Arena John D, Ghenbot Yohannes, Tomlinson Samuel B, Wathen Connor A, Schneider Andrea L C, Chen H Isaac, Ali Zarina S, Schuster James M, Petrov Dmitriy
Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
World Neurosurg. 2025 Feb;194:123524. doi: 10.1016/j.wneu.2024.11.107. Epub 2024 Dec 18.
Fractures of the atlas are typically considered stable or unstable based on the integrity of the transverse ligament. Whereas stable Jefferson burst fractures can be treated nonoperatively, unstable fractures with disruption of the transverse ligament often require surgical intervention. Atlas osteosynthesis has been proposed as a motion-preserving alternative to atlantoaxial fusion. Intraoperative navigation may facilitate safe placement of C1 instrumentation.
Cases of patients with unstable atlas fractures treated with navigated osteosynthesis at a single level I trauma center were identified and retrospectively reviewed. Clinical presentation, surgical management, and postoperative outcomes were assessed.
Eight patients underwent navigated posterior atlas osteosynthesis for unstable C1 fractures between December 2015 and January 2024. All patients demonstrated injury to the transverse ligament (Dickman type I [n = 1] and type II [n = 7]). Patients were followed with serial radiographs showing preserved alignment, with no significant change in postoperative atlantodental interval at the most recent follow-up (+0.2 ± 0.87 mm [mean change ± standard deviation]; P = 0.53). Six patients obtained follow-up computed tomography, all of which demonstrated evidence of osseous union across fractures without hardware complication. No patients developed postoperative instability requiring fusion.
Atlas osteosynthesis is an attractive motion-preserving approach to the treatment of unstable atlas fractures, avoiding the morbidity of atlantoaxial fusion. Classically reserved for Jefferson fractures with Dickman type II transverse ligament injury, atlas osteosynthesis may also be a viable option for type I transverse ligament injuries. Intraoperative navigation can be particularly useful for screw placement in the setting of traumatically distorted anatomy with lateral mass displacement.
根据横韧带的完整性，寰椎骨折通常被认为是稳定或不稳定的。稳定的Jefferson爆裂骨折可采用非手术治疗，而横韧带断裂的不稳定骨折通常需要手术干预。有人提出寰椎接骨术可作为一种保留运动功能的替代方法，以取代寰枢椎融合术。术中导航可能有助于安全放置C1内固定器械。
确定并回顾性分析在一家一级创伤中心接受导航接骨术治疗的不稳定寰椎骨折患者的病例。评估临床表现、手术管理和术后结果。
2015年12月至2024年1月期间，8例患者因不稳定的C1骨折接受了导航下寰椎后路接骨术。所有患者均表现出横韧带损伤（Dickman I型[n = 1]和II型[n = 7]）。对患者进行系列X线片随访，显示对线良好，在最近一次随访时寰齿间隙无明显变化（平均变化±标准差为+0.2±0.87 mm；P = 0.53）。6例患者接受了随访CT检查，所有检查均显示骨折处有骨愈合迹象，且无硬件并发症。没有患者出现需要融合的术后不稳定情况。
寰椎接骨术是一种有吸引力的保留运动功能的治疗不稳定寰椎骨折的方法，可避免寰枢椎融合术的并发症。传统上用于治疗伴有Dickman II型横韧带损伤的Jefferson骨折，寰椎接骨术对于I型横韧带损伤也可能是一种可行的选择。术中导航对于在伴有侧块移位的创伤性解剖结构变形情况下的螺钉放置可能特别有用。
