Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, The Third Military Medical University, Chongqing, People's Republic of China.
Eur Spine J. 2012 Aug;21(8):1568-74. doi: 10.1007/s00586-012-2153-y.
Even though transarticular screw (TAS) fixation has been commonly used for posterior C1-C2 arthrodesis in both traumatic and non-traumatic lesions, anterior TAS fixation C1-2 is a less invasive technique as compared with posterior TAS which produces significant soft tissue injury, and there were few reports on percutaneous anterior TAS fixation and microendoscopic bone graft for atlantoaxial instability. The goals of our study were to describe and evaluate a new technique for anterior TAS fixation of the atlantoaxial joints for traumatic atlantoaxial instability by analyzing radiographic and clinical outcomes.
This was a retrospective study of seven consecutive patients with C1-C2 instability due to upper cervical injury treated by a minimally invasive procedure from May 2007 to August 2009. Bilateral anterior TAS were inserted by the percutaneous approach under Iso-C3D fluoroscopic control. The atlantoaxial joint space was prepared for morselized autogenous bone graft under microendoscopy. The data for analysis included time after the injuries, operating time, intraoperative blood loss, X-ray exposure time, clinical results, and complications. Radiographic evaluation included the assessment of atlantoaxial fusion rate and placement of TAS. Bone fusion of the atlantoaxial joints was assessed by flexion extension lateral radiographs and 1-mm thin-slice computed tomography images as radiographic results. Clinical assessment was done by analyzing the recovery state of clinical presentation from the preoperative period to the last follow-up and by evaluating complications.
A total of 14 screws were placed correctly. The atlantoaxial solid fusion without screw failure was confirmed by CT scan in seven cases after a mean follow-up of 27.5 months (range 18-45 months). All patients with associated clinical presentation made a recovery without neurologic sequelae. Postoperative dysphagia occurred and disappeared in two cases within 5 days after surgery. There were no other complications during the follow-up period.
Percutaneous anterior TAS fixation and microendoscopic bone graft could be an option for achieving C1-C2 stabilization with several potential advantages such as less tissue trauma and better accuracy. Bilateral TAS fixation and morselized autograft affords effective fixation and solid fusion by a minimally invasive approach.
尽管经关节突螺钉（TAS）固定已广泛应用于创伤性和非创伤性病变的后路 C1-C2 融合，但与产生显著软组织损伤的后路 TAS 相比，前路 TAS 固定 C1-2 是一种侵袭性较小的技术，并且对于经皮前路 TAS 固定和微内窥镜骨移植治疗寰枢椎不稳定的报道较少。我们的研究目的是通过分析影像学和临床结果来描述和评估一种用于创伤性寰枢椎不稳定的前路 TAS 固定寰枢关节的新技术。
这是一项回顾性研究，纳入了 2007 年 5 月至 2009 年 8 月期间因颈椎上段损伤接受微创治疗的 7 例连续 C1-C2 不稳定患者。在 Iso-C3D 荧光透视控制下，经皮双侧前路 TAS 插入。在微内窥镜下，寰枢关节间隙准备用于碎骨自体骨移植。分析的资料包括损伤后的时间、手术时间、术中失血量、X 线曝光时间、临床结果和并发症。影像学评估包括寰枢融合率和 TAS 放置的评估。通过寰枢侧位屈伸位 X 线片和 1mm 薄层 CT 图像评估寰枢关节融合情况作为影像学结果。临床评估是通过分析术前到最后随访的临床表现恢复情况和评估并发症来进行的。
共正确放置了 14 颗螺钉。7 例患者平均随访 27.5 个月（18-45 个月）后，通过 CT 扫描证实寰枢椎融合牢固，无螺钉失败。所有伴有临床症状的患者均无神经后遗症恢复。术后吞咽困难在 2 例患者中出现，术后 5 天内消失。随访期间无其他并发症。
经皮前路 TAS 固定和微内窥镜骨移植可作为实现 C1-C2 稳定的一种选择，具有组织创伤小、准确性高的潜在优势。双侧 TAS 固定和碎骨自体移植通过微创入路提供有效的固定和牢固融合。
