Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Road, Huangpu District, 200003 Shanghai, People's Republic of China.
Eur Spine J. 2011 Jul;20 Suppl 2(Suppl 2):S284-8. doi: 10.1007/s00586-011-1693-x. Epub 2011 Jan 25.
A case of a 34-year-old female with unilateral cleft of atlas posterior arch associated with os odontoideum is reported. The patient had experienced neck pain for 6 months. Five days earlier to admission the pain aggravated as a result of mild head trauma from behind. Imaging examinations revealed C1-2 subluxation as well as the deformity. After 3 days of skull traction, a sound C1-2 reduction was achieved. Post atlantoaxial fusion using bilateral transarticular screws combined with C1 laminar hook on the intact side and autogenous bone graft was performed. On the sixth month of postoperative follow-up, CT revealed solid fusion was achieved. No related complications were detected within 3 years of follow-up. The clinical manifestations and imaging findings were presented. The incidence and etiopathogenesis of hypoplastic posterior arch of the atlas were concisely introduced. Techniques of post atlantoaxial fusion under circumstances of unilateral C1 posterior elements defects were discussed. The authors believe bilateral transarticular screws combined with C1 laminar hook on the intact side and autogenous bone graft can be applicable to atlantoaxial fusion on the premise of preoperative C1-2 reduction and C1 posterior arch remaining >1/2 of its full length.
现报道 1 例 34 岁女性患者，存在寰椎后弓单侧裂合并齿状突游离。患者曾有 6 个月的颈部疼痛史，5 天前因轻微的枕部创伤后疼痛加重。影像学检查显示 C1-2 半脱位和畸形。颅骨牵引 3 天后，实现了 C1-2 的复位。采用双侧经关节突螺钉联合完整侧 C1 椎板钩和自体骨移植进行寰枢融合。术后 6 个月随访 CT 显示融合牢固。3 年内无相关并发症。介绍了临床表现和影像学发现。简述了寰椎后弓发育不全的发生率和病因。讨论了单侧寰椎后弓结构缺损时寰枢融合的技术。作者认为，在术前 C1-2 复位和 C1 后弓保留长度>其全长的 1/2 的前提下，双侧经关节突螺钉联合完整侧 C1 椎板钩和自体骨移植可适用于寰枢融合。
