제 1, 2 경추의 불안정성 환자에서 관절면을 이용한 나사못 고정에 대한 초기 결과와 합병증 분석

초록

Objective: To assess the outcomes associated with C1-C2 transarticular screw fixation for atlantoaxial instability. Methods: The clinical and radiological results of 13 patients treated with posterior C1-C2 transarticular screws and wired posterior C1-C2 iliac bone grafts were retrospecitvely evaluated. C1-C2 instability was caused by rheumatoid arthritis 6 cases, os odontoidium 3 patients, odontoid fracture type Ⅱ 2 case, traumatic atlantoaxial dislocation 1 case, psoriatic arthritis 1 case who previously managed with only C1-C2 wire fixation. Results: One patient had only one screw placed because of abnormal anatomical structure, one patients was breakage of guide K-wire, and one screw was medial location to lateral mass of C1, but clinical results was excellent and radiological instability was not noted. Only ones patients recorded screw loosening because of infection and poor surgical condition. However, no patients had neu개logical complications, stroke and vertebral artery injuries. 12 patients was preserved radiological stability at the follow up periods. Conclusion: The author's experience demonstrates that C1-C2 stransarticular screw fixation with wired bone graft was a safe procedure with higher fusion rate and risk of catastrophic vascular or neural injury was rare. However, the risk of malpositioning of screw can be minimized by profound surgical experience, curiously using the cannulated screw with guide wire and adequate surgical indication.