Progress in treatment of unstable atlas fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZOU Xiaobao ^1,2 , OUYANG Beiping ^1,2 ,  MA Xiangyang ^1,2 , CHEN Yuyue ² , GE Su ² , ZHANG Shuang ² , NI Ling ² , XIA Hong ² , WU Zenghui ²

1. The First School of Clinical Medicine, Southern Medical University, Guangzhou Guangdong, 510515, P.R.China;
2. Department of Orthopedics, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China;

Corresponding?author：

MA Xiangyang, Email: maxy1001@126.com

Keywords：

Unstable atlas fracture; nonsurgical treatment; surgical treatment; single-segment fixation; treatment progress

DOI：

10.7507/1002-1892.201909129

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the progress in treatment of unstable atlas fracture, the existing problems, and the research direction.Methods Related literature at home and abroad was reviewed. The stability evaluation of atlas fracture and treatment methods were introduced, and the selection of surgical approach and fixation instruments in treatment of unstable atlas fracture were summarized and analyzed.Results At present, atlas fractures are considered as unstable fractures except single anterior arch fractures with complete transverse ligament or simple posterior arch fractures. The treatment of unstable atlas fracture has been developed from nonsurgical treatment and traditional fusion surgery to single-segment fixation. Nonsurgical treatment is less effective, while traditional fusion surgery has a disadvantage of limited the motion of the upper cervical spine. Single-segment fixation can not only restore and fix the fracture, but also preserve the upper cervical motion function. Single-segment fixation approaches include posterior and transoral approaches, and the fixation instruments are being constantly improved, mainly including screw-rod system, screw-plate system, and plate system.Conclusion For unstable atlas fracture, single-segment fixation is an ideal surgical method, and has more advantages when compared with nonsurgical treatment and traditional fusion surgery. Single-segment fixation via transoral approach is more direct for atlas anterior arch fracture reduction, but there is a high risk of infection; and single-segment fixation via posterior approach is less effective for the reduction of atlas anterior arch fracture. Therefore, a better reduction method should be explored.

Citation： ZOU Xiaobao, OUYANG Beiping, MA Xiangyang, CHEN Yuyue, GE Su, ZHANG Shuang, NI Ling, XIA Hong, WU Zenghui. Progress in treatment of unstable atlas fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(6): 793-796. doi: 10.7507/1002-1892.201909129 Copy

