Em nossa série foram ainda verificados quatro casos de pacientes com lesão ligamentar associada evidente. Um caso de fratura de C1 e C2 com luxação das facetas C1-C2 direitas, tratado com fixação através de parafuso de massa lateral em C1, pars de C2 e massa lateral de C3. Um caso de fratura de massa lateral C1 com luxação facetária C1-C2 unilateral, tratado através de fixação occipito – C2 (parafuso de pars) – C3 parafusos de massa lateral (bilateral). Nesse caso o occipício foi fixado com amarria, pois a espessura do osso não permitiu a colocação de parafuso. O paciente apresentava dor intensa que melhorou no pós- operatório. Um caso de fratura de odontóide com fratura de C1 e distração de C1- C2, submetido à fixação C1 (massa lateral) e lâmina de C2, após tração. Um caso de distração de C1-C2, associada com fratura de côndilo bilateral, submetida à
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fixação de occipício-C2 (pars)-C3. Todos os pacientes evoluíram sem piora neurológica durante o seguimento.
Em casos de suspeita de lesão ligamentar, dada à necessidade de tratamento cirúrgico, o exame radiológico dinâmico (com tomografia ou radiografia) associados à ressonância magnética pode ser útil para o diagnóstico dessas lesões quando não há deslocamento ou luxações evidentes. Como regra, todo paciente com lesão ligamentar é submetido a tratamento cirúrgico (16, 17).
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Conclusões
Em nossa série de lesões da junção craniocervical, predominaram as fraturas de odontóide e as fraturas dos elementos posteriores do áxis.
Nossos resultados sugerem que a cirurgia precoce nas fraturas do odontóide do tipo II deve ser considerada devido à alta taxa de não consolidação com o uso de colar, mesmo na ausência de fatores de risco para falha do tratamento conservador.
A indicação cirúrgica precoce para realizar a estabilização dos pacientes com lesão ligamentar mostrou-se adequada para preservação da função neurológica.
Excetuando-se as fraturas do odontóide tipo II e fraturas com luxação de facetas de C2-C3, o tratamento conservador com colar rígido mostrou-se adequado nas fraturas da junção craniocervical onde não houve lesão ligamentar.
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