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Die subdentale Synchondrose

Eine computertomographische und histologische Untersuchung zu morphologischen Aspekten der Densbasisfraktur an 36 humanen Axispräparaten

Subdental synchondrosis

Computed tomographic and histologic investigation on morphological aspects of fracture at the base of the dens in 36 human axis specimens

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Zusammenfassung

Hintergrund

Entwicklungsgeschichtlich wird der Axis aus 4 Knochenkernen gebildet: 2 kraniale Knochenkerne, welche das Odontoid ausformen, werden von den Knochenkernen des Corpus axis durch die sog. subdentale Synchondrose getrennt. Während der weiteren Entwicklung können Anteile der subdentalen Synchondrose – welche nach bisheriger Vorstellung vollständig schließt – auch im adulten Axis persistieren.

Ergebnisse

Im klinischen Alltag müssen Rudimente der subdentalen Synchondrose bisweilen von einer Fraktur der Densbasis (Typ II gemäß Anderson und D’Alonzo) unterschieden werden. Um die Morphologie der subdentalen Synchondrose sowie des Axis zu charakterisieren, wurde der komplette Axis von 36 Patienten dreier Altersgruppen, welche den natürlichen Alterungsprozess des Skeletts repräsentieren, entnommen und untersucht. Zunächst wurde die Knochendichte (BMD) der Axispräparate mittels peripherer quantitativer Computertomographie (pQCT) bestimmt. Die morphologische Analyse an unentkalkten Präparaten zeigt eine Persistenz der subdentalen Synchondrose bei 87% aller Präparationen. Die histologische Charakterisierung der subdentalen Synchondrose weist auf eine überwiegend knorpelige Matrix hin, in welcher einige nur schwach ausgeprägte ossifizierte Bereiche eingegliedert sind. Histomorphometrisch konnte eine signifikante Verminderung der trabekulären Knochenmasse sowie der Kortikalisdicke im Bereich der Densbasis verglichen mit dem Dens und dem Corpus axis nachgewiesen werden.

Schlussfolgerung

Zusammenfassend wird durch diese Untersuchung die strukturelle Besonderheit der subdentalen Synchondrose hervorgehoben. Neben den bekannten biomechanischen Eigenschaften weisen diese Daten darauf hin, dass die strukturelle Besonderheit der Densbasis des Axis zu einer erhöhten Frakturneigung in dieser Region prädisponieren und zu einer verminderten Frakturheilungspotenz nach Typ-II-Frakturen gemäß Anderson und D’Alonzo beitragen könnte.

Abstract

Background

During development of the axis, four different ossification centers are formed. The two cranial ossification centers are demarcated from the ossification center of the vertebral corpus by a subdental synchondrosis. During further development the subdental synchondrosis – which is thought to close spontaneously – might not close completely, which leads to the necessity for differentiating synchondrotic remnants from a fracture at the base of the dens (type II according to Anderson and D’Alonzo).

Results

To characterize the architecture of the axis with particular attention to the subdental synchondrosis, the axis was harvested from 36 age- and gender-matched patients covering the human aging process from adolescence to senescence. In all specimens bone mineral density (BMD) was measured by peripheral quantitative computed tomography (pQCT). Morphological analysis after undecalcified processing of all specimens revealed a persistency of the subdental synchondrosis in 87% of all patients. Histological characterization of the subdental synchondrosis showed a cartilaginous structure interspersed with focal mineralization. Furthermore, static histomorphometric analysis revealed that trabecular bone volume and cortical thickness were significantly reduced within the base of the axis as compared to the dens and the corpus, respectively.

Conclusion

Taken together, these results provide evidence that the base of the axis is a structurally distinct region. Besides well-recognized biomechanical aspects, these results suggest that the structure of the base of the axis might contribute to the occurrence of fractures of the axis and offer an additional explanation for the observation of nonunion after type II dens fractures.

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Authors and Affiliations

  1. Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf

    K. Püschel

  2. Zentrum für Biomechanik, Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg

    M. Gebauer, F. Barvencik, F. T. Beil, C. Lohse, P. Pogoda, J. M. Rueger &  M. Amling

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  1. M. Gebauer
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  2. F. Barvencik
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  3. F. T. Beil
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  4. C. Lohse
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  5. P. Pogoda
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  6. K. Püschel
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  7. J. M. Rueger
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  8. M. Amling
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Correspondence to M. Amling.

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M. Gebauer und F. Barvencik teilen sich die Erstautorenschaft.

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Gebauer, M., Barvencik, F., Beil, F.T. et al. Die subdentale Synchondrose. Unfallchirurg 110, 97–103 (2007). https://doi.org/10.1007/s00113-006-1201-7

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