1.	Hein C, Richter HP, Rath SA. Atlantoaxial screw fixation for the treatment of isolated and combined unstable jefferson fractures—experiences with 8 patients. Acta Neurochir (Wien), 2002, 144(11): 1187-1192.
2.	王迎松, 劉路平, 張穎, 等. C_{1, 2} 椎弓根釘棒固定治療寰椎骨折(Jefferson 骨折)療效分析. 脊柱外科雜志, 2010, 8(1): 1-3, 14.
3.	宮德峰, 肖增明, 陳前芬, 等. 后路寰椎側塊螺釘結合樞椎椎弓根螺釘內固定治療 Jefferson 骨折伴橫韌帶損傷 11 例. 廣東醫學, 2011, 32(24): 3246-3247.
4.	陳建明, 張成程, 許天明, 等. 經寰樞椎椎弓根螺釘固定治療 Jefferson 骨折合并寰樞椎不穩. 中華創傷雜志, 2011, 27(10): 873-877.
5.	郭翔, 倪斌, 謝寧, 等. 寰樞椎椎弓根釘內固定植骨融合術治療不穩定寰椎爆裂骨折. 中國骨與關節損傷雜志, 2013, 28(1): 10-12.
6.	Dickman CA, Sonntag VK. Surgical management of atlantoaxial nonunions. J Neurosurg, 1995, 83(2): 248-253.
7.	Lee C, Woodring JH. Unstable Jefferson variant atlas fractures: an unrecognized cervical injury. AJNR Am J Neuroradiol, 1991, 12(6): 1105-1110.
8.	楊惠林, 唐天駟, 費仕相, 等. 變異型 Jefferson 骨折(一種尚未認識的頸椎損傷). 中華外科雜志, 1995, 33(12): 707-710.
9.	Dvorak MF, Johnson MG, Boyd M, et al. Long-term health-related quality of life outcomes following Jefferson-type burst fractures ofthe atlas. J Neurosurg Spine, 2005, 2(4): 411-417.
10.	Lvine AM, Edwards CC. Fractures of the atlas. J Bone Joint Surg (Am), 1991, 73(5): 680-691.
11.	Kontautas E, Ambrozaitis KV, Kalesinskas RJ, et al. Management of acute traumatic atlas fractures. J Spinal Disord Tech, 2005, 18(5): 402-405.
12.	陳學明, 張雪梅, 李響, 等. 寰樞椎骨折的非手術治療. 中國脊柱脊髓雜志, 2006, 16(8): 600-603.
13.	秦輝, 曾勇, 李康仁, 等. 橫韌帶未斷裂寰椎骨折的療效分析. 中華創傷雜志, 2013, 29(7): 626-627.
14.	胡萬坤, 顧龍殿, 李承, 等. 枕頸固定系統間接內固定治療不穩定寰椎骨折. 中國骨與關節損傷雜志, 2017, 32(11): 1163-1164.
15.	Abeloos L, De Witte O, Walsdorff M, et al. Posterior osteosynthesis of the atlas for nonconsolidated Jefferson fractures: a new surgical technique. Spine (Phila Pa 1976), 2011, 36(20): E1360-E1363.
16.	Jo KW, Park IS, Hong JT. Motion-preserving reduction and fixation of C₁ Jefferson fracture using a C₁ lateral mass screw construct. J Clin Neurosci, 2011, 18(5): 695-698.
17.	Li L, Teng H, Pan J, et al. Direct posterior C₁ lateral mass screws compression reduction and osteosynthesis in the treatment of unstable jefferson fractures. Spine (Phila Pa 1976), 2011, 36(15): E1046-E1051.
18.	徐榮明, 趙紅勇, 胡勇, 等. 后路寰椎有限內固定治療寰椎不穩定性骨折. 中國脊柱脊髓雜志, 2012, 22(2): 118-122.
19.	Ma W, Xu N, Hu Y, et al. Unstable atlas fracture treatment by anterior plate C₁-ring osteosynthesis using a transoral approach. Eur Spine J, 2013, 22(10): 2232-2239.
