Since 2000, 14 cases of fractures and bone diseases in the cervical spine have been treated with the head ring dorsal clamp braking system (Hollvest) in our hospital, with a follow-up of 3 months to 2 years and an average follow-up of 7 months, all with satisfactory results.
1 Data and methods Liu Xiang, Department of Orthopedics, Baicheng Central Hospital
1.1 Data There were 14 cases in this group, 9 males and 5 females. The duration of the disease before surgery was 2-43d, with an average of 7d. 6 cases were seen in other hospitals in an emergency, and all failed to make correct diagnosis and treatment in time. In this group, there were 9 cases of cervical spine trauma, 3 cases of tumor, 2 cases of tuberculosis, and 8 cases of surgery. Those with a disease duration of more than 2 weeks combined with small joint disorders and jumping required emergency traction for observation.
1.2 Surgical method Patients were placed in the supine position, and assistants supported the head with auxiliary instruments that could be connected to the traction device. The head ring is placed on the head by the assistant. The head ring should be placed below the maximum diameter of the skull, about 1 cm above the tip of the ear and around the plane of the eyebrows. Four entry points are selected in the direction of the 2, 4, 8 and 10 points of the skull. Two anterior pins are inserted in the bare skin i.e. 1 cm above the outer 1/3 of the brow arch, not in the hairline. The posterior central communication is often the best site for needle insertion. The nails are inserted and the two nails are simultaneously screwed diagonally. The head of the nail is entered 3 mm into the outer plate of the skull, secured, and tested for stability, and the nail is secured to the head ring with an appropriate locking nut before using head ring traction, using anterior and posterior risers to attach the head ring to the matching dorsal clip. The patient’s gaze was level and slightly upward, and the head was mildly tilted back, with unrestricted movement away from the bed.
2 Results
For atlantoaxial arch fracture combined with atlantoaxial dislocation and Hangman fracture displacement, head ring traction was required for about 6 d. Bedside X-ray was taken daily to observe the fracture repositioning, and once repositioned, the head ring was immediately fixed with the back clip to maintain the stability of the fracture. Bony healing was obtained in all 14 patients after cervical spine with Holl vest, and no complications occurred. The flexion, extension, lateral flexion and rotation functions of the cervical spine were restored to a greater extent at the 6-month postoperative review, with no re-dislocation and no painful sensations or secondary pathologies in the neck. The patient’s self-satisfaction rate was 100%, and the treatment had satisfactory results.
2 Discussion
Perry and Nickels then first applied the Halovest for postoperative fixation in cervical fusion in 1959, and since then the Halo vest external fixation system (head ring dorsal clamp braking system) has begun to be widely used in the treatment of many cervical spine injuries. This device was introduced to China in the early 1990s. For stable cervical spine injuries without neurological compression, the use of a strong head ring frame allows patients to achieve stability, be pain-free and remain deformity-free. Stable vertebral compression fractures, nondisplaced lamina, lateral mass or spinous process fractures can also be treated with Halo vest braking. For primary care hospitals Halo vest can increase the safety margin for long distance transport required due to cervical spinal cord injury. Its importance as an adjunctive stabilizing support after cervical spine surgery has attracted widespread attention from clinicians. Now Halo vest is widely used by clinicians for external fixation treatment of cervical instability after extended cervical plate decompression, after bone graft fusion and in patients with cervical osteomyelitis, and good therapeutic results have been received.
Note: The correct selection of surgical indications can effectively achieve the treatment purpose. For cases of cervical spine old fracture dislocation, this surgery alone cannot achieve the final therapeutic effect. For cervical spine osteomyelitis and tumor can be used as an adjuvant therapeutic measure after treatment, but cannot replace the basic treatment plan of the original disease. Complications should be fully considered and prevented during the procedure: (1) before inserting the anterolateral nail, the patient should be asked to close both eyes to prevent the patient from closing the eyes due to skin fixation of the head nail; (2) the most common injuries are the supraorbital and supraclavicular nerve injuries, which can be avoided as long as the nail is not placed in the medial 1/3 of the orbit; (3) proper placement of the head nail between the supraorbital and the maximum circumference of the skull (3) proper placement of the head nail between the supraorbital and the maximum circumference of the skull minimizes the risk of loosening of the head ring; (4) retightening of the fixation nail after 24-48 h should be routine to effectively prevent the head ring from falling out during traction. If no resistance is encountered during the tightening process, the operation should be interrupted immediately; (5) the presence of cranial disease itself should be fully considered before surgery, such as cranial osteomyelitis or tumors, such as poor bone fiber structure and other diseases affecting the quality of the skull are not suitable for surgical treatment; (6) the placement of the anterolateral nail in the temporal fossa of the hairline should be avoided as much as possible, because the skull is weakest here. If the nail is fixed in the temporal fossa, it will also pierce the temporal muscle and often cause pain when chewing. (7) If the patient develops muscle spasm, abnormal movement or asymmetrical eye movement during the reset of cervical dislocation using head ring traction, it is a critical sign that excessive traction has occurred, and the traction weight should be immediately and appropriately reduced. (8) After the fracture has healed or the primary cervical spine disease has been treated and the stability of the cervical spine has been confirmed to be restored, the Halo vest device can be released and rehabilitation exercises can be performed.
Published in Chinese Primary Medicine
(Received: 2004-02-07, Revision date: 2004-08-12)
Authors: Department of Orthopedics, Baicheng Central Hospital, 137000 Baicheng, Jilin, China (Xiang Liu, Yunxia Wang, Liying Su); Sheli Town Hospital, Daan, Jilin, China (Yandong Wang)