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Die transartikuläre C1-C2-Verschraubung

Ergebnisse bei instabilen Frakturen und Pseudarthrosen des Dens axis im Alter

Transarticular C1-C2 screw fixation

Results of unstable odontoid fractures and pseudarthrosis in the elderly

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Zusammenfassung

Hintergrund

Die transartikuläre dorsale Verschraubung bei atlantoaxialer Instabilität im Alter wird in der Literatur selten beschrieben. Die vorliegende Untersuchung zeigt die Ergebnisse dieser Technik bei Patienten ab einem Alter von 70 Jahren. Es wird ein modifiziertes Verfahren der indirekten Verschraubung angewandt, bei dem die Weichteildissektion gegenüber dem klassischen Vorgehen reduziert ist.

Patienten und Methode

Zwischen 1998 und 2005 wurden insgesamt 36 Patienten mit einer akuten oder chronischen traumatischen Instabilität des atlantoaxialen Komplexes operativ behandelt. Das Durchschnittsalter betrug 80,1 Jahre (70–93 Jahre). Begleitverletzungen waren bei 7 Patienten (19,4%) zu verzeichnen. Die Operationstechnik war einheitlich. Der radiologische Nachuntersuchungszeitraum betrug im Mittel 23 Monate (12–57 Monate), der klinische dagegen 38 Monate (12–72 Monate).

Ergebnisse

Es traten keine intraoperative Komplikationen auf. Von insgesamt 72 inserierten Schrauben zeigten sich 2 (2,8%) fehlplaziert. Nicht verfahrensassoziierte Komplikationen waren bei 16 Patienten (44,4%) zu verzeichnen, am häufigsten waren nosokomiale Infekte und Stürze. Zwei Todesfälle ereigneten sich innerhalb des ersten postoperativen Monats. Im Nachuntersuchungszeitraum verstarben 4 weitere Patienten infolge unfallunabhängiger Erkrankungen. Von den 30 Überlebenden konnten 28 Patienten (93,3%) klinisch und radiologisch nachuntersucht werden. Die knöcherne dorsale Fusion konnte bei jedem erfassten Patienten dokumentiert werden. Weitere Eingriffe an der Halswirbelsäule waren bei keinem Patienten erforderlich.

Schlussfolgerung

Die vorgestellte Technik der transartikulären C1-C2-Verschraubung führt zu zuverlässigen Fusionsraten und guten funktionellen Ergebnissen. Das Verfahren kann bei atlantoaxialen Instabilitäten im Alter empfohlen werden.

Abstract

Background

Transarticular dorsal screw fixation of atlantoaxial instability in the elderly is seldom described in the literature. This study presents the results of this technique in patients aged at least 70 years. A modified method of indirect screw fixation is used in which soft tissue dissection is reduced compared to the classic procedure.

Patients and methods

Between 1998 and 2005 a total of 36 patients with acute or chronic traumatic instability of the atlantoaxial complex were treated surgically. The average age was 80.1 years (70–93 years). Seven patients (19.4%) had associated injuries. The operative technique was standard. The duration of radiological follow-up averaged 23 months (12–57 months) whereas clinical follow-up was for 38 months (12–72 months).

Results

There were no intraoperative complications. Of the total 72 screws inserted, 2 (2.8%) proved to be incorrectly positioned. There were complications not associated with the procedure in 16 patients (44.4%). Nosocomial infections and falls were the most common complications. Two deaths occurred within the first postoperative month. Four more patients died in the follow-up period as a result of diseases not associated with the trauma. Of the 30 surviving patients, 28 (93.3%) were followed up clinically and radiologically. Bony dorsal fusion was documented in every patient followed up. Further operation on the cervical spine was not required in any patient.

Conclusion

The presented technique of transarticular C1-C2 screw fixation is associated with reliable fusion rates and good functional results. The procedure can be recommended for atlantoaxial instability in the elderly.

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Authors and Affiliations

  1. Unfallchirurgische Abteilung, Landeskrankenhaus Klagenfurt, St. Veiter Str. 47, 9020, Klagenfurt, Österreich

    A. Kaminski, A. Gstrein & E.J. Müller

  2. Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bochum, Deutschland

    G. Muhr

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  1. A. Kaminski
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  2. A. Gstrein
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  3. G. Muhr
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  4. E.J. Müller
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Correspondence to A. Kaminski.

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Kaminski, A., Gstrein, A., Muhr, G. et al. Die transartikuläre C1-C2-Verschraubung. Unfallchirurg 111, 167–172 (2008). https://doi.org/10.1007/s00113-007-1383-7

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