20.	Hu Y, Xu RM, Albea TJ, et al. Function-preserving reduction and fixation of unstable Jefferson fractures using a C₁ posterior limited construct. J Spinal Disord Teeh, 2014, 27(6): E219-E225.
21.	B?hm H, Kayser R, El Saghir H, et al. Direct osteosynthesis of instable Gehweiler type Ⅲ atlas fractures. Presentation of a dorsoventral osteosynthesis of instable atlas fractures while maintaining function. Unfallchirurg, 2006, 109(9): 754-760.
22.	歐陽振, 楊斌輝, 劉豐虎, 等. 后路單椎節椎弓根釘橫向加壓內固定治療寰椎骨折. 中國骨與關節損傷雜志, 2018, 33(11): 1161-1163.
23.	張巖, 韓應超, 李立鈞, 等. 2 例后路寰椎側塊螺釘內固定治療不穩定性寰椎骨折的遠期療效觀察. 中國脊柱脊髓雜志, 2017, 27(2): 181-184.
24.	韓應超, 楊明杰, 潘杰, 等. 單純寰椎側塊螺釘固定選擇性治療不穩定寰椎骨折的生物力學分析. 中國脊柱脊髓雜志, 2014, 24(1): 68-73.
25.	馬維虎, 許楠健, 徐榮明, 等. 經后路單純寰椎椎弓根螺釘內固定治療不穩定性寰椎骨折. 脊柱外科雜志, 2011, 9(3): 140-143.
26.	Koller H, Resch H, Tauber M, et al. A biomechanical rationale for C₁-ring osteosynthesis as treatment for displaced Jefferson burst fractures with incompetency of the transverse atlantal ligament. Eur Spine J, 2010, 19(8): 1288-1298.
27.	吳超, 鄧佳燕, 譚倫, 等. 逐級擴大型 3D 打印導板系統輔助寰樞椎椎弓根植釘準確性分析及臨床應用. 中國修復重建外科雜志, 2019, 33(2): 212-218.
28.	馬向陽, 楊進城, 鄒小寶, 等. 經口單開門小鈦板復位固定治療寰椎前后弓骨折. 脊柱外科雜志, 2018, 16(2): 66-70.
29.	蔣小紅. 椎弓根螺釘寰椎骨環重建術治療不穩定性寰椎骨折的生物力學分析. 南寧: 廣西醫科大學, 2011.
30.	覃海飚, 韋蒙, 劉義斌, 等. 后路寰椎釘板系統內固定治療不穩定型 Jefferson 骨折. 中國脊柱脊髓雜志, 2012, 22(2): 123-126.
31.	He B, Yan L, Zhao Q, et al. Self-designed posterior atlas polyaxial lateral mass screw-plate fixation for unstable atlas fracture. Spine J, 2014, 14(12): 2892-2896.
32.	陳誠, 顧慶國, 王占超, 等. 后路板-棒內固定系統治療不穩定性寰椎骨折的生物力學研究. 中國脊柱脊髓雜志, 2015, 25(4): 349-354.
33.	Ruf M, Melcher R, Harms J. Transoral reduction and osteosynthesis C1 as a function-preserving option in the treatment of unstable Jefferson fractures. Spine (Phila Pa 1976), 2004, 29(7): 823-827.
34.	胡勇, 馬維虎, 顧勇杰, 等. 經口咽入路內固定治療孤立性寰椎骨折臨床療效分析. 脊柱外科雜志, 2011, 9(3): 131-134.
35.	孫韶華, 方劍利, 馬維虎, 等. 經口咽入路鋼板內固定治療不穩定性寰椎骨折. 中國骨傷, 2013, 26(1): 81-84.
36.	尹慶水, 夏虹, 吳增暉, 等. 經口入路復位內固定治療不穩定性 Jefferson 骨折. 中國骨科臨床與基礎研究雜志, 2012, 4(6): 405-410.
37.	夏虹, 尹慶水, 林宏衡, 等. Jefferson 骨折復位鋼板的設計、改良及初步臨床應用. 中華骨科雜志, 2015, 35(5): 527-535.
38.	李小峰, 謝富榮, 占龍, 等. 寰椎前路鎖定加壓鋼板的設計. 中國組織工程研究, 2019, 23(12): 1824-1828.
39.	李小峰, 冀晶, 農桔安, 等. 經口咽入路重建鋼板單節段內固定治療不穩定性寰椎骨折. 脊柱外科雜志, 2019, 17(3): 158-162.

