Hein C, Richter H-P, Rath S A
Department of Neurosurgery, Hospital of Deggendorf, Deggendorf, Germany.
Acta Neurochir (Wien). 2002 Nov;144(11):1187-92. doi: 10.1007/s00701-002-0998-2.
The unstable atlas burst fracture ("Jefferson fracture") is a fracture of the anterior and posterior atlantal arch with rupture of the transverse atlantal ligament and an incongruence of the atlanto-occipital and the atlanto-axial joint facets. The question whether it has to be treated surgically or nonsurgically is still discussed and remains controversial. During the last decade 8 patients with unstable atlas burst fractures were examined and treated in our department. Five of the eight patients were first treated conservatively by external immobilization. Because of continuing instability due to insufficient bony fusion of the atlantal fracture all five patients underwent atlanto-axial transarticular screw fixation and fusion - as described by Magerl - with good results. In all 8 patients a good bony fusion of the atlanto-axial segment was achieved. None of the patients exhibited neurological deficits after surgical treatment. Although immobilization with a halo vest is recommended by most authors, from our view primary transarticular C1-C2 screw fixation has to be discussed as an alternative for unstable atlas burst fractures. Nonsurgical treatment with halo extension always bears the risk of insufficient healing with further instability and a fixated incongruence of the atlanto-occipital and the atlanto-axial joints, leading to arthrosis, immobility and increasing neck pain. After 10 weeks of insufficient immobilization secondary pre- and intra-operative reposition manoeuvres and surgical fixation hardly can reverse this fixated incongruence. Moreover, halo-extension needs an immobilization of the cervical spine for about 10 weeks and more, which is very uncomfortable and leads to further complications especially in elderly patients.
不稳定型寰椎爆裂骨折（“杰斐逊骨折”）是寰椎前后弓骨折，伴有寰椎横韧带断裂以及寰枕关节和寰枢关节面不匹配。对于该骨折是采用手术治疗还是非手术治疗仍存在争议且讨论不断。在过去十年中，我们科室对8例不稳定型寰椎爆裂骨折患者进行了检查和治疗。8例患者中有5例最初采用外部固定进行保守治疗。由于寰椎骨折骨融合不足导致持续不稳定，所有5例患者均接受了Magerl描述的寰枢椎经关节螺钉固定融合术，效果良好。所有8例患者均实现了寰枢椎节段良好的骨融合。手术治疗后，所有患者均未出现神经功能缺损。尽管大多数作者推荐使用头环背心固定，但我们认为对于不稳定型寰椎爆裂骨折，应考虑将一期经关节C1-C2螺钉固定作为一种替代方法。采用头环延长进行非手术治疗始终存在愈合不足、进一步不稳定以及寰枕关节和寰枢关节固定性不匹配的风险，进而导致关节病、活动受限和颈部疼痛加剧。在固定不足10周后，二期术前和术中复位操作及手术固定很难纠正这种固定性不匹配。此外，头环延长需要对颈椎进行约10周或更长时间的固定，这非常不舒服，尤其在老年患者中会导致更多并发症。
