PHẪU THUẬT GÃY CỘT SỐNG CỔ C1 KHÔNG VỮNG CÓ MÔ PHỎNG ĐẶT ỐC C1 TRƯỚC MỔ: BÁO CÁO LOẠT 4 CA

Abstract

Objectives: To evaluate the benefits of preserving neck range of motion in patients with unstable C1 vertebra fractures who are candidates for osteosynthesis. This technique maintains bone stability while preserving normal neck mobility. The choice of surgical intervention must be assessed and tailored to each patient to ensure long-term stability and optimal outcomes. Case series and methods: This series of four cases of unstable C1 fractures. Two patients underwent C1 posterior ring osteosynthesis, while the other two required occipitocervical fusion due to the difficulty of screw placement in C1. Precise preoperative planning was performed using high-quality three-dimensional (3D) imaging simulating the C1 cervical spine screws. Clinical outcomes and radiographic data were recorded. Results: Four surgeries were performed on three male and one female patient, all of whom sustained injuries from work or traffic accidents. Prior to surgery, all patients underwent thorough CT scan evaluations. In the two isolated C1 fracture cases, screws were placed in the posterior arch of C1 and secured with rods. For the other two patients, occipitocervical fusion was required. No intraoperative or postoperative complications were reported. In patients treated with C1 ring osteosynthesis, neck motor function remained intact and did not impede daily activities. However, occipitocervical fusion significantly restricted neck mobility. Conclusion: Open reduction and osteosynthesis for unstable C1 fractures are effective in maintaining structural stability, controlling pain, preserving cervical spine stability, and minimizing impact on neck range of motion. In contrast, occipitocervical fusion provides neck stability but substantially limits neck mobility.