불안정 아틀라스 골절의 직접 내고정술

Abstract

Purpose: To investigate the radiologic and clinical outcomes of direct internal fixation for unstable atlas fractures. Materials and Methods: This retrospective study included 12 patients with unstable atlas fractures surgically treated using C1 lateralmass screws, rods, and transverse connector constructs. Nine lateral mass fractures with transverse atlantal ligament (TAL)avulsion injury and three 4-part fractures with TAL injury (two avulsion injuries, one TAL substance tear) were treated. Radiologicoutcomes included the anterior atlantodental interval (AADI) in flexion and extension cervical spine lateral radiographs at 6months and 1 year after treatment. CT was also performed to visualize bony healing of the atlas at 6 months and 1 year. Visual AnalogScale (VAS) scores for neck pain, Neck Disability Index (NDI) values, and cervical range of motion (flexion, extension, androtation) were recorded at 6 months after surgery. Results: The mean postoperative extension and flexion AADIs were 3.79±1.56 (mean±SD) and 3.13±1.01 mm, respectively. Thenmean AADI was 3.42±1.34 and 3.33±1.24 mm at 6 months and 1 year after surgery, respectively. At 1 year after surgery, 11 patientsshowed bony healing of the atlas on CT images. Only one patient underwent revision surgery 8 months after primary surgery dueto nonunion and instability findings. The mean VAS score for neck pain was 0.92±0.99, and the mean NDI value was 8.08±5.70. Conclusion: C1 motion-preserving direct internal fixation technique results in good reduction and stabilization of unstable atlasfractures. This technique allows for the preservation of craniocervical and atlantoaxial motion.