Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2022 Mar;63(3):265-271. doi: 10.3349/ymj.2022.63.3.265.
To investigate the radiologic and clinical outcomes of direct internal fixation for unstable atlas fractures.
This retrospective study included 12 patients with unstable atlas fractures surgically treated using C1 lateral mass screws, rods, and transverse connector constructs. Nine lateral mass fractures with transverse atlantal ligament (TAL) avulsion injury and three 4-part fractures with TAL injury (two avulsion injuries, one TAL substance tear) were treated. Radiologic outcomes included the anterior atlantodental interval (AADI) in flexion and extension cervical spine lateral radiographs at 6 months and 1 year after treatment. CT was also performed to visualize bony healing of the atlas at 6 months and 1 year. Visual Analog Scale (VAS) scores for neck pain, Neck Disability Index (NDI) values, and cervical range of motion (flexion, extension, and rotation) were recorded at 6 months after surgery.
The mean postoperative extension and flexion AADIs were 3.79±1.56 (mean±SD) and 3.13±1.01 mm, respectively. Then mean AADI was 3.42±1.34 and 3.33±1.24 mm at 6 months and 1 year after surgery, respectively. At 1 year after surgery, 11 patients showed bony healing of the atlas on CT images. Only one patient underwent revision surgery 8 months after primary surgery due to nonunion and instability findings. The mean VAS score for neck pain was 0.92±0.99, and the mean NDI value was 8.08±5.70.
C1 motion-preserving direct internal fixation technique results in good reduction and stabilization of unstable atlas fractures. This technique allows for the preservation of craniocervical and atlantoaxial motion.
研究不稳定寰椎骨折直接内固定的放射学和临床结果。
本回顾性研究纳入了 12 例接受 C1 侧块螺钉、棒和横连接器构建物手术治疗的不稳定寰椎骨折患者。9 例伴有横韧带（TAL）撕脱伤的侧块骨折和 3 例伴有 TAL 损伤的 4 部分骨折（2 例撕脱伤，1 例 TAL 实质撕裂）。影像学结果包括治疗后 6 个月和 1 年颈椎侧位屈伸位颈椎侧位片的寰齿前间距（AADI）。还进行了 CT 检查，以观察寰椎的骨愈合情况，6 个月和 1 年。术后 6 个月记录了颈痛的视觉模拟量表（VAS）评分、颈残障指数（NDI）值和颈椎活动度（屈伸、旋转）。
术后平均伸展和屈曲 AADI 分别为 3.79±1.56（均值±标准差）和 3.13±1.01mm。然后，术后 6 个月和 1 年的平均 AADI 分别为 3.42±1.34 和 3.33±1.24mm。术后 1 年，11 例患者 CT 图像显示寰椎骨愈合。仅 1 例患者因发现未愈合和不稳定，在初次手术后 8 个月进行了翻修手术。颈痛的平均 VAS 评分为 0.92±0.99，NDI 值平均为 8.08±5.70。
C1 保持运动的直接内固定技术可实现不稳定寰椎骨折的良好复位和稳定。该技术可保留颅颈和寰枢关节的运动。
