Horn Eric M, Hott Jonathan S, Porter Randall W, Theodore Nicholas, Papadopoulos Stephen M, Sonntag Volker K H
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
J Neurosurg Spine. 2006 Aug;5(2):172-7. doi: 10.3171/spi.2006.5.2.172.
Atlantoaxial stabilization has evolved from simple posterior wiring to transarticular screw fixation. In some patients, however, the course of the vertebral artery (VA) through the axis varies, and therefore transarticular screw placement is not always feasible. For these patients, the authors have developed a novel method of atlantoaxial stabilization that does not require axial screws. In this paper, they describe the use of this technique in the first 10 cases. Ten consecutive patients underwent the combined C1-3 lateral mass-sublaminar axis cable fixation technique. The mean age of the patients was 62.6 years (range 23-84 years). There were six men and four women. Eight patients were treated after traumatic atlantoaxial instability developed (four had remote trauma and previous nonunion), whereas in the other two atlantoaxial instability was caused by arthritic degeneration. All had VA anatomy unsuitable to traditional transarticular screw fixation. There were no intraoperative complications in any of the patients. Postoperative computed tomography studies demonstrated excellent screw positioning in each patient. Nine patients were treated postoperatively with the aid of a rigid cervical orthosis. The remaining patient was treated using a halo fixation device. One patient died of respiratory failure 2 months after surgery. Follow-up data (mean follow-up duration 13.1 months) were available for seven of the remaining nine patients and demonstrated a stable construct with fusion in each patient. The authors present an effective alternative method in which C1-3 lateral mass screw fixation is used to treat patients with unfavorable anatomy for atlantoaxial transarticular screw fixation. In this series of 10 patients, the method was a safe and effective way to provide stabilization in these anatomically difficult patients.
寰枢椎固定技术已从简单的后路钢丝固定发展到经关节螺钉固定。然而，在一些患者中，椎动脉（VA）通过枢椎的走行有所不同，因此经关节螺钉置入并不总是可行的。对于这些患者，作者开发了一种无需枢椎螺钉的新型寰枢椎固定方法。在本文中，他们描述了该技术在最初10例患者中的应用。连续10例患者接受了C1 - 3侧块 - 枢椎板下缆线固定技术。患者的平均年龄为62.6岁（范围23 - 84岁）。其中男性6例，女性4例。8例患者在发生创伤性寰枢椎不稳后接受治疗（4例有陈旧性创伤和既往不愈合），而另外2例寰枢椎不稳由关节炎退变引起。所有患者的VA解剖结构均不适合传统的经关节螺钉固定。所有患者均未发生术中并发症。术后计算机断层扫描研究显示每位患者的螺钉位置良好。9例患者术后使用坚固的颈椎矫形器进行治疗。其余1例患者使用头环固定装置进行治疗。1例患者术后2个月死于呼吸衰竭。其余9例患者中有7例有随访数据（平均随访时间13.1个月），结果显示每位患者的固定结构稳定且已融合。作者提出了一种有效的替代方法，即使用C1 - 3侧块螺钉固定来治疗寰枢椎经关节螺钉固定解剖结构不佳的患者。在这组10例患者中，该方法是为这些解剖结构复杂的患者提供稳定固定的一种安全有效的方式。
