Xu Zhenji, Wu Ji, Wang Haibin, Chen Changhong, Zhang Bangke, Lu Xuhua, Ni Bin, Chen Fei, Guo Qunfeng
Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai , People's Republic of China.
Department of Orthopedics, Jiangyin Hospital of Traditional Chinese Medicine, Jiangyin , People's Republic of China.
Oper Neurosurg. 2025 Jun 1;28(6):772-778. doi: 10.1227/ons.0000000000001399. Epub 2024 Oct 16.
Posterior reduction and temporary fixation (PRTF) through open approach can effectively avoid the loss of C1-C2 motion caused by posterior atlantoaxial fusion in the treatment of odontoid fracture. PRTF through intermuscular approach can preserve the integrity of the paravertebral muscle. However, its contribution to the preservation of C1-C2 rotation remains unassessed in the context of fresh odontoid fractures.
The data of 31 patients with odontoid fractures who underwent PRTF through intermuscular approach were retrospectively reviewed. Operation time, intraoperative blood loss, the time of ambulation and surgery-related complications were recorded. After fracture healing, the instrumentation was removed. The Japanese Orthopedic Association score, Visual Analog Scale score for neck pain, and patient satisfaction were recorded. The range of motion in rotation of C1-C2 was calculated 1 month after removing the instrumentation.
Fracture healing was observed in all patients, and the instrumentation was removed. After removing the instrumentation, the range of motion of C1-C2 in rotation was returned to 35.6° ± 4.8°. Patient satisfaction was improved ( P < .05). There was no significant difference in Japanese Orthopedic Association scores and Visual Analog Scale score for neck pain between 2 values before and after removing the instrumentation ( P > .05). No osteoarthritis was observed at the C1-C2 lateral mass joints. There were no perioperative complications.
PRTF through intermuscular approach can be used as a salvage treatment of an odontoid fracture with an intact transverse ligament in cases of failure of, or contraindication to, anterior screw fixation. This minimally invasive technique can effectively preserve the rotational function of the atlantoaxial complex.
在治疗齿状突骨折时，通过开放入路进行后路复位及临时固定（PRTF）可有效避免因寰枢椎后路融合导致的C1-C2活动度丧失。经肌间隙入路的PRTF可保留椎旁肌的完整性。然而，在新鲜齿状突骨折的情况下，其对保留C1-C2旋转功能的作用尚未得到评估。
回顾性分析31例行经肌间隙入路PRTF治疗的齿状突骨折患者的数据。记录手术时间、术中出血量、下床活动时间及手术相关并发症。骨折愈合后取出内固定装置。记录日本骨科协会评分、颈部疼痛视觉模拟量表评分及患者满意度。取出内固定装置1个月后计算C1-C2的旋转活动度。
所有患者骨折均愈合，内固定装置均已取出。取出内固定装置后，C1-C2的旋转活动度恢复至35.6°±4.8°。患者满意度提高（P<.05）。取出内固定装置前后两个时间点的日本骨科协会评分及颈部疼痛视觉模拟量表评分差异无统计学意义（P>.05）。C1-C2侧块关节未观察到骨关节炎。无围手术期并发症发生。
对于前路螺钉固定失败或有禁忌证的完整横韧带齿状突骨折，经肌间隙入路的PRTF可作为一种挽救治疗方法。这种微创技术可有效保留寰枢椎复合体的旋转功能。
