后路寰枢椎椎弓根融合固定治疗Ⅱ型齿突骨折  

Posterior atlantoaxial pedicle fixation in the treatment of type Ⅱ odontoid fracture

作　　者：周德春[1] 程跃[1] 吴庆鸣[1] 

机构地区：[1]四川眉山市中医医院骨科,四川眉山620010

出　　处：《颈腰痛杂志》2017年第1期40-43,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨应用后路寰枢椎椎弓根融合固定治疗Ⅱ型齿突骨折的临床治疗效果。方法回顾性分析从2010-02-2014-04采用后路寰枢椎椎弓根融合固定治疗Ⅱ型齿突骨折19例的临床资料,男12例,女7例,年龄28~75岁,平均51.5岁;交通伤10例,高处坠落伤7例,打击伤2例;均有颈痛、颈部活动受限,但无肢体感觉与运动功能障碍。伤后6~21 d,平均12 d,行一期寰枢椎后路椎弓根钉棒复位植骨内固定术,3例一侧椎动脉高跨者用椎板钉固定。观察手术时间、手术失血、骨折复位、内固定及并发症,对比术前、术后及随访的影像学资料,评价骨折复位、骨折愈合、植骨融合及内固定情况。结果 19例均顺利完成手术,术中骨折复位满意。随访时间12~33个月,平均(14.2±4.6)个月。骨折骨性愈合时间5~13个月,平均(7.5±2.8)个月,植骨融合时间3~6个月,平均(4.5±2.4)个月。手术后患者颈痛症状明显改善,视觉模拟疼痛评分(VAS),自术前的平均(7.5±1.1)分下降至末次随访时(1.2±0.6)分,差异有统计学意义。未见寰枢椎不稳、骨折复位丢失、内固定失败。结论后路寰枢椎椎弓根植骨融合固定治疗Ⅱ型齿突骨折,近期临床疗效肯定,但对寰枢椎的旋转活动有一定影响。Objective To discuss the clinical effect of posterior atlantoaxial pedicle fixation in the treatment of type Ⅱ odontoid fractures. Methods The clinical data of 19 cases with type Ⅱ odontoid fracture who received posterior atlantoaxial pedicle fixation fusion from February 2010 to April 2014 were retrospectively analyzed. Of the 19 cases, 12 males and 7 females, aged 28-75 years, their mean age at presentation was 51.5 years old;10 cases of traffic injuries, falls injury in 7 cases, 2 cases of combat injuries. Both neck pain and neck activity were limited, but no limb sensory and motor dysfunction. After injury 6-21 days, average 12 d, one stage posterior atlantoaxial pedicle nail rod reset graft bone internal fixation was conducted, 3 cases of unilateral vertebral artery high across participants with laminar screw fixation. The operation time, blood loss, fracture reduction, internal fixation and complications were observed, and the preoperation, postoperation and follow-up imaging data were compared to evaluate fracture reduction, fracture healing, bone graft fusion and internal fixation. Results 19 cases were performed successfully, and the fracture reduction was satisfactory. The follow- up period ranged from 12 to 33 months, average （14.2±4.6） months. The bone healing time of fracture was 5-13 months, average （7.5±2.8） months, the fusion time was 3-6 months, average （4.5±2.4） months. After surgery, the symptoms of neck pain were significantly improved, the visual analog pain score （VAS） from （7.5±1.1） preoperation decreased to the last follow-up （1.2±0.6）, the difference wasstatistically significant. No atlantoaxial instability, fracture fixation failure, loss of reduction were observed. Conclusion Posterior atlantoaxial pedicle graft bone fusion and fixation in the treatment of type Ⅱ odontoid fracture has good short-term clinical effect, but has certain influence on atlantoaxial rotatory motion.

关 键 词：齿状突 骨折 后路钉棒 内固定 

分 类 号：R683.2[医药卫生—骨科学]