1. Hein C, Richter HP, Rath SA. Atlantoaxial screw fixation for the treatment of isolated and combined unstable jefferson fractures—experiences with 8 patients. Acta Neurochir (Wien), 2002, 144(11): 1187-1192.
2. 王迎松, 劉路平, 張穎, 等. C_{1, 2} 椎弓根釘棒固定治療寰椎骨折(Jefferson 骨折)療效分析. 脊柱外科雜志, 2010, 8(1): 1-3, 14.
3. 宮德峰, 肖增明, 陳前芬, 等. 后路寰椎側塊螺釘結合樞椎椎弓根螺釘內固定治療 Jefferson 骨折伴橫韌帶損傷 11 例. 廣東醫學, 2011, 32(24): 3246-3247.
4. 陳建明, 張成程, 許天明, 等. 經寰樞椎椎弓根螺釘固定治療 Jefferson 骨折合并寰樞椎不穩. 中華創傷雜志, 2011, 27(10): 873-877.
5. 郭翔, 倪斌, 謝寧, 等. 寰樞椎椎弓根釘內固定植骨融合術治療不穩定寰椎爆裂骨折. 中國骨與關節損傷雜志, 2013, 28(1): 10-12.
6. Dickman CA, Sonntag VK. Surgical management of atlantoaxial nonunions. J Neurosurg, 1995, 83(2): 248-253.
7. Lee C, Woodring JH. Unstable Jefferson variant atlas fractures: an unrecognized cervical injury. AJNR Am J Neuroradiol, 1991, 12(6): 1105-1110.
8. 楊惠林, 唐天駟, 費仕相, 等. 變異型 Jefferson 骨折(一種尚未認識的頸椎損傷). 中華外科雜志, 1995, 33(12): 707-710.
9. Dvorak MF, Johnson MG, Boyd M, et al. Long-term health-related quality of life outcomes following Jefferson-type burst fractures ofthe atlas. J Neurosurg Spine, 2005, 2(4): 411-417.
10. Lvine AM, Edwards CC. Fractures of the atlas. J Bone Joint Surg (Am), 1991, 73(5): 680-691.
11. Kontautas E, Ambrozaitis KV, Kalesinskas RJ, et al. Management of acute traumatic atlas fractures. J Spinal Disord Tech, 2005, 18(5): 402-405.
12. 陳學明, 張雪梅, 李響, 等. 寰樞椎骨折的非手術治療. 中國脊柱脊髓雜志, 2006, 16(8): 600-603.
13. 秦輝, 曾勇, 李康仁, 等. 橫韌帶未斷裂寰椎骨折的療效分析. 中華創傷雜志, 2013, 29(7): 626-627.
14. 胡萬坤, 顧龍殿, 李承, 等. 枕頸固定系統間接內固定治療不穩定寰椎骨折. 中國骨與關節損傷雜志, 2017, 32(11): 1163-1164.
15. Abeloos L, De Witte O, Walsdorff M, et al. Posterior osteosynthesis of the atlas for nonconsolidated Jefferson fractures: a new surgical technique. Spine (Phila Pa 1976), 2011, 36(20): E1360-E1363.
16. Jo KW, Park IS, Hong JT. Motion-preserving reduction and fixation of C₁ Jefferson fracture using a C₁ lateral mass screw construct. J Clin Neurosci, 2011, 18(5): 695-698.
17. Li L, Teng H, Pan J, et al. Direct posterior C₁ lateral mass screws compression reduction and osteosynthesis in the treatment of unstable jefferson fractures. Spine (Phila Pa 1976), 2011, 36(15): E1046-E1051.
18. 徐榮明, 趙紅勇, 胡勇, 等. 后路寰椎有限內固定治療寰椎不穩定性骨折. 中國脊柱脊髓雜志, 2012, 22(2): 118-122.
19. Ma W, Xu N, Hu Y, et al. Unstable atlas fracture treatment by anterior plate C₁-ring osteosynthesis using a transoral approach. Eur Spine J, 2013, 22(10): 2232-2239.
