Современные концепции классификации, диагностики и лечения атлантоокципитальных дислокаций у взрослых: несистематический обзор литературы

Цель исследования. Анализ литературы по теме атлантоокципитальной дислокации у взрослых для определения оптимальной классификации, метода диагностики и лечения.

Материал и методы. Статья представляет собой несистематический обзор. Проведен поиск  источников в базе данных PubMed за период с 1966 по 2020 г. Начальный поиск выявил 564 резюме статей. Для детального изучения полного текста были выбраны 95 исследований, из которых 47 работ, описывающих данные 130 пациентов, включены в настоящий обзор.

Результаты. Проиллюстрированы все имеющиеся классификации атлантоокципитальных дислокаций с их подробным описанием, обсуждены их достоинства и недостатки. Представлены клиническая картина, особенности диагностики в опубликованных наблюдениях атлантоокципитальных дислокаций у взрослых, а также примененные методы лечения и их результаты.

Заключение. Атлантоокципитальная дислокация является одним из наиболее тяжелых видов повреждений шейного отдела позвоночника у взрослых, которая в 70 % случаев сопровождается повреждением продолговатого мозга и грубым неврологическим дефицитом. Чувствительность рентгенографии для диагностики атлантоокципитальных дислокаций составила 56,3 %, у 18,5 % ее применение привело к несвоевременной диагностике и могло послужить причиной последующего ухудшения. Чувствительность КТ – 96,8 %. Наиболее точным методом верификации атлантоокципитальных дислокаций является определение атлантоокципитального интервала (100 % чувствительность и специфичность). Оптимальным методом лечения пострадавших с атлантоокципитальными дислокациями является хирургический.

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