Blondel Benjamin, Metellus Philippe, Fuentes Stephane, Dutertre Guillaume, Dufour Henry
Department of Neurosurgery, CHU Timone, Marseille, France.
Spine (Phila Pa 1976). 2009 Apr 1;34(7):E255-7. doi: 10.1097/BRS.0b013e318195ab2d.
A case of a 3-part fracture of the axis combining an odontoid dens and a hangman fracture is reported.
To describe a single anterior procedure allowing stabilization with an odontoid screw fixation and a C2-C3 fusion in a case of complex fracture of the axis.
Even if fractures of the axis are common, multiples fractures of the axis are rare and their management is still challenging for surgeons who have to achieve primary stability, early mobilization, preserved cervical range of motion, and favorable outcome.
A 79-year-old man was referred in our neurosurgical department 3 weeks after a bicycle accident. He had persistent neck pain without radicular pain. Neurologic examination was normal. The initial CT scan showed a rare and complex fracture of the axis consisting of a fracture of the dens and a traumatic spondylolisthesis of C2-C3.
The surgical procedure was performed using an anterior cervical approach under fluoroscopic guidance. First, a C2-C3 fusion was performed using an iliac crest graft. Then an anterior odontoid screw was placed under fluoroscopic guidance. Finally, an anterior plating of C2-C3 covering the odontoid screw was achieved. Postoperative course was uneventful and patient was discharged at day 6.
This single time procedure was able to achieve primary stability of the fractures of the axis and offers the possibility of an early mobilization of the patient with a good outcome. This approach allowed a better preservation of the cervical range of motion compared with a classic posterior fusion.
报告一例枢椎三部分骨折病例，该骨折合并齿状突骨折和绞刑者骨折。
描述一种单一前路手术方法，用于在枢椎复杂骨折病例中通过齿状突螺钉固定和C2-C3融合实现稳定。
尽管枢椎骨折很常见，但枢椎多处骨折很少见，对于外科医生来说，其治疗仍然具有挑战性，他们必须实现初始稳定性、早期活动、保留颈椎活动范围并获得良好的治疗效果。
一名79岁男性在自行车事故3周后被转诊至我们的神经外科。他持续颈部疼痛但无神经根性疼痛。神经学检查正常。初始CT扫描显示枢椎罕见且复杂的骨折，包括齿状突骨折和C2-C3创伤性椎体滑脱。
手术在透视引导下采用颈椎前路进行。首先，使用髂嵴植骨进行C2-C3融合。然后在透视引导下置入前路齿状突螺钉。最后，对覆盖齿状突螺钉的C2-C3进行前路钢板固定。术后过程顺利，患者于第6天出院。
这种一次性手术能够实现枢椎骨折的初始稳定性，并为患者早期活动提供了可能，且治疗效果良好。与经典的后路融合相比，这种方法能更好地保留颈椎活动范围。
