Trans-articular 1-2 screw fixation

Treatment of diseases: cervical spine fracture and dislocation Indication The 1~2 screw fixation through the joint neck is suitable for: 1. Due to atlantoaxial dislocation, the neck and 2 are unstable due to odontoid fracture. 2. Unstable Jefferson fracture. Surgical procedure 1. The incision is made from the occipital tuberosity to the cervical spine. Conventional exposure of the lower periosteum of 3 cervical vertebrae. If the neck 1 or neck 2 has a anterior dislocation, gently lift the posterior arch of the neck 1 or push the neck 2 spine down. This technique can also be accomplished by a laminar wire. 2. Using a small stripper, the periosteum was removed from the cranial side of the cervical 2 lamina and the isthmus to the posterior joint capsule of the atlantoaxial, and the medial cortex of the lamina and isthmus was marked. Under the side TV perspective monitoring, a special 2.0mm drill bit is drilled from the sagittal direction, and the inner edge of the lamina and the isthmus should be taken care of during operation. The drilling point is located at the inner upper edge of the lower joint of the neck 2, the drill bit enters on the posterior medial side of the isthmus, passes through the posterior side of the articular surface of the neck 2, and then enters the joint side block of the atlas, and wears forward. The cortical bone on the anterior side of the lateral block of the 1 joint. Measure the length of the required screws and check the direction of the screw entry with a C-arm X-ray machine. After reaming, screw in a 3.5mm screw. Due to the action of the upper muscles of the neck and trunk, it is sometimes difficult to select the appropriate head or caudal direction during drilling. For ease of drilling, the spines of the neck 1 and neck 2 can be used with two towel clamps. Gently pull toward the head side. 3. A 1.2mm K-wire can also be used instead of a 2.0mm drill bit. However, a 2.0 mm drill bit must be used to drill holes in the penetration point of the neck 2 joint. Insert the Kirschner wire under the TV fluoroscopy. Screw the 3.5 mm cannulated screw through the Kirschner wire. To prevent damage to the vertebral artery, the direction of the screw should be avoided to avoid excessive outward and excessive levels. 4. After the screws are fixed, the necks 1 and 2 are merged on the back side. The lower lamina wire and the H-shaped bone graft can be used to strengthen the screw fixation of the necks 1 and 2. Instead of a thin steel wire, a thick suture that does not absorb may be used. 5. When performing posterior fusion, it is generally not necessary to make a rough surface (de-cortex) at the necks 1 and 2 joints. However, if accompanied by a neck 1 posterior arch fracture, the neck 1 and 2 joints should be exposed, and the posterior side should be removed to create a rough bone surface and filled with cancellous bone.