Wang Lei, Liu Chao, Zhao Qinghua, Tian Jiwei
Department of Orthopaedics, Shanghai Jiaotong University Affiliated First People's Hospital, 100 Haining Road, Shanghai, 200080, China.
Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
J Orthop Surg Res. 2014 Nov 19;9:104. doi: 10.1186/s13018-014-0104-5.
Previous studies have demonstrated that the posterior pedicle screw fixation is an effective and safe method to treat atlantoaxial fractures. However, no report focuses on only the complex atlantoaxial fractures with atlanto-dental interval (ADI) of ≥ 5 mm or C2-C3 angulation of ≥ 11°.
This study was to retrospectively evaluate the outcome of 15 patients (six females and nine males; age, 27-55 years) who underwent posterior pedicle screw fixation for the above complex atlantoaxial fractures between July 2006 and March 2011. Fracture combinations included three Jefferson-type II odontoid, four anterior ring-type II odontoid, two posterior ring-type II odontoid, one lateral mass-type II odontoid, one Jefferson-hangman's fracture, three anterior ring-hangman's fracture, and one lateral mass-hangman's fracture. Fracture healing and bone fusion were determined on X-ray scan. Upper limbs, lower limbs, and sphincter functions were assessed using the Japanese Orthopaedic Association (JOA) score. The Frankel grading system was used to determine the neurological situation.
The mean operative time, blood loss, and hospital stays were 108.9 ± 25.8 min, 508.0 ± 209.6 ml, and 13.3 ± 2.0 days. Fracture healing and graft fusion were obtained in all patients within 9 months. The ADI or C2-C3 angulation was reduced to ≤ 5 mm or ≤ 11°. The JOA score was significantly improved from 7.27 ± 1.10 preoperatively to 15.7 ± 2.1 postoperatively (P < 0.001), with 88.1 ± 18.3% recovery rate and 93.3% excellent and good rate. The neurological situation was improved in all patients by at least 1 grade in the Frankel scale. After a mean of 36.5 months of follow-up (range, 18 to 58 months), no operative complications (spinal cord injury, vertebral artery injury, or cerebrospinal fluid leakage) were observed.
Posterior pedicle screw fixation is a reliable, effective, and minimally invasive procedure for patients suffering from complex atlantoaxial fractures.
既往研究表明，后路椎弓根螺钉固定术是治疗寰枢椎骨折的一种有效且安全的方法。然而，尚无报告仅聚焦于寰齿间距（ADI）≥5 mm或C2-C3成角≥11°的复杂寰枢椎骨折。
本研究旨在回顾性评估2006年7月至2011年3月期间因上述复杂寰枢椎骨折接受后路椎弓根螺钉固定术的15例患者（6例女性，9例男性；年龄27-55岁）的治疗结果。骨折类型包括3例杰斐逊II型齿突骨折、4例前环II型齿突骨折、2例后环II型齿突骨折、1例侧块II型齿突骨折、1例杰斐逊-绞刑者骨折、3例前环-绞刑者骨折和1例侧块-绞刑者骨折。通过X线扫描确定骨折愈合和骨融合情况。采用日本骨科学会（JOA）评分评估上肢、下肢及括约肌功能。使用Frankel分级系统确定神经功能状况。
平均手术时间、失血量和住院时间分别为108.9±25.8分钟、508.0±209.6毫升和13.3±2.0天。所有患者均在9个月内实现骨折愈合和植骨融合。ADI或C2-C3成角减小至≤5 mm或≤11°。JOA评分从术前的7.27±1.10显著提高至术后的15.7±2.1（P<0.001），恢复率为88.1±18.3%，优良率为93.3%。所有患者的神经功能状况在Frankel分级中至少改善1级。平均随访36.5个月（范围18至58个月）后，未观察到手术并发症（脊髓损伤、椎动脉损伤或脑脊液漏）。
后路椎弓根螺钉固定术对于患有复杂寰枢椎骨折的患者是一种可靠、有效且微创的手术方法。
