{"title":"治疗 C1 爆裂性骨折合并 II 型颌骨骨折的旋转保留固定术：2 例病例报告和文献综述。","authors":"Hui Tao, Shanzhong Shao, Kun Yang, Chang Liu, Cailiang Shen, Yinshun Zhang","doi":"10.14444/8646","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the clinical feasibility and effectiveness of a monoaxial screw-rod system and anterior screw fixation for C1 and type II odontoid fractures.</p><p><strong>Methods: </strong>We conducted a retrospective review of 2 consecutive patients with acute C1 and Anderson-D'Alonzo type II odontoid fractures. Both patients underwent treatment using a posterior monoaxial screw-rod system and anterior screw fixation. We reviewed their clinical records, including the visual analog pain scale and Neck Disability Index scores, as well as pre- and postoperative radiographs. Additionally, pre- and postoperative computed tomography images were used to classify the fracture types and assess the C1 to C2 reduction, rotation, and instability.</p><p><strong>Results: </strong>Both patients presented with type II C1 and type II B odontoid fractures, combined with Dickman type II transverse atlantal ligament injuries. All surgical procedures were successfully performed without complications such as vertebral artery injury, neurological deficit, esophageal injury, or wound infection. Both patients achieved almost complete bone healing of the fractures, and C1 to C2 rotation was well preserved (32° and 49°) without atlantoaxial instability after follow-ups of 21 and 25 months, respectively.</p><p><strong>Conclusions: </strong>A monoaxial screw-rod system and anterior screw fixation could be promising surgical strategies for C1 fractures combined with type II odontoid fractures, even in cases involving transverse atlantal ligament injuries. The preservation of C1 to C2 rotation without atlantoaxial instability was observed after fixation. However, extensive case-finding and long-term follow-up are needed to understand the effectiveness of this treatment.</p><p><strong>Clinical relevance: </strong>In order to preserve the C1-C2 rotation, a monoaxial screw-rod system and anterior screw fixation may be more suitable for patients with C1 fractures combined with type II odontoid fractures.</p><p><strong>Level of evidence: 5: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"617-625"},"PeriodicalIF":1.7000,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Rotation Preserving Fixation for the Treatment of C1 Burst Fracture Combined With Type II Odontoid Fracture: 2 Case Reports and Literature Review.\",\"authors\":\"Hui Tao, Shanzhong Shao, Kun Yang, Chang Liu, Cailiang Shen, Yinshun Zhang\",\"doi\":\"10.14444/8646\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>This study aimed to evaluate the clinical feasibility and effectiveness of a monoaxial screw-rod system and anterior screw fixation for C1 and type II odontoid fractures.</p><p><strong>Methods: </strong>We conducted a retrospective review of 2 consecutive patients with acute C1 and Anderson-D'Alonzo type II odontoid fractures. Both patients underwent treatment using a posterior monoaxial screw-rod system and anterior screw fixation. We reviewed their clinical records, including the visual analog pain scale and Neck Disability Index scores, as well as pre- and postoperative radiographs. Additionally, pre- and postoperative computed tomography images were used to classify the fracture types and assess the C1 to C2 reduction, rotation, and instability.</p><p><strong>Results: </strong>Both patients presented with type II C1 and type II B odontoid fractures, combined with Dickman type II transverse atlantal ligament injuries. All surgical procedures were successfully performed without complications such as vertebral artery injury, neurological deficit, esophageal injury, or wound infection. Both patients achieved almost complete bone healing of the fractures, and C1 to C2 rotation was well preserved (32° and 49°) without atlantoaxial instability after follow-ups of 21 and 25 months, respectively.