Zhu Xuan-Chen, Liu Yi-Jie, Li Xue-Feng, Yan Han, Zhang Ge, Jiang Wei-Min, Sun Hou-Yi, Yang Hui-Lin
Department of Orthopedics, First Affiliated Hospital of Suzhou University, Suzhou 215008, Jiangsu Province, China.
World J Clin Cases. 2019 Apr 6;7(7):898-902. doi: 10.12998/wjcc.v7.i7.898.
Fractures of the axis are commonly seen in spinal injuries. Upper cervical fractures are usually managed conservatively. However, the complications due to long-term external immobilization cannot be ignored. The traditional open surgery has the disadvantages of too much blood loss and soft tissue injury. The aim of our paper is to introduce a minimally invasive surgical treatment for multiple axis fractures.
We report a 40-year-old Chinese male who had severe neck pain and difficult neck movement after falling from 3 meters. X-ray and computed tomography (CT) scan revealed an axis injury consisting of an odontoid Type III fracture associated with a Hangman fracture categorized as a Levine-Edwards Type I fracture. The patient underwent anterior odontoid screw fixation and posterior percutaneous screw fixation using intraoperative O-arm navigation. Neck pain was markedly improved after surgery. X-rays and CT scan reconstructions of 3-mo follow-up showed good stability and fusion. The range of cervical motion was well preserved.
Anterior odontoid screw fixation and posterior direct C2 percutaneous pedicle screw fixation with the aid of O-arm navigation and neurophysiological monitoring can be an interesting alternative option for complicated multiple axis fractures.
枢椎骨折在脊柱损伤中较为常见。上颈椎骨折通常采用保守治疗。然而，长期外固定引起的并发症不容忽视。传统开放手术存在失血过多和软组织损伤等缺点。本文旨在介绍一种治疗多节段枢椎骨折的微创手术方法。
我们报告一名40岁中国男性，从3米高处坠落致颈部剧痛、活动困难。X线及计算机断层扫描（CT）显示枢椎损伤，包括Ⅲ型齿突骨折合并Hangman骨折，后者分类为Levine-Edwards Ⅰ型骨折。患者接受了前路齿突螺钉固定及后路经皮螺钉固定，术中使用O型臂导航。术后颈部疼痛明显改善。术后3个月的X线及CT扫描重建显示稳定性良好且融合佳。颈椎活动范围保存良好。
借助O型臂导航和神经电生理监测的前路齿突螺钉固定及后路C2直接经皮椎弓根螺钉固定，对于复杂的多节段枢椎骨折而言，可能是一种有趣的替代选择。
