伸直型枢椎泪滴样骨折的特点与治疗方式选择  

Features and treatments of teardrop fracture of the axis

作　　者：赵宏斌 商洪涛 李宏倬[1] 

机构地区：[1]山西省长治医学院附属和平医院骨科,046000 [2]北京陆军总医院骨科,100700

出　　处：《中华创伤骨科杂志》2017年第9期814-816,共3页Chinese Journal of Orthopaedic Trauma

基　　金：国际科技合作项目（2010DFA31250）

摘　　要：目的分析伸直型枢椎泪滴样骨折的影像学特点和治疗方式的选择。方法回顾性分析2008年1月至2016年1月收治的13例枢椎泪滴样骨折患者资料。颅底侧位x线片测量泪滴样骨折块矢状位高度、宽度、侧方移位和旋转移位程度，颈椎MRI评估前纵韧带的连续性、C2/3，椎间盘、后方韧带复合体损伤情况，以及椎间稳定程度。采用颈托或HMo—vest外固定治疗7例，前路复位c2/3，椎间植骨融合内固定术治疗6例。结果两种方法治疗患者的泪滴样骨块矢状位平均高度分别为12．0mm和14．8mm，平均宽度为6．85mm和8．33mm，平均侧方移位为7．07mm和8．50mm，平均向前旋转移位为20．0°和30．1°；平均枢椎后脱位为1．71mm和3．00mm；Cz和C，椎间盘损伤分别为1例和6例。所有患者平均随访26．4个月（12～36个月）；并发吞咽不适3例，慢性颈部轴性疼痛1例；无骨折延迟愈合、不愈合，无椎间不稳等相关并发症。末次随访时疼痛视觉模拟评分为1．7分，11例日本骨科协会评分为17分，2例为16分。结论伸直型枢椎泪滴样骨折骨块小，移位不明显，牵引后能复位者可以选择保守治疗，而骨折块较大、C2/3，椎间盘损伤和椎间不稳是前路复位融合固定的手术适应证。Objective To investigate the features and treatments of teardrop fracture of the axis. Methods Of the 17 consecutive patients with teardrop fracture of the axis who had been managed between January 2008 and January 2016 at our trauma center, 13 were included in this study according to our research criteria. On their lateral X-ray films of the skull base, the height, width, lateral displacement and rotation of the fracture fragments were measured. Continuity of the anterior longitudinal ligament and instability of C2-3 and posterior ligamentous complex were evaluated on their cervical MRI images. Seven patients were immobilized for 3 months with the Philadelphia collar or Halo-vest device and 6 ones underwent anterior C2-3 cervical surgery. Results For patients receiving conservative and operative treatments, at the sagittal view, the height, width, lateral displacement, anterior rotation and posterior displacement of the fracture fragments aver- aged 12.0 ram versus 14. 8 ram, 6.85 mm versus 8.33 ram, 7.07 mm versus 8.50 mm, 20.0° versus 30.1°, and 1.71 mm versus 3.0 ram, respectively. One patient suffered C2 disc injury and 6 ones C3 disc injury. All the patients were followed up for an average of 26. 4 months （from 12 to 36 months） . Complications included uncomfortable swallowing in 3 cases and mild residual neck pain in one. There was no delayed union, nonunion, or vertebral instability. At last follow-ups, the mean visual analogue score for pain was 1.7 and the Japanese Orthopaedic Association scores were 17 in 11 patients and 16 in 2 patients. Conclusions Most teardrop fractures can be treated conservatively because their small fracture fragments and minor displacements can be reduced after traction. However, those with large fragments and C2-3 vertebral injury and instability should be treated by anterior cervical discectomy and fusion.

关 键 词：枢椎 骨折 脊柱融合术 适应证 

分 类 号：R687.3[医药卫生—骨科学]