Kim Moon Seok, Kim Jun Young, Kim Il Sup, Cho Kyoung Seok, Kim Sang Don, Lee Ho Jin, Kim Jong Tae, Hong Jae Taek
Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, 93-6 Ji-Dong, Paldal-Gu, Suwon, Gyeonggi-do, 442-723, South Korea.
Department of Neurosurgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
Eur Spine J. 2016 Jan;25(1):103-109. doi: 10.1007/s00586-015-3848-7. Epub 2015 Mar 10.
To describe the effect of the C1 bursting fracture on the location of the internal carotid artery (ICA) around the atlas.
The authors analyzed the morphology of the atlas and the ICA in 15 patients with C1 bursting fracture and compared with control group (77 patients) without any pathology. All patients were evaluated with CT angiography for the anatomical assessment. The laterality of the ICA, the distances of the ICA from the midline, anterior tubercle, and ventral surface of the C1 lateral mass were compared between two groups. The distance between the lateral margin of the longus capitis muscle and the inner edge of the transverse foramen was also measured.
Medially located ICA was more common in the C1 bursting fracture group than control group (76.7 vs 42.8 %). There were no significant differences between 2 groups for the distance from the midline, anterior tubercle, and ventral surface of the C1 lateral mass, respectively. The distance of the longus capitis muscle to transverse foramen was 2.52 ± 2.09 and 4.15 ± 3.09 mm in each group, and there was statistically significant difference (p < 0.01).
Lateral displacement of the bony structure of C1 bursting fracture changes the relative location of the ICA medially, which increase the injury risk during the bicortical C1 screw insertion. These data suggest that CT angiography or enhanced CT scans can give critical information to choose the ideal fixation technique and the proper trajectory of the screws for C1 bursting fracture.
描述C1爆裂骨折对寰椎周围颈内动脉（ICA）位置的影响。
作者分析了15例C1爆裂骨折患者的寰椎和ICA形态，并与无任何病变的对照组（77例患者）进行比较。所有患者均接受CT血管造影以进行解剖学评估。比较两组之间ICA的侧别、ICA与中线、前结节以及C1侧块腹侧面的距离。还测量了头长肌外侧缘与横突孔内缘之间的距离。
C1爆裂骨折组中ICA位于内侧的情况比对照组更常见（76.7%对42.8%）。两组之间ICA与中线、前结节以及C1侧块腹侧面的距离分别无显著差异。每组中头长肌至横突孔的距离分别为2.52±2.09和4.15±3.09mm，存在统计学显著差异（p<0.01）。
C1爆裂骨折的骨结构侧方移位使ICA相对位置向内改变，这增加了C1双皮质螺钉置入过程中的损伤风险。这些数据表明，CT血管造影或增强CT扫描可为选择理想的固定技术以及C1爆裂骨折螺钉的合适轨迹提供关键信息。
