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Direct posterior osteosynthesis for treatment of unstable atlas fractures

Ma Weihu  Li Guoqing  
【摘要】:OBJECTIVE:To assess the clinical and radiographic results after direct posterior osteosynthesis for treatment of unstable atlas fracture and to further analyse the safety and efficacy of this surgical technique through a new point of view.SUMMARY OF BACKGROUND DATA:The treatment of isolated unstable burst fracture of the atlas(Jefferson fractures) is controversial.Conservative treatment always involves a long time of immobilization and osseous nonunion.While surgical intervention generally performs C_0-C_2 or C_1-C_2 fusion,eliminating the range of motion of upper cervical spine.Direct posterior osteosynthesis as a valid technique for treatment of unstable atlas fracture was reported in a rare cases.METHODS:We retrospectively analyzed the clinical and radiographic records of 12(3 female and 9 male)patients with unstable Jefferson fractures who had undergone direct posterior osteosynthesis during a 3-year period.All patients in this study were unstable mainly based on pre-operative three-dimensional(3D) CT and MR.Intraoperative reduction of the dislocated lateral masses and posterior ring of C_1 was performed by the compression of screws or screw-rod,aiming at restoring the C0-C2 height and the vertical ligamentous tension.Postoperative external immobilization via soft collar was used for 1-2 months.Long-term follow-up was performed.RESULTS:A total 24 lateral mass screws were well positioned by post-operative CT shows.All patients were followed up for 6-30 months(mean 15 months) and achieved both a satisfactory clinical outcome and radiographic records.No plate-related complications and C_1-C_2 instability on the flexion-extension radiographs were observed in any patients during the follow-up period.CONCLUSION:Direct posterior osteosynthesis not only offers immediate postoperative stability but also preserves the range of motion of upper cervical spine.In our study,the technique may be also a valid method for treatment of isolated unstable Jefferson fractures with avulsion of the transverse ligament(Dickman type II),perhaps because restoring the C_0-C_2 height and maintaining the vertical ligamentous tension.

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