Ibrahim Yakubu, Li Hao, Zhao Geng, Yuan Suomao, Zhao Yiwei, Liu Wubo, Tian Yonghao, Wang Lianlei, Liu Xinyu
Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China.
Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.
Global Spine J. 2023 Jul;13(6):1522-1532. doi: 10.1177/21925682211039186. Epub 2021 Aug 19.
Retrospective.
To present rarely reported complex fractures of the upper cervical spine (C1-C2) and discuss the clinical results of the posterior temporary C1-2 pedicle screws fixation for C1-C2 stabilization.
A total of 19 patients were included in the study (18 males and 1 female). Their age ranged from 23 to 66 years (mean age of 39.6 years). The patients were diagnosed with complex fractures of the atlas and the axis of the upper cervical spine and underwent posterior temporary C1-2 pedicle screws fixation. The patients underwent a serial postoperative clinical examination at approximately 3, 6, 9 months, and annually thereafter. The neck disability index (NDI) and the range of neck rotary motion were used to evaluate the postoperative clinical efficacy of the patients.
The average operation time and blood loss were 110 ± 25 min and 50 ± 12 ml, respectively. The mean follow-up was 38 ± 11 months (range 22 to 60 months). The neck rotary motion before removal, immediately after removal, and the last follow-up were 68.7 ± 7.1°, 115.1 ± 11.7°, and 149.3 ± 8.9° ( < 0.01). The NDI scores before and after the operation were 42.7 ± 4.3, 11.1 ± 4.0 ( < 0.01), and the NDI score 2 days after the internal fixation was removed was 7.3 ± 2.9, which was better than immediately after the operation ( < 0.01), and 2 years after the internal fixation was removed. The NDI score was 2.0 ± 0.8, which was significantly better than 2 days after the internal fixation was taken out ( < 0.001).
Posterior temporary screw fixation is a good alternative surgical treatment for unstable C1-C2 complex fractures.
回顾性研究。
介绍上颈椎（C1 - C2）罕见的复杂骨折，并探讨后路临时C1 - 2椎弓根螺钉固定用于C1 - C2稳定的临床效果。
本研究共纳入19例患者（18例男性，1例女性）。年龄范围为23至66岁（平均年龄39.6岁）。患者被诊断为上颈椎寰椎和枢椎复杂骨折，并接受了后路临时C1 - 2椎弓根螺钉固定。患者术后分别在约3、6、9个月及之后每年进行系列临床检查。采用颈部功能障碍指数（NDI）和颈部旋转活动范围评估患者术后临床疗效。
平均手术时间和失血量分别为110 ± 25分钟和50 ± 12毫升。平均随访时间为38 ± 11个月（范围22至60个月）。拆除内固定前、拆除后即刻及末次随访时的颈部旋转活动度分别为68.7 ± 7.1°、115.1 ± 11.7°和149.3 ± 8.9°（P < 0.01）。手术前后NDI评分分别为42.7 ± 4.3、11.1 ± 4.0（P < 0.01），拆除内固定2天后NDI评分为7.3 ± 2.9，优于术后即刻（P < 0.01），且在拆除内固定2年后NDI评分为2.0 ± 0.8，显著优于拆除内固定2天后（P < 0.001）。
后路临时螺钉固定是不稳定C1 - C2复杂骨折的一种良好的替代手术治疗方法。
