改良Brook法结合C1-2经关节突螺钉治疗陈旧性齿状突骨折  

Modified Brook＇s technique combined with posterior C1-2 transarticular screw fixation to treat old odontoid fractures

作　　者：连小峰[1] 徐建广[1] 刘小康[1] 杨二柱[1] 赵成[1] 张长青[1] 曾炳芳[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,200233

出　　处：《中华创伤骨科杂志》2012年第3期203-206,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨改良Brook法结合C1-2经关节突螺钉固定治疗陈旧性齿状突骨折的临床疗效。方法自2007年1月至2010年6月通过改良Brook法结合C1-2经关节突螺钉内固定技术治疗18例陈旧性齿状突骨折患者，男12例，女6例；年龄21～68岁，平均41．8岁。骨折根据Anderson-D’Alonzo，分型：Ⅱ型15例．Ⅲ型3例。其中4例合并颅脑损伤，3例合并胸部损伤。受伤至手术时间41d至13年，平均18．4个月。结果本组患者手术时间100～180min．平均125min；术中出血量100—600mL，平均250mL。术中无椎动脉、脊髓损伤发生。所有患者获平均30．2个月（14～50个月）随访。术后临床症状评价按照Mayo（McGmry）颈椎创伤后临床评分系统：优7例，良9例，可2例，优良率为88．9％。术后VAS评分（1．4±0．8）分较术前（5．3±1．2）分有明显改善，差异有统计学意义（t=15．853．P=0．000），6例合并神经症状的患者神经症状均有至少1级改善。术后6个月所有患者均获骨性融合。所有患者螺钉位置良好，在随访过程中无松动、移位、断裂等发生。结论改良Brook法结合C1-2经关节突螺钉固定是一种安全可靠的方法，为陈旧性齿状突骨折的治疗提供了一种术式选择。Objective To explore clinical efficacy of modified Br^ok＇s technique combined with posterior C1-2 transarticnlar screw fixation in the management of old odontoid fractures. Methods From January 2007 to June 2010, 18 patients with old odontoid fractures were treated surgically by modified Brook＇ s technique comlfined with posterior C1-2 transarlicular screw fixation in our unit. They were 12 males and 6 females with an average age of 41.8 years （from 21 to 68 years）. By the Anderson-D＇ Ahmzo chtssification, there were 15 cases of type II and 3 cases of type III. Among them, 4 palients were complicated with brain injury and 3 patients with breast injury. The duration from injury to operation averaged 18.4 months, ranging from 41 days to 13 years. Results The average operative time was 125 minutes （from 100 to 180 minutes） and the average blood loss was 250 mL （from 100 to 600 ml.） in ibis series. No inlraoperatiw＂ injure..＇ occurred to the vertebral artery, or to lhe spinal cord. All the patients were followed up for an average of 30. 2 months （from 14 to 50 months） . By the Mayo （MeGrory） evahmtion system, the posloperative clinical symptoms were rated as excellent in 7 cases, good in 9 cases and fair in 2 eases, with a good to excellent rate of 88.9%. The mean Visual Analogne Scale （VAS） score was improved significantly fi＇om i）reoperative 1. 4 ± 0. 8 points to postoperative 5.3 ± 1.2 points （t = 15. 853, P =0. 000） . The 6 patients complicated with neural injury obtained improvement by at least one grade. All the patients achieved bone fitsion at 6 months posloperation, and no loosening, displacement or breakage of the screws was found in the follow-up. Conclusion As Modified Brook＇ s technique combined with posterior C1-2 transartieular screw fixation is a safe and reliable treatment of atlantoaxial instability, it can serve as a surgical option for old odonloid fractures.

关 键 词：骨钉 枢椎齿突 骨折固定术 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]