20. Hu Y, Xu RM, Albea TJ, et al. Function-preserving reduction and fixation of unstable Jefferson fractures using a C₁ posterior limited construct. J Spinal Disord Teeh, 2014, 27(6): E219-E225.
21. B?hm H, Kayser R, El Saghir H, et al. Direct osteosynthesis of instable Gehweiler type Ⅲ atlas fractures. Presentation of a dorsoventral osteosynthesis of instable atlas fractures while maintaining function. Unfallchirurg, 2006, 109(9): 754-760.
22. 歐陽振, 楊斌輝, 劉豐虎, 等. 后路單椎節椎弓根釘橫向加壓內固定治療寰椎骨折. 中國骨與關節損傷雜志, 2018, 33(11): 1161-1163.
23. 張巖, 韓應超, 李立鈞, 等. 2 例后路寰椎側塊螺釘內固定治療不穩定性寰椎骨折的遠期療效觀察. 中國脊柱脊髓雜志, 2017, 27(2): 181-184.
24. 韓應超, 楊明杰, 潘杰, 等. 單純寰椎側塊螺釘固定選擇性治療不穩定寰椎骨折的生物力學分析. 中國脊柱脊髓雜志, 2014, 24(1): 68-73.
25. 馬維虎, 許楠健, 徐榮明, 等. 經后路單純寰椎椎弓根螺釘內固定治療不穩定性寰椎骨折. 脊柱外科雜志, 2011, 9(3): 140-143.
26. Koller H, Resch H, Tauber M, et al. A biomechanical rationale for C₁-ring osteosynthesis as treatment for displaced Jefferson burst fractures with incompetency of the transverse atlantal ligament. Eur Spine J, 2010, 19(8): 1288-1298.
27. 吳超, 鄧佳燕, 譚倫, 等. 逐級擴大型 3D 打印導板系統輔助寰樞椎椎弓根植釘準確性分析及臨床應用. 中國修復重建外科雜志, 2019, 33(2): 212-218.
28. 馬向陽, 楊進城, 鄒小寶, 等. 經口單開門小鈦板復位固定治療寰椎前后弓骨折. 脊柱外科雜志, 2018, 16(2): 66-70.
29. 蔣小紅. 椎弓根螺釘寰椎骨環重建術治療不穩定性寰椎骨折的生物力學分析. 南寧: 廣西醫科大學, 2011.
30. 覃海飚, 韋蒙, 劉義斌, 等. 后路寰椎釘板系統內固定治療不穩定型 Jefferson 骨折. 中國脊柱脊髓雜志, 2012, 22(2): 123-126.
31. He B, Yan L, Zhao Q, et al. Self-designed posterior atlas polyaxial lateral mass screw-plate fixation for unstable atlas fracture. Spine J, 2014, 14(12): 2892-2896.
32. 陳誠, 顧慶國, 王占超, 等. 后路板-棒內固定系統治療不穩定性寰椎骨折的生物力學研究. 中國脊柱脊髓雜志, 2015, 25(4): 349-354.
33. Ruf M, Melcher R, Harms J. Transoral reduction and osteosynthesis C1 as a function-preserving option in the treatment of unstable Jefferson fractures. Spine (Phila Pa 1976), 2004, 29(7): 823-827.
34. 胡勇, 馬維虎, 顧勇杰, 等. 經口咽入路內固定治療孤立性寰椎骨折臨床療效分析. 脊柱外科雜志, 2011, 9(3): 131-134.
35. 孫韶華, 方劍利, 馬維虎, 等. 經口咽入路鋼板內固定治療不穩定性寰椎骨折. 中國骨傷, 2013, 26(1): 81-84.
36. 尹慶水, 夏虹, 吳增暉, 等. 經口入路復位內固定治療不穩定性 Jefferson 骨折. 中國骨科臨床與基礎研究雜志, 2012, 4(6): 405-410.
37. 夏虹, 尹慶水, 林宏衡, 等. Jefferson 骨折復位鋼板的設計、改良及初步臨床應用. 中華骨科雜志, 2015, 35(5): 527-535.
38. 李小峰, 謝富榮, 占龍, 等. 寰椎前路鎖定加壓鋼板的設計. 中國組織工程研究, 2019, 23(12): 1824-1828.
39. 李小峰, 冀晶, 農桔安, 等. 經口咽入路重建鋼板單節段內固定治療不穩定性寰椎骨折. 脊柱外科雜志, 2019, 17(3): 158-162.

Chinese Journal of Reparative and Reconstructive Surgery

Progress in treatment of unstable atlas fracture

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content