Department of Orthopedics Union Hospital Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
J Healthc Eng. 2021 Sep 29;2021:4562618. doi: 10.1155/2021/4562618. eCollection 2021.
The treatment of C1-C2 fractures mainly depends on fracture type and the stability of the atlantoaxial joint. Disruption of the C1-C2 combination is a big challenge, especially in avoiding vertebral artery, nerve, and vein sinus injury during the operation.
This study aims to show the benefit of using the posterior approach and pedicle screw insertion by nailing technique and direct visualization to treat unstable C1-C2 and, moreover, to determine the advantages of performing early MRI in patients with limited neck movement after trauma.
Between Jan 2017-Feb 2019, we present 21 trauma patients who suffered from C1, C2, or unstable atlantoaxial joint. X-ray, computed tomography (CT), and magnetic resonance image (MRI) were performed preoperatively. All the patients underwent our surgical procedure (posterior approach and pedicle screw placement by direct visualization and nailing technique).
The mean age was 41.1 years old, 8 females and 14 males. The average follow-up time was 2.6 years. Four patients were with C1 fracture, seven with C2 fracture, six with atlantoaxial dislocation, and four with C1 and C2 fractures. The time of MRI was between 12 hours and 48 hours; neck movement symptoms appeared between 2 days and 2 weeks.
The posterior approach to treat the C1 and C2 fractures or dislocation by direct visualization and nailing technique can reduce the risk of the vertebral artery, vein sinus, and nerve root injuries with significant improvement. It can show a better angle view while inserting the pedicle screws. An early MRI (12-48 hours) is essential even if no symptoms appear at the time of admission, and if it is normal, it is necessary to repeat it. The presence of skull bleeding can be associated with upper neck instability.
C1-C2 骨折的治疗主要取决于骨折类型和寰枢关节的稳定性。寰枢关节复合体的破坏是一个巨大的挑战，尤其是在手术过程中避免椎动脉、神经和静脉窦损伤。
本研究旨在展示后路入路和经皮钉棒技术治疗不稳定 C1-C2 的优势，并确定对创伤后颈部活动受限患者进行早期 MRI 的优势。
2017 年 1 月至 2019 年 2 月，我们共收治了 21 例 C1、C2 或不稳定寰枢关节损伤的创伤患者。所有患者术前均行 X 线、CT 和 MRI 检查。所有患者均行后路入路和经皮钉棒技术治疗。
患者平均年龄 41.1 岁，女性 8 例，男性 14 例。平均随访时间为 2.6 年。4 例为 C1 骨折，7 例为 C2 骨折，6 例为寰枢关节脱位，4 例为 C1 和 C2 骨折。MRI 时间为伤后 12 小时至 48 小时；颈部运动症状出现在伤后 2 天至 2 周。
后路直视下经皮钉棒技术治疗 C1、C2 骨折或脱位可降低椎动脉、静脉窦和神经根损伤的风险，显著改善疗效。置钉时可获得更好的角度视图。即使入院时无症状，也应进行早期 MRI（12-48 小时）检查，如果结果正常，需要重复检查。颅底出血可能与上颈部不稳定有关。
