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, 刘路平, 张颖, 等. C_{1, 2} 椎弓根钉棒固定治疗寰椎骨折(Jefferson 骨折)疗效分析. 脊柱外科杂志, 2010, 8(1): 1-3, 14.
3.	宫德峰, 肖增明, 陈前芬, 等. 后路寰椎侧块螺钉结合枢椎椎弓根螺钉内固定治疗 Jefferson 骨折伴横韧带损伤 11 例. 广东医学, 2011, 32(24): 3246-3247.
4.	陈建明, 张成程, 许天明, 等. 经寰枢椎椎弓根螺钉固定治疗 Jefferson 骨折合并寰枢椎不稳. 中华创伤杂志, 2011, 27(10): 873-877.
5.	郭翔, 倪斌, 谢宁, 等. 寰枢椎椎弓根钉内固定植骨融合术治疗不稳定寰椎爆裂骨折. 中国骨与关节损伤杂志, 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.	杨惠林, 唐天驷, 费仕相, 等. 变异型 Jefferson 骨折(一种尚未认识的颈椎损伤). 中华外科杂志, 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.	陈学明, 张雪梅, 李响, 等. 寰枢椎骨折的非手术治疗. 中国脊柱脊髓杂志, 2006, 16(8): 600-603.
13.	秦辉, 曾勇, 李康仁, 等. 横韧带未断裂寰椎骨折的疗效分析. 中华创伤杂志, 2013, 29(7): 626-627.
14.	胡万坤, 顾龙殿, 李承, 等. 枕颈固定系统间接内固定治疗不稳定寰椎骨折. 中国骨与关节损伤杂志, 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.	徐荣明, 赵红勇, 胡勇, 等. 后路寰椎有限内固定治疗寰椎不稳定性骨折. 中国脊柱脊髓杂志, 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.	Böhm 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.	欧阳振, 杨斌辉, 刘丰虎, 等. 后路单椎节椎弓根钉横向加压内固定治疗寰椎骨折. 中国骨与关节损伤杂志, 2018, 33(11): 1161-1163.
23.	张岩, 韩应超, 李立钧, 等. 2 例后路寰椎侧块螺钉内固定治疗不稳定性寰椎骨折的远期疗效观察. 中国脊柱脊髓杂志, 2017, 27(2): 181-184.
24.	韩应超, 杨明杰, 潘杰, 等. 单纯寰椎侧块螺钉固定选择性治疗不稳定寰椎骨折的生物力学分析. 中国脊柱脊髓杂志, 2014, 24(1): 68-73.
25.	马维虎, 许楠健, 徐荣明, 等. 经后路单纯寰椎椎弓根螺钉内固定治疗不稳定性寰椎骨折. 脊柱外科杂志, 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.	吴超, 邓佳燕, 谭伦, 等. 逐级扩大型 3D 打印导板系统辅助寰枢椎椎弓根植钉准确性分析及临床应用. 中国修复重建外科杂志, 2019, 33(2): 212-218.
28.	马向阳, 杨进城, 邹小宝, 等. 经口单开门小钛板复位固定治疗寰椎前后弓骨折. 脊柱外科杂志, 2018, 16(2): 66-70.
29.	蒋小红. 椎弓根螺钉寰椎骨环重建术治疗不稳定性寰椎骨折的生物力学分析. 南宁: 广西医科大学, 2011.
30.	覃海飚, 韦蒙, 刘义斌, 等. 后路寰椎钉板系统内固定治疗不稳定型 Jefferson 骨折. 中国脊柱脊髓杂志, 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.	陈诚, 顾庆国, 王占超, 等. 后路板-棒内固定系统治疗不稳定性寰椎骨折的生物力学研究. 中国脊柱脊髓杂志, 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, 马维虎, 顾勇杰, 等. 经口咽入路内固定治疗孤立性寰椎骨折临床疗效分析. 脊柱外科杂志, 2011, 9(3): 131-134.
35.	孙韶华, 方剑利, 马维虎, 等. 经口咽入路钢板内固定治疗不稳定性寰椎骨折. 中国骨伤, 2013, 26(1): 81-84.
36.	尹庆水, 夏虹, 吴增晖, 等. 经口入路复位内固定治疗不稳定性 Jefferson 骨折. 中国骨科临床与基础研究杂志, 2012, 4(6): 405-410.
37.	夏虹, 尹庆水, 林宏衡, 等. Jefferson 骨折复位钢板的设计、改良及初步临床应用. 中华骨科杂志, 2015, 35(5): 527-535.
38.	李小峰, 谢富荣, 占龙, 等. 寰椎前路锁定加压钢板的设计. 中国组织工程研究, 2019, 23(12): 1824-1828.
