Zong Rui, Li Teng, Lu Lenian, Qiao Guangyu, Yu Xinguang
Department of Neurosurgery, General Hospital of People's Liberation Army, Beijing, China.
Department of Neurosurgery, The First People's Hospital of Shunde, Foshan City, Guangdong Province, China.
World Neurosurg. 2019 Jan;121:e70-e76. doi: 10.1016/j.wneu.2018.09.014. Epub 2018 Sep 11.
Upper cervical fixation with C2 pedicle screw insertion may predispose patients to vertebral artery injury, in particular, patients with craniovertebral junction anomalies. The aim of this study was to describe an alternative technique with trans-C2 inferior articular process screw (C2IAPS) insertion for rigid C2 fixation, which can be used to anchor the C2 vertebra for upper cervical fixation.
Records of 19 patients who underwent posterior atlantoaxial fixation using C2IAPS combined with C1 lateral mass screw were retrospectively reviewed. Efficacy was assessed by postoperative imaging and Japanese Orthopaedic Association scores.
There were 22 C2IAPSs successfully implanted (3 on both sides and 16 on 1 side). With the exception of 2 screws that had intruded into the outlet of the intervertebral foramen, all screws were safely implanted. Average Japanese Orthopaedic Association scores improved from 11.8 ± 1.9 preoperatively to 15.3 ± 1.3 postoperatively. Bony fusion rate was 100%.
For patients who are not eligible for C2 pedicle screw fixation, C2IAPS fixation can be considered as an alternative technique for upper cervical fixation of C2.
使用C2椎弓根螺钉进行上颈椎固定可能会使患者易发生椎动脉损伤，尤其是颅颈交界区异常的患者。本研究的目的是描述一种替代技术，即通过植入C2下关节突螺钉（C2IAPS）进行C2的坚强固定，该技术可用于固定C2椎体以进行上颈椎固定。
回顾性分析19例行C2IAPS联合C1侧块螺钉后路寰枢椎固定术患者的病历。通过术后影像学检查和日本骨科协会评分评估疗效。
成功植入22枚C2IAPS（双侧3枚，单侧16枚）。除2枚螺钉侵入椎间孔外口外，所有螺钉均安全植入。日本骨科协会平均评分从术前的11.8±1.9提高到术后的15.3±1.3。骨融合率为100%。
对于不适合C2椎弓根螺钉固定的患者，C2IAPS固定可作为C2上颈椎固定的替代技术。
