Orthopedic & Trauma-Surgery Department, East Hospital, Tongji University, Shanghai, PR China.
Spine (Phila Pa 1976). 2009 Nov 1;34(23):2505-9. doi: 10.1097/BRS.0b013e3181b4009a.
Primary clinical trial of limited fixation for unstable Atlas fracture.
To clinically validate feasibility, safety and value of the C1 later-mass screw C2 pedicle screw and crosslink compression fixation technique.
[corrected] In previous clinical studies, several techniques have been introduced to fix Atlas fracture. But all these treatments have intrinsic disadvantages. Now seeking a means of limited internal fixation has become a worthwhile subject of clinical study.
From January 2001 to December 2004, 17 cases of atlas fracture were diagnosed consecutively, 11 cases were operated on with C1 lateral mass and C2 pedicle screws and crosslink fixation, of whom 6 patents had axial instability and rupture of transverse ligament, 1 patient had C2 laminal fracture, and the remaining 4 patients had axial instability. With the assistant of regional anatomy study and fluoroscopy C1 lateral mass screws and C2 pedicle screws were implanted in place, between which connecting rods were applied bilaterally. A crosslink compression was applied between the 2 rods to achieve realignment of C1 lateral mass fracture and C0-C1-C2 into the anatomic position. C1-C2 fusion with posterior bone grafting was performed in patients with axial instability or transverse ligament discontinuity.
Operative time ranged from 90 to 176 minutes with a mean of 124 minutes. Intraoperative blood loss ranged from 270 to 1200 mL with a mean of 432 mL. There were no neurologic deficits, vertebral artery related complications or other complications in all patients. No deterioration of the neurologic deficits was noticed 5 days after operation when the patients were brace fixed and began to ambulate. No cerebral hemodynamic deficit was observed in this patient. Radiograph examination showed bone fusion and stability in all patients 3 months after operation. Healing of C2 fracture was confirmed by computed tomography scan.
Osteosynthesis of the atlas by C1 lateral mass screws C2 pedicle screws and crosslink compression fixation is an ideal option for C1 burst fracture with or without rupture of the transverse ligament. The procedure allows for partially physiologic reconstruction of the C0-C1-C2 joint and shortens external fixation.
不稳定寰椎骨折的有限固定初步临床试验。
临床验证 C1 侧块螺钉 C2 椎弓根螺钉和交叉链接压缩固定技术的可行性、安全性和价值。
在以前的临床研究中，已经介绍了几种固定寰椎骨折的技术。但所有这些治疗都有内在的缺点。现在寻求一种有限内固定的方法已成为临床研究的一个有价值的课题。
从 2001 年 1 月至 2004 年 12 月，连续诊断出 17 例寰椎骨折患者，其中 11 例采用 C1 侧块和 C2 椎弓根螺钉和交叉链接固定术治疗，其中 6 例患者存在轴向不稳定和横韧带断裂，1 例患者存在 C2 椎板骨折，其余 4 例患者存在轴向不稳定。在区域解剖学研究和透视的辅助下，将 C1 侧块螺钉和 C2 椎弓根螺钉植入适当位置，在两者之间应用双侧连接杆。在 2 个杆之间施加交叉链接压缩，使 C1 侧块骨折和 C0-C1-C2 重新排列到解剖位置。对于轴向不稳定或横韧带不连续的患者，进行 C1-C2 融合和后路植骨。
手术时间为 90-176 分钟，平均为 124 分钟。术中出血量为 270-1200ml，平均为 432ml。所有患者均无神经功能缺损、椎动脉相关并发症或其他并发症。所有患者在术后 5 天佩戴支具固定并开始行走时，神经功能缺损均无恶化。患者无脑血流动力学缺陷。所有患者术后 3 个月 X 线检查均显示骨融合和稳定性。CT 扫描证实 C2 骨折愈合。
C1 侧块螺钉 C2 椎弓根螺钉和交叉链接压缩固定治疗寰椎爆裂骨折伴或不伴横韧带断裂是一种理想的选择。该手术可部分重建 C0-C1-C2 关节，并缩短外固定时间。
