Treatment of Jefferson fracture combined with atlantoaxial instability with C1-C2 pedicle screw fixation / 中华创伤杂志

ABSTRACT

Objective To discuss the clinical outcomes of C1-C2 pedicle screw fixation in treatment of Jefferson fracture combined with aflantoaxial instability.Methods Eleven adult patients with Jefferson fracture combined with atlantoaxial instability were treated with C1-C2 pedicle screw fixation in our department from January 2006 to December 2009.There were eight males and three females at age range of 20-52 years(mean 36 years).There were eight patients with fresh fractures,three with old fracture and three complicated with odontoid process fracture.The main preoperative clinical symptoms were the limitation of head torsion and pain in the occiput and neck,with no spinal dysfunction in all patients.X-ray,CT scan,three-dimensional reconstruction,MRI scan and skull traction were performed in all patients before operation.Then,the patients were treated with C1-C2 pedicle screw fixation without fusion between C1-C2 under general anesthesia.Results The atlantoaxial dislocation was reduced completely and the patients could move from bed,wearing the neck collar.There was no injury of vertebral artery,spinal cord or nerve roots during operation,but one patient suffered the venous plexus bleeding which was packed with the hemostatic gauze.Eleven patients were followed up for 6-24 months(average 15 months),which showed bone union,with no internal fixation breakage,loosening or dislocation.The internal fixation was removed from seven patients 15 months after operation,with mild limitation of the cervical vertebra torsion(90°-135°,average 115°)but with no limitation of obvious extension-flexion motion.Conclusion C1-C2 pedicle screw fixation has features of simple operation,short segment fixation,solid fixation and high rate of bone healing for treatment of Jefferson fracture combined with atlantoaxial instability.