Experimental Neurosurgery Unit, IRCCS Ist Neurologico Mediterraneo Neuromed, Pozzilli, Italy.
Neurosurgery Service, Azienda Ospedaliera-Universitaria Sant'Andrea, Sapienza University of Rome, Rome, Italy.
World Neurosurg. 2024 Apr;184:112-118. doi: 10.1016/j.wneu.2024.01.094. Epub 2024 Jan 22.
Combined triple atlas (C1)-axis (C2) fixation has been described in previous literature as a safe, effective, and minimally invasive procedure for complex atlas and odontoid fractures that allows for a greater range of motion compared with posterior approaches and atlanto-occipital fusion. However, it is rarely performed due to the occipital-cervical diastasis resulting from often-fractured C1 joint masses. No evidence-based consensus has been reached regarding the treatment of complex atlantoaxial fractures, and the choice of surgical strategy is based only on clinical experience.
We report the combined triple C1-C2 fixation technique with manual reduction of the joint masses during patient positioning on the operating table, which allowed for effective stabilization during a single surgical session. We describe our experience in the management of a 75-year-old patient presenting with an acute complex type II fracture of C1, which also involved 1 lateral mass, combined with a type II odontoid fracture and occipital-cervical diastasis.
We provide a step-by-step guide for combined triple C1-C2 anterior fixation with manual fracture reduction and describe the clinical case of an acute complex type II fracture of C1, which also involved 1 lateral mass, combined with a type II odontoid fracture and occipital-cervical diastasis.
Combined triple C1-C2 fixation represents a safe and efficient minimally invasive anterior approach for complex type II fractures of C1 with type II odontoid fractures. Manual reduction of the joint masses during patient positioning allows for effective stabilization in a single surgical session.
在先前的文献中，联合寰枢（C1）-枢椎（C2）固定术已被描述为一种安全、有效且微创的方法，适用于复杂寰枢和齿状突骨折，与后路入路和寰枢融合相比，可获得更大的活动范围。然而，由于 C1 关节突常发生骨折导致的枕颈分离，该术式很少实施。对于复杂寰枢椎骨折的治疗，尚未达成基于证据的共识，手术策略的选择仅基于临床经验。
我们报告了一种联合寰枢 triple C1-C2 固定技术，在患者置于手术台上时通过手动复位关节突来实现，这使得在单次手术中能够进行有效的固定。我们描述了我们在管理一位 75 岁患者中的经验，该患者表现为急性复杂 II 型 C1 骨折，同时还累及 1 个侧块，伴有 II 型齿状突骨折和枕颈分离。
我们提供了一种联合 triple C1-C2 前路固定的分步指南，该指南包括手动骨折复位，并描述了一位急性复杂 II 型 C1 骨折患者的临床病例，该患者还累及 1 个侧块，伴有 II 型齿状突骨折和枕颈分离。
联合 triple C1-C2 固定术是一种安全有效的微创前路入路，适用于伴有 II 型齿状突骨折的复杂 II 型 C1 骨折。在患者置于手术台上时手动复位关节突突可在单次手术中实现有效的固定。
