陈旧性齿突骨折并寰枢椎脱位的手术治疗  

Surgical treatment of old odontoid fracture associated with atlantoaxial dislocation

作　　者：倪斌[1] 贾连顺[1] 刘洪奎[1] 李家顺[1] 袁文[1] 陈德玉[1] 

机构地区：[1]第二军医大学附属长征医院骨科,上海200003

出　　处：《中华骨科杂志》2000年第8期457-460,共4页Chinese Journal of Orthopaedics

摘　　要：目的 观察陈旧性齿突骨折并寰枢椎脱位的手术疗效，并分析影响疗效的因素。方法 1987年 6月～ 1998年 3月共收治陈旧性齿突骨折并寰枢椎脱位患者 65例，男 47例，女 18例；年龄 15～ 58岁，平均 37岁。病程 3周～ 14个月，平均 3.5个月。根据 JOA评分标准， 32例脊髓受压者中，轻度脊髓损伤者 26例（ JOA评分≥ 10分），重度脊髓损伤者 6例（ JOA评分 50％为优，改善 25％～ 50％为良，改善 0～ 25％为中 ,术后症状加重为差。 65例患者中 37例行寰枢椎融合术，包括 Gallie法 18例， Brooks法 15例， Apofix椎板钩加压内固定法 4例； 28例行枕颈融合术。结果 随访 6个月～ 11年 2个月，平均 3年 7个月。其中 59例获得坚强骨愈合； 6例不愈合，包括枕颈融合术 5例，寰枢椎融合术 1例。术后脊髓功能改善情况 :优 15例，占 47％；良 8例，占 25％；中 6例，占 19％；差 3例，占 9％。轻度脊髓损伤组优良率为 77％（ 20/26），重度脊髓损伤组优良率为 50％（ 3/6）。局部症状缓解率为 90％（ 52/58）。结论 陈旧性齿突骨折并寰枢椎脱位造成寰枢椎不稳及脊髓受压时，应早期进行融合手术。术前复位，控制寰枢椎活动，精心准备植骨床是手术成功的关键。Objective To investigate the results of surgical treatment of old odontoid fracture associated with atlantoaxial dislocation. Methods Sixty- five cases of old odontoid fracture associated with atlantoaxial dislocation were encountered from June 1987 to March 1998. Forty- seven of them were male and eighteen were female. The mean age of the patients was 37 years (range 15－ 58 years). The course of illness varied from 3 weeks to 14 months with an average of 3.5 months. Thirty- two patients with myelopathy were evaluated by JOA score, among them 26 patients had JOA score of 10 or more were considered as mild myelopathy and 6 had JOA score of less than 10 as severe myelopathy. The extent of improvement of myelopathy at follow- up were compared with that before surgery. The results were classified into four groups: excellent cases had recovery rate of more than 50％ , the cases with recovery rate of 25％ to 50％ were considered as good, and those with fair recovery rate of zero to 25％ as fair, and those with recovery rate of less than zero and worsening of the symptoms as poor. Sixty- five patients were treated with surgery. Thirty- seven patients were operated upon by atlantoaxial arthrodesis using wire fixation or Apofix interlaminar clamping with autologous bone grafts, including 18 Gallie fusion, 15 Brooks fusion, 4 Apofix interlaminar clamping. Twenty- eight occipitocervical fusion were performed. Results The patients were followed- up for an average of three year and seven months(range 6－ 134 months). Solid fusion was seen in fifty- nine patients and non- union in six cases which occurred in five occipitocervical fusion and one in atlantoaxial fusion. Pain relief was achieved in 90％ of the cases. Of the patients with myelopathy evaluated, 47％ were rated as excellent, 25％ as good, 19％ as fair, and 9％ as poor. Better surgical results were obtained in mild myelopathy cases(≥ 10 points in JOA score), and 77％ were classified as excellent and good. However, the worst results occurred i

关 键 词：陈旧性齿突骨折 寰枢椎脱位 并发症 融合手术 

分 类 号：R683.2[医药卫生—骨科学]