Rajasekaran Shanmuganathan, Soundararajan Dilip Chand Raja, Shetty Ajoy Prasad, Kanna Rishi Mugesh
Department of Spine Surgery, Ganga Hospital, Coimbatore, India.
Asian Spine J. 2020 Aug;14(4):466-474. doi: 10.31616/asj.2019.0189. Epub 2020 Feb 14.
Prospective observational study.
To assess the safety, efficacy, and benefits of computed tomography (CT)-guided C1 fracture fixation.
The surgical management of unstable C1 injuries by occipitocervical and atlantoaxial (AA) fusion compromises motion and function. Monosegmental C1 osteosynthesis negates these drawbacks and provides excellent functional outcomes.
The patients were positioned in a prone position, and cranial traction was applied using Mayfield tongs to restore the C0-C2 height and obtain a reduction in the displaced fracture fragments. An intraoperative, CT-based navigation system was used to enable the optimal placement of C1 screws. A transverse rod was then placed connecting the two screws, and controlled compression was applied across the fixation. The patients were prospectively evaluated in terms of their clinical, functional, and radiological outcomes, with a minimal follow-up of 2 years.
A total of 10 screws were placed in five patients, with a mean follow-up of 40.8 months. The mean duration of surgery was 77±13.96 minutes, and the average blood loss was 84.4±8.04 mL. The mean combined lateral mass dislocation at presentation was 14.6±1.34 mm and following surgery, it was 5.2±1.64 mm, with a correction of 9.4±2.3 mm (p <0.001). The follow-up CT showed excellent placement of screws and sound healing. There were no complications and instances of AA instability. The clinical range of movement at 2 years in degrees was as follows: rotation to the right (73.6°±9.09°), rotation to the left (71.6°±5.59°), flexion (35.4°±4.5°), extension (43.8°±8.19°), and lateral bending on the right (28.4°±10.45°) and left (24.8°±11.77°). Significant improvement was observed in the functional Neck Disability Index from 78±4.4 to 1.6±1.6. All patients returned to their occupation within 3 months.
Successful C1 reduction and fixation allows a motion-preserving option in unstable atlas fractures. CT navigation permits accurate and adequate monosegmental fixation with excellent clinical and radiological outcomes, and all patients in this study returned to their preoperative functional status.
前瞻性观察性研究。
评估计算机断层扫描（CT）引导下C1骨折固定术的安全性、有效性和益处。
通过枕颈融合和寰枢椎（AA）融合对不稳定C1损伤进行手术治疗会损害运动和功能。单节段C1骨合成可消除这些缺点并提供出色的功能结果。
患者取俯卧位，使用Mayfield头架进行颅骨牵引，以恢复C0-C2高度并使移位的骨折碎片复位。术中使用基于CT的导航系统以实现C1螺钉的最佳置入。然后放置横向连接杆连接两个螺钉，并在固定装置上施加可控加压。对患者的临床、功能和放射学结果进行前瞻性评估，最短随访2年。
5例患者共置入10枚螺钉，平均随访40.8个月。平均手术时间为77±13.96分钟，平均失血量为84.4±8.04毫升。就诊时平均合并侧块移位为14.6±1.34毫米，术后为5.2±1.64毫米，矫正量为9.4±2.3毫米（p<0.001）。随访CT显示螺钉置入良好且愈合良好。无并发症及AA不稳定情况。2年时临床活动范围的度数如下：向右旋转（73.6°±9.09°）、向左旋转（71.6°±5.59°）、前屈（35.4°±4.5°）、后伸（43.8°±8.19°）、右侧侧弯（28.4°±10.45°）和左侧侧弯（24.8°±11.77°）。功能颈功能障碍指数从78±4.4显著改善至1.6±1.6。所有患者均在3个月内恢复工作。
成功的C1复位和固定为不稳定的寰椎骨折提供了一种保留运动功能的选择。CT导航允许进行准确且充分的单节段固定，具有出色的临床和放射学结果，本研究中的所有患者均恢复到术前功能状态。
