Ni Bin, Guo Qunfeng, Lu Xuhua, Xie Ning, Wang Liang, Guo Xiang, Chen Fei
From the Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China.
Spine (Phila Pa 1976). 2015 Feb 1;40(3):E168-74. doi: 10.1097/BRS.0000000000000709.
A prospective study.
To evaluate the outcomes of posterior reduction and temporary fixation using the C1-C2 screw-rod system for odontoid fracture unsuitable for anterior screw fixation.
Anterior screw fixation has become the most widely used surgical procedure for the stabilization of odontoid fractures. However, if there is any contraindication for anterior fixation, posterior atlantoaxial fusion is preferred, eliminating the normal rotation of the atlantoaxial complex.
A consecutive series of 22 patients with odontoid fracture unsuitable for anterior screw fixation were involved in this study. Posterior reduction and fixation without fusion using the C1-C2 screw-rod system was performed. Once fracture healing was obtained, instrumentation was removed. The visual analogue scale of neck pain, neck stiffness, American Spinal Injury Association impairment scale, patient satisfaction, and neck disability index were recorded. The range of motion of C1-C2 in flexion-extension and rotation was calculated.
The average age at internal fixation surgery was 40.2±11.3 years. The mean duration of follow-up was 41.8±26.8 months. There were no complications associated with instrumentation. All patients returned to their preoperative work. Fracture healing was observed in 21 patients and the instrumentation was removed. After removing the instrumentation, the visual analogue scale was reduced and neck stiffness were relieved (all P<0.01). Patient satisfaction and neck disability index had improved (all P<0.01). The range of motion of C1-C2 returned to 4.75°±1.62° and 25.70°±5.51° in flexion-extension and in rotation, respectively. No osteoarthritis was observed at the C1-C2 lateral mass joints.
Posterior reduction and temporary fixation using the C1-C2 screw-rod system was an optimal salvage maneuver to anterior screw fixation for odontoid fracture. It could effectively avoid the motion loss of C1-C2 caused by posterior atlantoaxial fusion.
前瞻性研究。
评估使用C1-C2螺钉棒系统进行后路复位和临时固定治疗不适于前路螺钉固定的齿状突骨折的疗效。
前路螺钉固定已成为治疗齿状突骨折应用最广泛的外科手术。然而，若存在前路固定的任何禁忌证，则优先选择寰枢椎后路融合术，这会消除寰枢复合体的正常旋转。
本研究纳入了连续22例不适于前路螺钉固定的齿状突骨折患者。采用C1-C2螺钉棒系统进行后路复位和非融合固定。一旦获得骨折愈合，即取出内固定器械。记录颈部疼痛视觉模拟量表、颈部僵硬程度、美国脊髓损伤协会损伤分级、患者满意度及颈部功能障碍指数。计算C1-C2在屈伸和旋转时的活动度。
内固定手术时的平均年龄为40.2±11.3岁。平均随访时间为41.8±26.8个月。未出现与内固定器械相关的并发症。所有患者均恢复了术前工作。21例患者观察到骨折愈合并取出了内固定器械。取出内固定器械后，视觉模拟量表评分降低，颈部僵硬缓解（均P<0.01）。患者满意度和颈部功能障碍指数得到改善（均P<0.01）。C1-C2在屈伸和旋转时的活动度分别恢复至4.75°±1.62°和25.70°±5.51°。在C1-C2侧块关节未观察到骨关节炎。
使用C1-C2螺钉棒系统进行后路复位和临时固定是齿状突骨折前路螺钉固定的一种最佳挽救措施。它可有效避免寰枢椎后路融合导致的C1-C2活动度丧失。
3级。