39.	李小峰, 冀晶, 农桔安, 等. 经口咽入路重建钢板单节段内固定治疗不稳定性寰椎骨折. 脊柱外科杂志, 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, 刘路平, 张颖, 等. C_{1, 2} 椎弓根钉棒固定治疗寰椎骨折(Jefferson 骨折)疗效分析. 脊柱外科杂志, 2010, 8(1): 1-3, 14.
3. 宫德峰, 肖增明, 陈前芬, 等. 后路寰椎侧块螺钉结合枢椎椎弓根螺钉内固定治疗 Jefferson 骨折伴横韧带损伤 11 例. 广东医学, 2011, 32(24): 3246-3247.
4. 陈建明, 张成程, 许天明, 等. 经寰枢椎椎弓根螺钉固定治疗 Jefferson 骨折合并寰枢椎不稳. 中华创伤杂志, 2011, 27(10): 873-877.
5. 郭翔, 倪斌, 谢宁, 等. 寰枢椎椎弓根钉内固定植骨融合术治疗不稳定寰椎爆裂骨折. 中国骨与关节损伤杂志, 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. 杨惠林, 唐天驷, 费仕相, 等. 变异型 Jefferson 骨折(一种尚未认识的颈椎损伤). 中华外科杂志, 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. 陈学明, 张雪梅, 李响, 等. 寰枢椎骨折的非手术治疗. 中国脊柱脊髓杂志, 2006, 16(8): 600-603.
13. 秦辉, 曾勇, 李康仁, 等. 横韧带未断裂寰椎骨折的疗效分析. 中华创伤杂志, 2013, 29(7): 626-627.
14. 胡万坤, 顾龙殿, 李承, 等. 枕颈固定系统间接内固定治疗不稳定寰椎骨折. 中国骨与关节损伤杂志, 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. 徐荣明, 赵红勇, 胡勇, 等. 后路寰椎有限内固定治疗寰椎不稳定性骨折. 中国脊柱脊髓杂志, 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. Böhm 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. 欧阳振, 杨斌辉, 刘丰虎, 等. 后路单椎节椎弓根钉横向加压内固定治疗寰椎骨折. 中国骨与关节损伤杂志, 2018, 33(11): 1161-1163.
23. 张岩, 韩应超, 李立钧, 等. 2 例后路寰椎侧块螺钉内固定治疗不稳定性寰椎骨折的远期疗效观察. 中国脊柱脊髓杂志, 2017, 27(2): 181-184.
24. 韩应超, 杨明杰, 潘杰, 等. 单纯寰椎侧块螺钉固定选择性治疗不稳定寰椎骨折的生物力学分析. 中国脊柱脊髓杂志, 2014, 24(1): 68-73.
25. 马维虎, 许楠健, 徐荣明, 等. 经后路单纯寰椎椎弓根螺钉内固定治疗不稳定性寰椎骨折. 脊柱外科杂志, 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. 吴超, 邓佳燕, 谭伦, 等. 逐级扩大型 3D 打印导板系统辅助寰枢椎椎弓根植钉准确性分析及临床应用. 中国修复重建外科杂志, 2019, 33(2): 212-218.
28. 马向阳, 杨进城, 邹小宝, 等. 经口单开门小钛板复位固定治疗寰椎前后弓骨折. 脊柱外科杂志, 2018, 16(2): 66-70.
29. 蒋小红. 椎弓根螺钉寰椎骨环重建术治疗不稳定性寰椎骨折的生物力学分析. 南宁: 广西医科大学, 2011.
30. 覃海飚, 韦蒙, 刘义斌, 等. 后路寰椎钉板系统内固定治疗不稳定型 Jefferson 骨折. 中国脊柱脊髓杂志, 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. 陈诚, 顾庆国, 王占超, 等. 后路板-棒内固定系统治疗不稳定性寰椎骨折的生物力学研究. 中国脊柱脊髓杂志, 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, 马维虎, 顾勇杰, 等. 经口咽入路内固定治疗孤立性寰椎骨折临床疗效分析. 脊柱外科杂志, 2011, 9(3): 131-134.
35. 孙韶华, 方剑利, 马维虎, 等. 经口咽入路钢板内固定治疗不稳定性寰椎骨折. 中国骨伤, 2013, 26(1): 81-84.
36. 尹庆水, 夏虹, 吴增晖, 等. 经口入路复位内固定治疗不稳定性 Jefferson 骨折. 中国骨科临床与基础研究杂志, 2012, 4(6): 405-410.
37. 夏虹, 尹庆水, 林宏衡, 等. Jefferson 骨折复位钢板的设计、改良及初步临床应用. 中华骨科杂志, 2015, 35(5): 527-535.
38. 李小峰, 谢富荣, 占龙, 等. 寰椎前路锁定加压钢板的设计. 中国组织工程研究, 2019, 23(12): 1824-1828.
39. 李小峰, 冀晶, 农桔安, 等. 经口咽入路重建钢板单节段内固定治疗不稳定性寰椎骨折. 脊柱外科杂志, 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