C1 lateral mass reduction screws for treating atlantoaxial dislocations: Bringing ease by modification.
C1 lateral mass reduction screws for treating atlantoaxial dislocations: Bringing ease by modification.
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DOI：
10.4103/jcvjs.jcvjs_8_22
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发表时间：
2022-04
影响因子：
1.1
通讯作者：
Yadav, Kuldeep
中科院分区：
文献类型：
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作者：
Singh, Deepak Kumar;Pathak, Vipul;Singh, Neha;Singh, Rakesh Kumar;Kaif, Mohammad;Yadav, Kuldeep
C1-C2固定技术彻底改变了复杂颅颈交界（CVJ）异常的治疗。目前使用的万向螺钉和棒系统在棒装配和寰枢椎脱位（AAD）复位方面存在意外的技术困难，需要有力的关节操作。本研究的目的是分析在C1-C2固定中使用特殊设计的C1侧块“复位螺钉”治疗伴有或不伴有基底动脉内陷（BI）的AAD。这是一项使用长侧块复位螺钉进行C1-C2固定的回顾性队列研究。本研究纳入了18例诊断为先天性AAD伴或不伴BI的患者，这些患者使用C1复位侧块进行C1-C2固定治疗。临床上通过改良的日本骨科协会评分和放射学上通过传统的颅骨测量指数来测量结果。在研究纳入的所有病例中，72%（13/18）为男性，18%（5/18）为女性，平均就诊年龄为33.5岁。在18例AAD患者中，84%（15/18）的患者患有BI，22%（4/18）的患者患有基亚里1型畸形，1例患者患有Klipple-Feil综合征。术后所有患者的症状均得到改善。在所有18例（100%）患者中，AAD充分减少，放射学指标正常化。C1-C2固定中的C1侧块复位螺钉有助于减少AAD和BI（A型），即使是在CVJ异常的困难病例中，术中技术简单，手术时间缩短，不需要特殊工具或复杂操作，并避免潜在的神经损伤。
The C1-C2 fixation technique revolutionized the management of complex craniovertebral junction (CVJ) anomalies. Presently used polyaxial screw and rod systems have inadvertent technical difficulties in rod fitting and reduction of atlantoaxial dislocations (AAD) requiring forceful joint handling. The purpose of this study is to analyze the use of a specially designed “reduction screw” in C1 lateral mass in C1-C2 fixation for treating AAD with or without basilar invagination (BI). This is a retrospective cohort study in which long lateral mass reduction screws were used for C1-C2 fixation. Eighteen patients diagnosed with congenital AAD with or without BI treated with C1-C2 fixations using C1 reduction lateral mass were included in the study. The outcome was measured clinically by the modified Japanese Orthopedic Association score and radiologically by conventional craniometric indices. Among all cases included in the study, 72% (13/18) are males and 18% (5/18) are females with average age at presentation of 33.5 years. Among 18 cases of AAD, 84% (15/18) of patients have BI, 22% (4/18) have Chiari Type 1 malformation, and one patient has Klipple–Feil syndrome. Symptomatic improvement is noted in all patients following surgery. Adequate reduction of AAD with normalization of radiological indices was also achieved in all 18 (100%) patients. C1 lateral mass reduction screw in C1-C2 fixation helps in reduction of AAD and BI (Type A) even in difficult cases of CVJ anomalies with intraoperative technical ease, reduced operative time, no need for special instruments or complex maneuvers, and avoiding potential neurological injury.