jiang Jianyuan;Kong Weiqing;Lin Bin;Liu Bin;Liu Baoge;Li Chunde;Li Fang;Li Feng;Lyu Guohua;Li Li;Liao Qi;Li Weishi;Liu Xiaoguang;Liu Yong;Liu Zhongjun;Lu Shibao;Luo Fei;Li Jianyi;Qiu Yong;Rong Limin;Shen Yong;Shen Huiyong;Shu Jun;Song Yueming;Sun Tiansheng;Shao Jiang;Tian Jiwei;Wang Yan;Wang Zhe;Wang Zheng;Wang Xiangyang;Xia Hong;Yan Jinglong;Yan Liang;Yuan Wen;Zhao Jie;Zhang Jianguo;Zhu Yue;Zhou Xuhui;Zhao Mingwei;Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association(Affiliated Hospital of Qingdao University,Qingdao 266003,China;Honghui Hospital,Xi′an Jiaotong University,Xi′an 710054,China;Beijing Jishuitan Hospital,Beijing 100035,China;Second Affiliated Hospital of Army Medical University,Chongqing 400037,China;Zhongshan Hospital Affiliated to Fudan University,Shanghai 200032,China;Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250012,China;Shanxi Bethune Hospital,Taiyuan 030032,China;Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China;Second Hospital of Shandong University,Jinan 250033,China;Henan Provincial People′s Hospital,Zhengzhou 450003,China;Affiliated Hospital of Qinghai University,Xining 810001,China;Beijing Chao‑Yang Hospital,Capital Medical University,Beijing 100020,China;Xi′an No.5 Hospital,Xi′an 710082,China;Third Affiliated Hospital of Chongqing Medical University,Chongqing 401120,China;Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China;16909th Hospital of Joint Logistics Support Force,Zhangzhou 363099,China;Inner Mongolia Medical University,Huhhot 010050,China;Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Peking University First Hospital,Beijing 100034,China;Seventh Medical Center of PLA General Hospital,Beijing 100007,China;Tongji Hospital

机构地区：[1]青岛大学附属医院,青岛266003 [2]西安交通大学附属红会医院,西安710054 [3]北京积水潭医院,北京100035 [4]陆军军医大学第二附属医院,重庆400037 [5]复旦大学附属中山医院,上海200032 [6]山东第一医科大学附属省立医院,济南250012 [7]山西白求恩医院,太原030032 [8]浙江大学医学院邵逸夫医院,杭州310016 [9]山东大学第二医院,济南250033 [10]河南省人民医院,郑州450003 [11]青海大学附属医院,西宁810001 [12]首都医科大学附属北京朝阳医院,北京100020 [13]西安市第五医院,西安710082 [14]重庆医科大学附属第三医院,重庆401120 [15]复旦大学附属华山医院,上海200040 [16]联勤保障部队第九〇九医院,漳州363099 [17]内蒙古医科大学,呼和浩特010050 [18]首都医科大学附属天坛医院,北京100070 [19]北京大学第一医院,北京100034 [20]中国人民解放军总医院第七医学中心,北京100007 [21]华中科技大学同济医学院附属同济医院,武汉430030 [22]中南大学湘雅二医院,长沙410012 [23]中国人民解放军总医院,北京100853 [24]南昌大学附属第三医院,南昌330008 [25]北京大学第三医院,北京100191 [26]北京大学医学部,北京100191 [27]西藏自治区人民医院,拉萨850010 [28]首都医科大学附属宣武医院,北京100053 [29]陆军军医大学第一附属医院,重庆400038 [30]南京大学医学院附属南京鼓楼医院,南京210008 [31]中山大学附属第三医院,广州510630 [32]河北医科大学第三医院,石家庄050051 [33]中山大学附属第八医院,深圳518033 [34]昆明医科大学第二附属医院,昆明650106 [35]四川大学华西医院,成都610041 [36]上海交通大学医学院附属新华医院,上海200092 [37]南京江北医院,南京210048 [38]空军军医大学西京医院,西安710032 [39]温州医科大学第二附属医院,温州325027 [40]解放军南部战区总医院,广州510010 [41]哈尔滨医科大学附属第二医院,哈尔滨150001 [42]海军军医大学�

出　　处：《中华创伤杂志》2023年第4期299-308,共10页Chinese Journal of Trauma

摘　　要：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.

关 键 词：颈寰椎 枢椎 颈椎 脊柱骨折 指南 

分 类 号：R683[医药卫生—骨科学]