MINISTRY OF EDUCATION
AND TRAINING
MINISTRY OF
NATIONAL DEFENCE
MILITARY MEDICAL UNIVERSITY
KIEU VIET TRUNG
RESEARCH THE CLINICAL, DIAGNOSTIC
IMAGING CHARACTERISTICS AND
EVALUATE THE SURGICAL OUTCOMES
OF TRAUMATIC C1-C2 FRACTURE
Specialty : Surgery
Code : 97 20104
DOCTOR OF MEDICINE DISSERTATION SUMMARY
Hanoi - 2020
THE RESEARCH WAS COMPLETED AT
THE MILITARY MEDICAL UNIVERSITY
Scientific instructor:
Associate Prof. PhD. Vu Van Hoe
Reviewer 1: Associate Prof. PhD. Nguyen Van Thach
Reviewer 2: Associate Prof. PhD. Bui Van Lenh
Reviewer 3: Associate Prof. PhD. Nguyen The Hao
The thesis will be defended before the university grade thesis
examination board in military medical university:
The thesis can be found at:
- National library of Viet Nam
- Library of military medical university
INTRODUCTION
Upper cervical spine injury is a very serious injury in general,
particularly in spinal injury. The mortality or severe sequelae rate
caused by cervical spine injury are very high. The upper cervical
spine including the atlas (C1) and the axis (C2) is the transition area
between the skull and the spine, which is one of the most
complicated joints in the body. At the Neurosurgery Department of
the Da Nang Hospital, we have applied this technique for 10 recent
years for unstable C1 – C2 injury treatment. Through clinical practice,
we realize that the unsolved problem in C1 – C2 fracture is a full
understanding of the injury characteristics, classification, indications
for surgery and the selection of techniques and tools for surgery as
well as bone graft. In order to make new contributions to the process
of diagnosis, selection of treatment method and plan for unstable C1 –
C2 injury, we conducted the thesis "Research the clinical, diagnostic
imaging characteristics and evaluate the surgical outcomes of
traumatic C1 – C2 fracture ” with 2 objectives:
1. Describe the clinical and diagnostic imaging characteristics of
unstable traumatic C1 - C2 fracture.
2. Evaluate the surgical outcomes of C1 - C2 stabilization with
screw via C1 lateral mass and C2 pedicle combined with bone
allograft.
New contributions of the thesis:
-Gave the size of C1 lateral mass and C2 pedicle, then calculated
the appropriate screws size in the C1-C2 fixation surgery.
-Provided the effectiveness of a surgical method and the use
of bone-graft materials which helped patients have no pain at the
bone donor site, shorter operation duration and 100% bone
healing rate.
- Showed further postoperative outcomes (long time
tracking, 18 months); the VAS score, NDI and ASIA were better
than before surgery with statistical significance (11.24% compared
with 52.8%)
The thesis structure: The thesis consists of 137 pages including
45 tables, 68 pictures and 4 charts. The layout includes the
introduction (3 pages); chapter 1: Overview (35 pages); chapter 2:
patients and methods (26 pages); chapter 3: results (28 pages);
chapter 4: discussions (41 pages); conclusions (2 pages); the list of
research publishes (1 page); references (128 documents including 7
Vietnamese and 121 English documents) and appendices.
CHAPTER 1: OVERVIEW
1.1. The cervical spine anatomy
1.1.1. The bone structure
1.1.1.1. The atlas C1
The C1 vertebral has no vertebral body. It is ring-like, rugged
and consists of two large lateral masses which contain two superior
concave facets for articulation with occipital condyles and two inferior
concave facets for articulation with the axis C2. The structure of the atlas
includes anterior arch, posterior arch, lateral mass, anterior tubercle,
posterior tubercle, transverse process, transverse foramen, articular facet
with occipital condyles and articular facet with the axis. The anterior
and posterior arches are thinner to the two sides and where contact