Anterior reduction and C1-ring osteosynthesis with Jefferson-fracture reduction plate (JeRP) via transoral approach for unstable atlas fractures

BMC Musculoskeletal Disorders

Changrong Zhu¹  Kai Zhang¹  Qingshui Yin¹  Xiangyang Ma¹  Aihong Xu¹  Xianhua Huang¹  Jianhua Wang¹  Yuyue Chen¹  Qiang Tu²  Hu Chen³  Hong Xia³  Jianzhong Xu⁴  Zhan Li⁵ 

[1] Department of Orthopaedics, PLA General Hospital of Southern Theatre Command: People’s Liberation Army General Hospital of Southern Theatre Command, 510010, Guangzhou, Guangdong, China;Department of Orthopaedics, PLA General Hospital of Southern Theatre Command: People’s Liberation Army General Hospital of Southern Theatre Command, 510010, Guangzhou, Guangdong, China;Department of Orthopaedics, Southwest Hospital, Third Military Medical University, 400038, Chongqing, China;The First School of Clinical Medicine, Southern Medical University, 510010, Guangzhou, Guangdong, China;Department of Orthopaedics, PLA General Hospital of Southern Theatre Command: People’s Liberation Army General Hospital of Southern Theatre Command, 510010, Guangzhou, Guangdong, China;The First School of Clinical Medicine, Southern Medical University, 510010, Guangzhou, Guangdong, China;Department of Orthopaedics, Southwest Hospital, Third Military Medical University, 400038, Chongqing, China;Guangzhou University of Chinese Medicine, 510006, Guangzhou, Guangdong, China;

关键词: Atlas;    Fractures;    Transoral approach;    Surgery;    Osteosynthesis;   

DOI  :  10.1186/s12891-021-04628-4

来源: Springer

【 摘 要 】

BackgroundTo introduce a novel transoral instrumentation in the treatment of unstable fractures of the atlas.MethodsFrom January 2008 to May 2018, 22 patients with unstable C1 fractures who received Jefferson-fracture reduction plate (JeRP) via transoral approach were retrospectively analyzed. The case history and the radiographs before and after surgery were noted. The type of fracture, the reduction of the fracture, and position of the internal fixation were assessed through preoperative and postoperative CT scans.ResultsAll 22 patients successfully underwent anterior C1-ring osteosynthesis using the JeRP system, with a follow-up of 26.84 ± 9.23 months. Among them, 9 patients had transverse atlantal ligament (TAL) injury, including 3 in Dickman type I and 6 in type II. The preoperative lateral mass displacement (LMD) decreased from 7.13 ± 1.46 mm to 1.02 ± 0.65 mm after the operation. Bone union was achieved in all patients without implant failure or loss of reduction. There were no surgery-related complications, such as wound infection, neurological deficit, or vertebral artery injury. However, atlantoaxial dislocation occurred in 3 patients with Dickman type I TAL injury 3 months postoperatively without any neurological symptoms or neck pain.ConclusionsTransoral C1-ring osteosynthesis with JeRP is an effective surgical strategy to treat unstable atlas fractures with a safe, direct, and satisfactory reduction. The primary indication for the JeRP system is an unstable fracture (Gehweiler type I/III) or/ and TAL injury (Dickman type II).

【 授权许可】

CC BY