Occipito-cervical fusion with plate fixation

This injury to the occipital neck is very rare in the clinic. There were only 8 cases reported in the literature worldwide before 1981. There were almost no survivors after the occipital neck () joint injury. Because most of the patients died immediately on the scene, a small number of patients who died within a few days were mostly of the type of fracture (injury). The treatment is mainly light weight (1 ~ 1.5kg) bone traction, the purpose is to maintain its position and warn everyone to be careful: this is a severe cervical spine injury. Often accompanied by nerve damage including brain damage, brain stem damage or high cervical spinal cord injury. These nerve injuries are often accompanied by loss of consciousness and loss of spontaneous breathing, requiring permanent artificial respiration. Often associated with skull base fractures or upper cervical spine fractures. Conventional radiographs are difficult to diagnose, and the presence of such lesions should be considered when epidural and suboccipital hematoma are found. MRI can confirm the diagnosis. Treatment of diseases: occipital neck injury Indication Plate fixation occipitocervical fusion is suitable for: 1. Occipital condyle fracture or occipital dislocation. 2. Chronic pain caused by traumatic arthritis of the occipital neck or neck 1 to 2 joints requires a second phase of fusion. 3. For unstable anterior or posterior arch fractures (Jefferson fracture), if the reduction is poor or the transverse ligament is broken, the neck 1 and neck 2 are unstable. Surgical procedure 1. Exposure: The posterior median incision reveals the occipital base to the cervical 4 lamina. 2. Select two appropriate lengths of AO plate according to the length of the desired fusion (from the occipital tuberosity to the neck 2 or neck 3). The steel plate is bent at an angle combined with the neck of the pillow. A 1.2 mm K-wire was drilled from the back side into the side block of the neck 2 or neck 3. The direction and position of the Kirschner wire are seen in the method of cervical pedicle screw fixation or neck 1 and 2 articular screw fixation. 3. After the position of the Kirschner wire is examined by TV fluoroscopy, two pre-bent steel plates are passed through the Kirschner wire to determine the position of the screw on the occipital bone. A drill with a diameter of 2 mm was used to penetrate the inner and outer plates of the skull. To prevent damage to the dura mater, a depth indicator pin and baffle should be used to prevent the bit from entering too deep. The plate was then fixed to the occipital bone with two cortical bone screws of 3.5 mm in diameter and 10 mm in length. 4. Use a self-tapping hollow screw to penetrate the Kirschner wire and fix the plate in the neck 2 side block and the neck 3 vertebral body. Or remove the Kirschner wire, ream the hole with a drill bit, and then screw it into the screw. Apply the lower lamina wire and fix it to the posterior arch of the neck 1 through the screw hole of the plate. If the width of the back arch of the neck 1 is appropriate, you can also screw in the two screws and fix the wire. 5. Take the autologous iliac bone block for posterior bone grafting between the occipital tuberosity and the neck 2 spinous process, and implant the broken bone scrap around the steel plate.

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