Kotil Kadır, Köksal Neslihan Sütpideler, Kayacı Selim
Department of Neurosurgery, Istanbul Educational and Research Hospital, Istanbul, Turkey.
J Craniovertebr Junction Spine. 2011 Jan;2(1):41-5. doi: 10.4103/0974-8237.85313.
Anterior odontoid screw fixation or posterior C1-2 fusion techniques are routinely used in the treatment of Type II odontoid fractures, but these techniques may be inadequate in some types of odontoid fractures. In this new technique (Kotil technique), through a posterior bilateral approach, transarticular screw fixation was performed at the non-dominant vertebral artery (VA) side and posterior transodontoid fixation technique was performed at the dominant VA side. C1-2 complex fusion was aimed with unilateral transarticular fixation and odontoid fixation with posterior transodontoid screw fixation. Cervical spinal computed tomography (CT) of a 40-year-old male patient involved in a motor vehicle accident revealed an anteriorly dislocated Type II oblique dens fracture, not reducible by closed traction. Before the operation, the patient was found to have a dominant right VA with Doppler ultrasound. He was operated through a posterior approach. At first, transarticular screw fixation was performed at the non-dominant (left) side, and then fixation of the odontoid fracture was achieved by directing the contralateral screw (supplemental screw) medially and toward the apex. Cancellous autograft was scattered for fusion without the need for structural bone graft or wiring. Postoperative cervical spinal CT of the patient revealed that stabilization was maintained with transarticular screw fixation and reduction and fixation of the odontoid process was achieved completely by posterior transodontoid screw fixation. The patient is at the sixth month of follow-up and complete fusion has developed. With this new surgical technique, C1-2 fusion is maintained with transarticular screw fixation and odontoid process is fixed by concomitant contralateral posterior transodontoid screw (supplemental screw) fixation; thus, this technique both stabilizes the C1-2 complex and fixes the odontoid process and the corpus in atypical odontoid fractures, appearing as an alternative new technique among the previously defined C1-C2 fixation techniques in eligible cases.
前路齿突螺钉固定或后路C1-2融合技术常用于治疗Ⅱ型齿突骨折，但这些技术在某些类型的齿突骨折中可能并不适用。在这项新技术（科蒂尔技术）中，通过双侧后路入路，在非优势椎动脉（VA）侧进行经关节螺钉固定，并在优势VA侧进行后路经齿突固定技术。通过单侧经关节固定实现C1-2复合体融合，并通过后路经齿突螺钉固定进行齿突固定。一名40岁男性机动车事故患者的颈椎计算机断层扫描（CT）显示为Ⅱ型斜形齿突骨折且向前脱位，经闭合牵引无法复位。术前，通过多普勒超声发现该患者右侧VA为优势侧。他接受了后路手术。首先，在非优势（左侧）侧进行经关节螺钉固定，然后将对侧螺钉（补充螺钉）向内侧并朝向齿突尖部置入以实现齿突骨折固定。分散植入松质骨自体骨进行融合，无需结构性骨移植或钢丝固定。患者术后颈椎CT显示，经关节螺钉固定维持了稳定性，后路经齿突螺钉固定完全实现了齿突的复位和固定。患者处于随访的第六个月，已实现完全融合。通过这项新的手术技术，经关节螺钉固定维持了C1-2融合，同时通过对侧后路经齿突螺钉（补充螺钉）固定了齿突；因此，在符合条件的病例中，这项技术既稳定了C1-2复合体，又固定了齿突和齿突体，在先前定义的C1-C2固定技术中，它是一种可供选择的新技术。
