Lleu Maxime, Charles Yann Philippe, Blondel Benjamin, Barresi Laurent, Nicot Benjamin, Challier Vincent, Godard Joël, Kouyoumdjian Pascal, Lonjon Nicolas, Marinho Paulo, Freitas Eurico, Schuller Sébastien, Fuentes Stéphane, Allia Jérémy, Berthiller Julien, Barrey Cédric
Service de neurochirurgie, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon cedex, France.
Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, 1, place de l'hôpital, BP 426, 67091 Strasbourg cedex, France.
Orthop Traumatol Surg Res. 2018 Nov;104(7):1049-1054. doi: 10.1016/j.otsr.2018.06.014. Epub 2018 Oct 9.
Three types of C1 fracture have been described, according to location: type 1 (anterior or posterior arc), type 2 (Jefferson: anterior and posterior arc), and type 3 (lateral mass). Stability depends on transverse ligament integrity. The main aim of the present study was to analyze complications and consolidation rates according to fracture type, age and treatment.
The French Society of Spinal Surgery (SFCR) performed a multicenter prospective study on C1-C2 trauma. All patients with recent fracture diagnosed on CT were included. Consolidation on CT was studied at 3 months and 1 year. Medical, neurologic, infectious and mechanical complications were inventoried using the KEOPS data-base.
Sixty-three of the 417 patients (15.1%) had C1 fracture: type 1 (33.3%), type 2 (38.1%), or type 3 (28.6%). The transverse ligament was intact in 53.9% of cases. Treatment was non-operative in 63.5% of cases, surgical in 27.0%, and surgical after failure of non-operative treatment in 9.5%. There were 8 medical complications, more frequently in patients aged >70 years, following surgery (p<0.0001). The consolidation rate was 84.2% with non-operative treatment, 100% for primary surgery, and 33.3% for secondary surgery (p=0.002). There were 10 cases of non-union, in 4.8% of type 1, 13.6% of type 2 and 33.3% of type 3 fractures (p=0.001).
Medical complications showed association with age and with type of treatment. Non-operative treatment was suited to types 1, 2 and 3 with minimal displacement and intact transverse ligament. C1-C2 fusion was suited to displaced unstable type 2 fracture. Displaced type 3 fracture incurred risk of non-union. Early surgery may be recommended.
III.
根据骨折部位，C1骨折可分为三种类型：1型（前弓或后弓骨折）、2型（Jefferson骨折：前弓和后弓骨折）和3型（侧块骨折）。稳定性取决于横韧带的完整性。本研究的主要目的是根据骨折类型、年龄和治疗方法分析并发症和骨折愈合率。
法国脊柱外科学会（SFCR）对C1-C2创伤进行了一项多中心前瞻性研究。纳入所有经CT诊断为近期骨折的患者。在3个月和1年时通过CT研究骨折愈合情况。使用KEOPS数据库记录医疗、神经、感染和机械并发症。
417例患者中有63例（15.1%）发生C1骨折：1型（33.3%）、2型（38.1%）或3型（28.6%）。53.9%的病例横韧带完整。63.5%的病例采用非手术治疗，27.0%采用手术治疗，9.5%在非手术治疗失败后采用手术治疗。有8例医疗并发症，在年龄>70岁的患者中更常见，且发生在手术后（p<0.0001）。非手术治疗的骨折愈合率为84.2%，一期手术为100%，二期手术为33.3%（p=0.002）。有10例骨不连，1型骨折中占4.8%，2型骨折中占13.6%，3型骨折中占33.3%（p=0.001）。
医疗并发症与年龄和治疗方式有关。非手术治疗适用于移位最小且横韧带完整的1型、2型和3型骨折。C1-C2融合术适用于移位不稳定的2型骨折。移位的3型骨折有骨不连风险。可能建议早期手术。
III级。
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