术中双壁定位椎弓根螺钉内固定治疗齿状突骨折  

Treatment of odontoid process fracture with pedicle screws by location through inferior and inner wall of atlas and superior and inner wall of axis

作　　者：林勇[1] 历强[1] 赵永生[1] 彭国栋[1] 

机构地区：[1]青岛市市立医院东院骨科脊柱病区,山东青岛266071

出　　处：《中国骨伤》2011年第7期606-608,共3页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨术中双壁定位寰枢椎椎弓根螺钉内固定治疗齿状突骨折的临床疗效。方法:自2006年6月至2010年9月采用双壁定位寰枢椎椎弓根螺钉固定治疗12例齿状突骨折,其中男8例,女4例,年龄18～62岁,平均37.9岁。按Anderson分类:Ⅱ型10例,Ⅲ型2例。新鲜骨折脱位9例,陈旧性骨折脱位3例。所有患者均有不同程度的颈枕部疼痛,颈部僵硬、活动受限。9例伴有脊髓损伤症状和体征,按美国脊髓损伤协会(ASIA)分级标准:C级4例,D级5例。术中经寰椎下壁、内壁,枢椎上壁、内壁定位后行寰枢椎椎弓根螺钉内固定治疗。结果:12例患者术中无椎动脉、脊髓及神经根损伤发生。术后随访6～24个月,平均14个月。X线和CT扫描显示所有寰枢椎椎弓根螺钉位置良好,植骨融合,无螺钉断裂、松动。所有患者枕颈部疼痛症状明显缓解。9例伴有神经损伤者按ASIA分级:C级1例,D级2例,E级6例。结论:术中双壁定位操作简单,寰枢椎椎弓根螺钉进钉点和进钉角度准确,可安全置入椎弓根镙钉并能获得满意的疗效。Objective：To evaluate the therapeutic effects of atlantoaxial pedicle screw in treating odontoid process fracture by location through inferior and inner wall of atlas and superior and inner wall of axis.Methods：From June 2006 to September 2010,12 patients with odontoid process fracture were treated with the atlantoaxial pedicle screw fixation by location through inferior and inner wall of atlas and superior and inner wall of axis.There were 8 males and 4 females,ranging in age from 18 to 62 years,with an average of 37.9 years.According to classification of Anderson,type Ⅱ was in 10 cases and type Ⅲ was in 2 cases.Fresh fracture was in 9 cases and old fracture was in 3 cases.All patients had symptoms such as cervical pain,stiffness and limitation of activity and 9 cases with symptoms were found physical signs of cervical spinal injury.According to grade of ASIA,grade C was in 4 cases and grade D was in 5 cases.Results：There were no severe complications such as injuries of vertebral artery,nerve root and spinal cord during operation.The mean time of follow-up was 14 months（6 to 24 months）.The X-ray film and CT scanning showed that all patients had steady bony union and all screws were in the proper position,no screws loosening or breaking were found.Clinical symptoms of all patients improved significantly.Nine patients with spinal injury before operation,of which nerve function obtained improvement,grade C was in 1 case,grade D was in 2 cases and grade E was in 6 cases according to grade of ASIA.Conclusion：Location through inferior and inner wall of atlas and superior and inner wall of axis is an effective method for the atlantoaxial pedicle screw implantation;atlantoaxial pedicle screw could be accurately and safely implanted thought this way.

关 键 词：寰椎 齿状回 脱位 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]