Liu Chao, Huang Kai, Dai Lei, Huang Xiaogang, Zhang Xinjun
Department of Orthopedics, Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, People's Republic of China.
Department of General Surgery, Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, People's Republic of China.
Eur J Med Res. 2025 Mar 18;30(1):184. doi: 10.1186/s40001-025-02459-w.
Combination atlas-axis fractures are less studied but relatively common with a higher incidence of neurological deficits than isolated C1 or C2 fractures. Several authors focused on the treatment strategies, but there is no study to compare the stability of different fixation methods; neither not yet clear which technique represents the best choice and whether stabilization devices can be efficient and beneficial for complex atlantoaxial fractures. The aim of this study was to compare the biomechanical properties of three fixation techniques: atlantoaxial pedicle screws fixation (PSF), occipital-cervical fusion (OCF) and transarticular screw fixation (TSF) based on combination factures model. Our results showed the range of motion (ROM) of fracture model increased obviously than intact model. The ROM in flexion/extension and rotation of C0-C1 in PSF and TSF models were increased. The ROM of C1-C2 in all conditions in PSF, OCF and TSF models were decreased. The ROM of C2-C3 was decreased in OCF, but remains the same stage in PSF and TSF. These suggested that three surgical methods are effective for the combination fractures of atlas and axis, which can ensure good stability. It can properly increase the ROM of C0-C1 when using PSF. These findings would aid in the treatment of this complex fractures.
寰枢椎联合骨折的研究较少，但相对常见，与单纯的C1或C2骨折相比，神经功能缺损的发生率更高。几位作者关注了治疗策略，但尚无研究比较不同固定方法的稳定性；也不清楚哪种技术是最佳选择，以及稳定装置对复杂的寰枢椎骨折是否有效和有益。本研究的目的是基于联合骨折模型比较三种固定技术的生物力学特性：寰枢椎椎弓根螺钉固定（PSF）、枕颈融合（OCF）和经关节螺钉固定（TSF）。我们的结果表明，骨折模型的活动范围（ROM）比完整模型明显增加。PSF和TSF模型中C0-C1在屈伸和旋转时的ROM增加。PSF、OCF和TSF模型在所有情况下C1-C2的ROM均降低。OCF中C2-C3的ROM降低，但在PSF和TSF中保持相同阶段。这些表明三种手术方法对寰枢椎联合骨折有效，可确保良好的稳定性。使用PSF时可适当增加C0-C1的ROM。这些发现将有助于治疗这种复杂骨折。
