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单纯后路 C1-C2 临时固定治疗移位性寰枢椎骨折。

Temporary Posterior C1-C2 Instrumentation without Fusion for Treatment of Displaced Atlantoaxial Fractures.

机构信息

Department of Neurosurgery, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA.

Department of Neurosurgery, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA.

出版信息

World Neurosurg. 2022 Aug;164:e718-e723. doi: 10.1016/j.wneu.2022.05.029. Epub 2022 May 16.

Abstract

OBJECTIVE

To describe open reduction internal fixation (ORIF) with posterior C1-C2 instrumentation without fusion to treat displaced atlantoaxial fractures with later instrumentation removal.

METHODS

A retrospective review identified 14 patients (mean age 44 years) with displaced atlantoaxial fractures treated with ORIF without fusion. Patient demographics, fracture morphology, trauma etiology, instrumentation levels, timing of hardware removal, and complications were collected. Patients were maintained in a cervical collar, and healing was confirmed via imaging before instrumentation removal.

RESULTS

Fractures included type III odontoid, C2 pars, C1 ring, and complex C1 or C2 fractures. All cases used C1 lateral mass screws and C2 pars or pedicle screws with a C1 cross-link. Two patients had C3 lateral mass screws. All patients showed fracture healing on imaging within 4 months after ORIF. Instrumentation removal was performed in 13 patients. No complications were noted.

CONCLUSIONS

Displaced atlantoaxial fractures have been traditionally managed with halo-vest immobilization closed reduction or ORIF with fusion. ORIF without fusion and subsequent hardware removal is an alternative approach. This strategy preserves mobility at C1-C2, avoids halo-vest immobilization, and appears to be a safe option for treatment of atlantoaxial fractures.

摘要

目的

描述不融合的后路 C1-C2 内固定术(ORIF)治疗可复位的寰枢椎骨折并后期取出内固定装置。

方法

回顾性研究纳入了 14 例采用不融合 ORIF 治疗的寰枢椎骨折患者(平均年龄 44 岁)。收集患者的人口统计学资料、骨折形态、创伤病因、内固定器水平、内固定取出时间和并发症等资料。患者在佩戴颈托的情况下接受治疗,在影像学确认愈合后再取出内固定装置。

结果

骨折类型包括 III 型齿状突骨折、C2 椎弓根骨折、C1 环骨折和复杂的 C1 或 C2 骨折。所有病例均采用 C1 侧块螺钉和 C2 椎弓根或椎弓根螺钉,并使用 C1 交叉固定。2 例患者采用 C3 侧块螺钉。所有患者在 ORIF 后 4 个月内的影像学检查中均显示骨折愈合。13 例患者进行了内固定取出术,无并发症发生。

结论

传统上,寰枢椎骨折采用 halo-vest 固定闭合复位或 ORIF 融合治疗。不融合的 ORIF 及随后的内固定取出是一种替代方法。这种策略保留了 C1-C2 的活动度,避免了 halo-vest 固定,并且似乎是治疗寰枢椎骨折的一种安全选择。

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