齿状突骨折前后入路手术方案选择及疗效分析  

Surgical approach for odontoid fracture and the curative effect analysis: anterior or posterior

作　　者：米明珊[1] 鲍剑峰[1] 许勇[1] 杜鹏[1] 彭兴国[1] 任磊[1] 赵立来[1] 

机构地区：[1]青海大学附属医院脊柱外科,青海西宁810001

出　　处：《中国矫形外科杂志》2015年第20期1841-1845,共5页Orthopedic Journal of China

摘　　要：[目的]通过分析齿状突骨折前、后路不同手术方式的疗效,指导齿状突骨折的治疗。[方法]回顾分析本院收治的60例齿状突骨折并行手术治疗患者的临床资料,将其分为后路和前路手术组,观察比较两组患者术中平均出血量、平均手术时间、平均住院时间、骨折融合或愈合率、并发症的发生率、术后颈椎活动度、颈部疼痛评分(VAS评分)。[结果](1)前路手术患者术中平均出血量、手术平均时间、平均住院时间、术后颈部疼痛评分均明显低于后路手术组,差异有统计学意义(P<0.05);前路手术组颈椎旋转活动度、屈伸活动度明显高于后路组,差异有统计学意义(P<0.05);(2)两组术后各有2例患者出现齿状突骨折不愈合,愈合率分别为94.4%(34/36)、91.7%(22/24),差异无统计学意义(P>0.05);前路手术组10例(41.67%)患者出现并发症,较后路手术组12例(33.33%)差异无统计学意义(P>0.05)。所有患者均无椎动脉、神经、静脉丛等重要结构损伤及其他严重并发症发生。[结论]前路齿状突螺钉固定术具有术中出血量少、手术时间短、住院时间短、颈椎活动度损伤小、术后疼痛程度轻等优点;后路寰枢椎融合术操作难度小、适应证广,但对颈椎功能有较大影响。[Objective]To compare the curative effects of anterior vs posterior approach for odontoid fracture,thus to find out the reasonable treatment.[Method]Sixty cases of odontoid fracture were enrolled in this study and divided into posterior and anterior approach groups.The indications that were observed and compared between two groups included mean intraoperative blood loss,mean operation time,average length of stay,the fusion or fracture healing rate,incidence of complications,postoperative range of motion,neck pain scores（ VAS score）.[Result]The mean blood loss,average operation time,average length of stay,postoperative neck pain scores in the anterior group were significantly lower than those in the posterior surgery group,the difference was statistically significant（ P〈0.05）.The range of rotation and the range of motion in the anterior group were higher than those in the posterior group,the difference was statistically significant（ P〈0.05）.Two cases of nonunion were found in each two groups,with the healing rates of 94.4%（ 34 /36）,91.7%（ 22 /24） respectively,the difference was not statistically significant（ P〈0.05）.Ten cases（ 41.67%） of postoperative complications were shown in anterior group,with no significant difference when compared with that in posterior group（ n = 12,33.33%）（ P〈0.05）.No other severe complications,such as vertebral artery,nervous or venous plexus damages,was found in both anterior and posterior groups.[Conclusion]Anterior approach for odontoid screw fixation has advantages of less blood loss,shorter operative time,shorter hospital stay,a small degree of cervical spine injury,as well as less postoperative pain.Posterior approach for atlantoaxial fusion operation is relatively easy to operate and has a wider indicaions,however,it could has a greater negative impact on cervical function.

关 键 词：齿状突骨折 寰枢椎融合术 内固定 齿状突螺钉 

分 类 号：R687.3[医药卫生—骨科学]