Clinical Original Article
The diagnosis and management for the combination fractures of atlas and axis
Lei Wang, Chao Liu, Jie Liu, Xinmeng Jin, Qinghua Zhao, Tian Xia, Shuanghai Dong, Jiwei Tian
Published 2015-10-01
Cite as Chin J Orthop, 2015, 35(10): 1041-1047. DOI: 10.3760/cma.j.issn.0253-2352.2015.10.011
Abstract
ObjectiveTo investigate the treatment strategies and clinical effect of the combination fractures of atlas and axis.
MethodsData of 56 cases with combination fractures of the atlas and axis treated from July 2006 to March 2014 were retrospectively analyzed. There were 36 males and 20 females with mean age of 38.6 years old (range, 21 to 63 years old). Dickman Atlantoaxial compound fracture classification: C1-II type dens fracture 21 cases, C1 fracture-atlantoaxial stability fracture 8 cases; C1 fracture-III type dens fracture 9 cases; C1 fracture-Hangman fracture 18 cases. 8 cases of C1-atlantoaxial stability fracture, 2 cases of C1-III type dens fracture and 7 cases of C1-Hangman fracture had conservative treatment and the other 39 cases were taken surgery. There were 13 patients who suffered from nerve injury such as limbs numbness, movement and the reflecting barrier before surgery: 2 Frankel B, 4 Frankel C, and 7 Frankel D. The mean preoperative JOA score was 8.6 ranging from 5.5 to 12.8.
ResultsAll patients were followed-up for a mean period of 32 months (range, 6-58 months). All the operated segments of atlas and axis showed stability and X ray showed fusion achieved within six months (average 4.5 months). Postoperative pain, upper limb numbness and neck pain were improved. 13 cases who had neurological symptoms before surgery achieved an average of 1-2 degrees of Frankel grade recovery after 6 months. The average JOA scores 6 months after operation were 14.1 ranging from 11.5 to 15.8 and the rate of improvement was 82.7% ranging from 71.5% to 95.3%. At the latest follow-up, 39 cases with surgical treatment had no complications such as fracture fixation, spinal cord injury, vertebral artery injury and cerebrospinal fluid leakage; 1 case occurred wound infection which healed after a month by debridement and dressing.
ConclusionC1 fracture-III type dens fracture and stable axis fracture and stable Hangman stability fracture should be undertaken with conservative treatment. C1 fracture-II type dens fracture with atlantoodontoid interval >5 mm and unstable Hangman fracture should be treated with posterior cervical pedicle screw fixation. Occipitocervical fixation could be taken with the atlas anatomical abnormalities, severe comminuted fractures and atlas pedicle screw fixation loosening.
Key words:
Cervical atlas; Axis; Fractures, bone; Fracture fixation, internal
Contributor Information
Lei Wang
Department of Orthopaedics, the First People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200080, China
Chao Liu
Jie Liu
Xinmeng Jin
Qinghua Zhao
Tian Xia
Shuanghai Dong
Jiwei Tian
