Surgical treatment selection for unstable at-las

胡 勇(Hu Yong，Dept Orthop，No.6 Hosp Ningbo，Ningbo 315040)…∥Chin J Trauma.－2011，27(2).－115～120

Surgical treatment selection for unstable at-las

胡 勇(Hu Yong，Dept Orthop，No.6 Hosp Ningbo，Ningbo 315040)…∥Chin J Trauma.－2011，27(2).－115～120

ObjectiveTo evaluate the clinical effect and safety of the occiput-cervicle or C1-C2internal fixation and bone graft fusion in treatment of the unstable atlas fracture.MethodsA retrospective study was performed in 38 pa-tients with unstable atlas fractures treated by the occiputcervicle or C1-C2internal fixation and bone graft fusion from October 2004 to March 2009.Six patients with comminuted atlas fracture combined with instability of the occipito-atlantoid articulations were treated with occiput-C2fusion(five patients)and with occiput-C3fusion(one patient).There were seven patients with typical Jefferson fractures，three with semiring fractures，eight with atlas fractures combined with Anderson typeⅡodontoid process fractures，three with atlas fractures combined with Hangman’s fractures(two patients with Levine and Edwards typeⅢ Hangman’s fractures were treated with occiput-C3fusion and one patient Levine and Edwards typeⅡ Hangman’s fracture was treated with C1-C2fusion)，three with atlas fracture combined with lower cervicle injury，six with rupture of transverse ligament combined with instability of atlanto-axial joint(Dickman transverse ligament typeⅠinjury)and two with comminuted fracture of the lateral mass associated with bony avulsion of the medial tubercle and transverse ligament(Dickman transverse ligament typeⅡ injury).Of all，five patients were treated wiith occiput-C2fusion，three treated with occiput-C3fusion and 30 treated with C1-C2fusion.ResultsAll the patients were follwed up for a range of 12～46 months(average 28 months)，which showed improvement of clinical symptoms in some extent postoperatively.The operation time ranged from 80 to 190 min(average 135 min)，with intraoperation blood loss for 200～3 300 mL(average 460 mL)and average fluoroscopic time for 60 seconds.There were no neurological deficits，vertebral artery related complications or other complications in all the patients during the surgical operation.No neurological deficit was aggravated after the patient’s mobilization with brace three days after operation.The enous plexus of blood vessel at C1-C2rupture induced by the use of electrocautery was found in three patients who showed no cerebral hemodynamic deficit after hemostasis with hemostatic sponge and cotton piece.The follow-up X-ray and CT manifested osseous fusion in all the patients，with no loosensess or breakage of the screws.The late follow-up showed pain associated with movement and limited range of motion in four patients(11%)and occipital neuralgia in one.ConclusionAn occiput-cervicle fixation fusion or a C1-C2fixation fusion combined with short external fixation can reestablish the upper cervical stability and prevent further injury of the spinal cord and nerve function and hence is an ideal option for C1burst fracture with or without rupture of the transverse ligament.21 refs，2 figs.

(Authors)