</p><p><strong>Conclusions: </strong>A monoaxial screw-rod system and anterior screw fixation could be promising surgical strategies for C1 fractures combined with type II odontoid fractures, even in cases involving transverse atlantal ligament injuries. The preservation of C1 to C2 rotation without atlantoaxial instability was observed after fixation. However, extensive case-finding and long-term follow-up are needed to understand the effectiveness of this treatment.</p><p><strong>Clinical relevance: </strong>In order to preserve the C1-C2 rotation, a monoaxial screw-rod system and anterior screw fixation may be more suitable for patients with C1 fractures combined with type II odontoid fractures.</p><p><strong>Level of evidence: 5: </strong></p>\",\"PeriodicalId\":38486,\"journal\":{\"name\":\"International Journal of Spine Surgery\",\"volume\":\" \",\"pages\":\"617-625\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2024-11-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Spine Surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.14444/8646\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Spine Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14444/8646","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
研究目的本研究旨在评估单轴螺钉连杆系统和前路螺钉固定治疗 C1 和 II 型寰枢椎骨折的临床可行性和有效性：我们对 2 名急性 C1 和 Anderson-D'Alonzo II 型蝶骨骨折的连续患者进行了回顾性研究。两名患者均接受了后方单轴螺钉连杆系统和前方螺钉固定治疗。我们回顾了他们的临床记录，包括视觉模拟疼痛量表和颈部残疾指数评分，以及术前和术后的X光片。此外，我们还利用术前和术后的计算机断层扫描图像对骨折类型进行了分类，并评估了C1至C2的复位、旋转和不稳定性：结果：两名患者均为II型C1和II型B椎骨骨折，合并迪克曼II型横寰韧带损伤。所有手术均顺利完成，未出现椎动脉损伤、神经功能缺损、食管损伤或伤口感染等并发症。两名患者的骨折几乎完全愈合，在分别随访21个月和25个月后，C1至C2的旋转均得到很好的保留（32°和49°），且无寰枢椎不稳：单轴螺钉连杆系统和前路螺钉固定是治疗C1骨折合并Ⅱ型蝶骨骨折的有效手术策略，即使是涉及寰横韧带损伤的病例也不例外。固定后可保留 C1 到 C2 的旋转，但不会造成寰枢椎失稳。然而，要了解这种治疗方法的有效性，还需要进行广泛的病例调查和长期随访：为了保留C1-C2旋转，单轴螺钉-连杆系统和前方螺钉固定可能更适合C1骨折合并II型寰枢椎骨折的患者：5:
Rotation Preserving Fixation for the Treatment of C1 Burst Fracture Combined With Type II Odontoid Fracture: 2 Case Reports and Literature Review.
Objective: This study aimed to evaluate the clinical feasibility and effectiveness of a monoaxial screw-rod system and anterior screw fixation for C1 and type II odontoid fractures.
Methods: We conducted a retrospective review of 2 consecutive patients with acute C1 and Anderson-D'Alonzo type II odontoid fractures. Both patients underwent treatment using a posterior monoaxial screw-rod system and anterior screw fixation. We reviewed their clinical records, including the visual analog pain scale and Neck Disability Index scores, as well as pre- and postoperative radiographs. Additionally, pre- and postoperative computed tomography images were used to classify the fracture types and assess the C1 to C2 reduction, rotation, and instability.
Results: Both patients presented with type II C1 and type II B odontoid fractures, combined with Dickman type II transverse atlantal ligament injuries. All surgical procedures were successfully performed without complications such as vertebral artery injury, neurological deficit, esophageal injury, or wound infection. Both patients achieved almost complete bone healing of the fractures, and C1 to C2 rotation was well preserved (32° and 49°) without atlantoaxial instability after follow-ups of 21 and 25 months, respectively.
Conclusions: A monoaxial screw-rod system and anterior screw fixation could be promising surgical strategies for C1 fractures combined with type II odontoid fractures, even in cases involving transverse atlantal ligament injuries. The preservation of C1 to C2 rotation without atlantoaxial instability was observed after fixation. However, extensive case-finding and long-term follow-up are needed to understand the effectiveness of this treatment.
Clinical relevance: In order to preserve the C1-C2 rotation, a monoaxial screw-rod system and anterior screw fixation may be more suitable for patients with C1 fractures combined with type II odontoid fractures.
期刊介绍：
The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.
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