環椎, 軸椎骨折および脱臼症に対する外科的治療法

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<Object> This study was conducted to determine the optimal surgical intervention associated with performing vertebral reconstruction in cases of fracture and dislocation of C1 and C2. <Methods> Between 1984 and 1999 twenty-five patients underwent surgical treatment for correction of traumatic C1 and C2 lesions. There were 21 men and 4 women, with ages ranging from 17 years to 62 years (mean age : 36 years). The pattern of C1 and C2 injury included 4 complex C1-2 fractures, 13 C2 odontoid fractures, 3 hangman's fractures of C2 and 5 atlantoaxial dislocations (AAD) (3 irreducible AAD and 2 reducible AAD). Seven patients underwent posterior fixation with monofilament wire and an iliac bone graft in the pre-instrumentation era. Four patients underwent posterior fusion with an interlaminar clamp and an iliac bone graft, four underwent posterior fusion with multifilament wire and an iliac bone graft, three of the hangman's fracture cases underwent anterior fusion with anterior plating and an iliac bone graft, three underwent posterior fusion with a transarticular screw, multifilament wire and an iliac bone graft, in four odontoid screws were placed (two of which needed an additional transarticular screw) and three underwent one staged-transoral decompression and posterior fusion. There were no operative deaths or neurological sequelae following surgery. <Conclusion> Surgical correction of traumatic C1 and C2 lesions has an important role to avoid progressive neurological sequelae. Tailored surgery should be performed taking into consideration the pattern of injury, the degree of instability, reducibility and the severity of cord compression.
日本脊髄外科学会の論文
2001-07-31

環椎, 軸椎骨折および脱臼症に対する外科的治療法

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