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后路 C0-C4 融合 C2 假体植入治疗病理性 C2 骨折。病例报告及文献复习。

Implantation of C2 prosthesis with dorsal fusion C0-C4 due to pathologic C2 fracture. Case report and literature review.

机构信息

Spine Center of East Switzerland, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.

Department of Orthopedics and Traumatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.

出版信息

Arch Orthop Trauma Surg. 2024 Jun;144(6):2547-2552. doi: 10.1007/s00402-024-05386-3. Epub 2024 May 22.

Abstract

INTRODUCTION

Pathological destruction of the axis vertebra leads to a highly unstable condition in an upper cervical spine. As surgical resection and anatomical reconstruction of the second cervical vertebrae represents a life threatening procedure, less radical approaches are preferred and only few cases of C2 prosthesis are described in literature.

CASE DESCRIPTION

The focus of this case report is a 21-year-old man with a pathological fracture of C2 managed primarily surgically with the C1-C3 dorsal fusion. Due to the progression of giant cell tumor and destruction of the axis vertebra, C2 prosthesis through anterior approach and dorsal occipito-cervical fusion C0-C4 were performed. Postoperative infection was managed surgically with a 2-staged dorsal debridement, ostheosynthesis material change and autologous bone graft. After a 4 week-intravenous therapy with the ceftriaxone in combination with the amoxicillin/clavulanate, followed by 12 week per oral therapy with amoxicillin/clavulanate in combination with ciprofloxacin, the complete recovery of the infection was achieved. Radiotherapy was initiated 2 months after the last revision surgery and the patient showed a good clinical outcome with stable construct at a 1 year follow-up. A review of literature of all reported C2 prosthesis cases was performed CONCLUSION: C2 prosthesis allows a more radical resection in pathological processes involving the axis vertebra. Combined with the posterior fusion, immediate stability is achieved. Anterior surgical approach is through a highly unsterile oral environment which presents a high-risk of postoperative infection.

摘要

简介

轴状脊椎的病理性破坏会导致上颈椎极不稳定。由于第二颈椎的手术切除和解剖重建是一项危及生命的手术,因此倾向于采用较少激进的方法,文献中仅描述了少数几例 C2 假体病例。

病例描述

本病例报告的重点是一名 21 岁男性,因 C2 病理性骨折,最初通过 C1-C3 背侧融合进行手术治疗。由于巨细胞瘤的进展和轴状脊椎的破坏,通过前路进行 C2 假体置换,并进行 C0-C4 后路枕颈融合。术后感染通过两阶段的背侧清创、骨合成材料更换和自体骨移植进行手术治疗。在静脉注射头孢曲松联合阿莫西林/克拉维酸 4 周后,改为口服阿莫西林/克拉维酸联合环丙沙星 12 周,感染完全恢复。在最后一次修正手术后 2 个月开始放疗,患者在 1 年随访时表现出良好的临床结果和稳定的结构。对所有报告的 C2 假体病例进行了文献回顾。

结论

C2 假体允许在涉及轴状脊椎的病理性过程中进行更激进的切除。与后路融合相结合,可立即获得稳定性。前路手术通过高度不无菌的口腔环境进行,术后感染风险高。

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