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Transoral reduction and osteosynthesis C1 as a functionpreserving option in the treatment of unstable Jefferson fracture

Yong Hu  Rong-ming Xu  Todd J.Albert  Wei-hu Ma  Zhen-shan Yuan  Wei-Xin Dong MD  
【摘要】:Purpose The aim of this study is to illustrate a new method and surgical technique in the treatment of Jefferson fractures which preserves the motion of the upper cervical spine.Materials and methods A retrospective review was performed of twelve patients with unstable Jefferson fractures treated with transoral osteosynthesis of CI between July 2008 and December 2011.A steel plate and C1 lateral mass screw fixation were placed to repair the unstable Jefferson fractures.The study group included eight males and four females with the average age of 33 years(range,23-62 years).Results The patients were followed up for between 12 and 28 months after surgery(average 16 months).Range of motion of the cervical spine was approximately physiologic:average flexion 35°(range 28°-40°),average extension 42°(range 30°-48°).Lateral bending to the right and left averaged 30° and 28°,respectively(range,12°-36°,14°-32°,respectively).The average postoperative rotation of the atlantoaxial joint,evaluated by functional CT scan,was 60°(range 35°-72°).Total average lateral displacement of the lateral masses was 7.0 mm before surgery(range,5-12 mm) which improved to 3.5 mm after surgery(range 1-6.5 mm).The total average difference of the atlanto-dens interval in flexion-extension after surgery was 1.0 mm(range 1-3 mm).Conclusions Transoral osteosynthesis of the anterior ring using C1 lateral masses screws is a novel technique for treating unstable Jefferson fractures which allows maintenance of rotation at the C1-C2 joint and restoration of congruency of the atlanto-occipital and atlantoaxial joints.

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