Department of Orthopaedic Surgery, West China Hospital, West China Clinical Medical School, Sichuan University, Chengdu, Sichuan (610041), PR China.
Spine (Phila Pa 1976). 2011 Jul 1;36(15):E983-92. doi: 10.1097/BRS.0b013e3181feb6b1.
Retrospective case series study of surgical outcome for 21 atlantoaxial subluxation patients treated with a new technique, called cable-dragged reduction/cantilever beam internal fixation. Surgery was performed by a single surgeon.
To describe and evaluate the cable-dragged reduction/cantilever beam internal fixation technique for the treatment for old atlantoaxial subluxation irreducible by traction.
Management of old atlantoaxial subluxation has always been a difficult task. A more effective way to achieve surgical reduction is needed.
Twenty one patients, aged 31.6 ± 13.3 years (range, 11-67 years), 17 men and four women, with atlantoaxial subluxation that failed to be reduced after 10 to 111 days in traction, underwent posterior cable-dragged reduction/cantilever beam internal fixation surgery. Frankel classification of neural function before surgery was the following: Frankel B, four patients; Frankel C, five patients; Frankel D, four patients; and Frankel E, eight patients. Plain radiographs, computed tomographic three-dimensional reconstructive images and magnetic resonance images of the cervical spine were obtained at 3, 6, and 12 months after surgery, and each year thereafter. No patient was lost to follow-up, and the follow-up time ranged from 6 months to 4 years. Rate of reduction and C1∼3 fusion, as well as improvement of neural function, were recorded and analyzed.
The average follow-up period was 13.2 months. Radiographic evaluation of the group at follow-up showed 16 complete and five partial reductions, and satisfactory decompression and C1∼3 fusion in all cases. Neural function at the end of the follow-up was Frankel B still in one patient, Frankel C in seven patients, and Frankel E in 13 patients.
Cable-dragged reduction/cantilever beam internal fixation is almost as effective for reduction as anterior release but is less invasive and risky. It has similar operative time and blood loss to occipitocervical fusion but avoids arthrodesis of occipitoatlantal joint. It is also suitable for patients with severe myelopathy before surgery. Its major disadvantage is that C3, which is left free in the traditional atlantoaxial fusion surgery, has to be involved in fusion. And it is suitable only for patients with intact posterior arches in C1.
回顾性病例系列研究，纳入 21 例采用新型技术（缆索牵拉复位/悬臂梁内固定术）治疗的寰枢椎半脱位患者，该技术由同一位外科医生实施。
介绍并评估缆索牵拉复位/悬臂梁内固定术治疗陈旧性寰枢椎半脱位的效果，此类半脱位经牵引无法复位。
陈旧性寰枢椎半脱位的治疗一直是个难题，需要一种更有效的手术复位方法。
21 例患者（年龄 31.6±13.3 岁，范围 1167 岁；男 17 例，女 4 例），因牵引 10111 天后仍无法复位而接受后路缆索牵拉复位/悬臂梁内固定术。术前神经功能按 Frankel 分级：B 级 4 例，C 级 5 例，D 级 4 例，E 级 8 例。术后 3、6、12 个月及之后每年随访颈椎正侧位、CT 三维重建及 MRI。无失访患者，随访时间 6~48 个月。记录并分析复位率、寰齿前间隙（C1∼3）融合及神经功能改善情况。
平均随访时间 13.2 个月。随访时影像学评估结果为：16 例完全复位，5 例部分复位，所有患者均减压充分且 C1∼3 融合满意。末次随访时，1 例仍为 Frankel B 级，7 例为 C 级，13 例为 E 级。
缆索牵拉复位/悬臂梁内固定术与前路松解复位的复位效果相当，但创伤更小、风险更低。该术式的手术时间和出血量与枕颈融合术相近，但避免了寰枢关节融合。对术前脊髓严重病变的患者也适用。主要缺点是传统寰枢融合术保留的 C3 也需要融合，且仅适用于 C1 后弓完整的患者。
