Khattab Mohamed F, Nageeb Mahmoud Ahmed, Saeed Younis Ahmed, El-Hawary Youssry
a Orthopaedic department , Faculty of medicine, Ain Shams University , Cairo , Egypt.
b Orthopaedic department , Faculty of medicine, Cairo University , Giza , Egypt.
Br J Neurosurg. 2019 Apr;33(2):135-139. doi: 10.1080/02688697.2018.1550191. Epub 2019 Jan 14.
Anterior odontoid screw fixation (AOSF) is an osteosynthetic technique used for fixation of type 2 and rostral type 3 odontoid fractures. Compared to other treatment modalities, it provides immediate stability, preservation of the majority of the remaining C1-2 motion and an achieved union rate of 80-100%. AOSF requires a stable and reduced odontoid to allow for placement of guide wire and cannulated screw. Image guidance with neuro-navigation or intraoperative fluoroscopy are used for accurate placement of instrumentation. Minimally invasive techniques have been described, such as endoscopic or percutaneous placement of odontoid screws and the use of tubular retractor system. Major site-specific complications include neural injury, esophageal or pharyngeal perforation, hemorrhage, and airway obstruction.
To assess safety and efficacy of a new simple technique developed by the Authors for insertion of the odontoid screw through a less invasive anterior approach.
Prospective case series Methods: Eight patients, 7 males, with odontoid fractures were treated with AOSF under fluoroscopic guidance between January 2014 and October 2015. The operation was successfully completed without technical difficulties using a beveled bone marrow biopsy needle (Jamshidi needle) as a sleeve for guide wire insertion.
No soft tissue complications such as esophageal or neuro-vascular injury occurred. Intraoperative bleeding was 25 mL on average. The operation time averaged 75 min. All of the screws were placed in good positions. After a mean follow-up of 12.1 months (range 8-18 months), radiographic fusion was documented for 7 of 8 patients (87.5%). Neither clinical complications nor hardware loosening or breakage occurred.
Our short term clinical results suggest that the new less invasive anterior odontoid screw fixation procedure using a Jamshidi needle and fluoroscopy is technically easy with good clinical and radiological results.
前路齿突螺钉固定术（AOSF）是一种用于固定Ⅱ型和头侧Ⅲ型齿突骨折的骨合成技术。与其他治疗方式相比，它能提供即时稳定性，保留大部分C1-2节段的活动度，骨折愈合率达80%-100%。AOSF需要稳定且复位良好的齿突，以便置入导丝和空心螺钉。神经导航或术中透视的影像引导用于器械的精确置入。已描述了微创技术，如内镜或经皮置入齿突螺钉以及使用管状牵开器系统。主要的特定部位并发症包括神经损伤、食管或咽部穿孔、出血和气道梗阻。
评估作者开发的一种通过微创前路置入齿突螺钉的新简单技术的安全性和有效性。
前瞻性病例系列
2014年1月至2015年10月期间，8例齿突骨折患者（7例男性）在透视引导下接受AOSF治疗。使用斜面骨髓活检针（Jamshidi针）作为导丝置入套管，手术顺利完成，无技术困难。
未发生食管或神经血管损伤等软组织并发症。术中平均出血25毫升。手术时间平均75分钟。所有螺钉位置良好。平均随访12.1个月（范围8-18个月）后，8例患者中有7例（87.5%）影像学显示融合。未发生临床并发症，也未出现内固定松动或断裂。
我们的短期临床结果表明，使用Jamshidi针和透视的新型微创前路齿突螺钉固定术技术操作简便，临床和影像学效果良好。
