新鲜Ⅱ型齿状突骨折外科治疗策略  

Clinical strategy of surgical treatment of type Ⅱ fresh odontoid fracture

作　　者：杨瑞峰[1] 谭俊铭[2] YANG Rui-feng;TAN Jun-ming(98 Clinical School of PLA, Anhui Medical University,Huzhou 313000,China;Rehabilitation and reconstruction center of traumatic Department of orthopedics of PLA ninety-eighth hospital ,Huzhou 313000,China)

机构地区：[1]安徽医科大学解放军98临床学院,浙江湖州313000 [2]解放军第98医院全军创伤骨科修复重建中心,浙江湖州313000

出　　处：《吉林医学》2018年第3期445-448,共4页Jilin Medical Journal

基　　金：南京军医药重大基金课题[课题编号:15DX002];全军医学科研“十二五”课题[课题编号:CWS11J260]

摘　　要：目的:探讨不同类型新鲜Ⅱ型齿状突骨折手术策略的选择。方法:选取收治的16例新鲜Ⅱ型(Anderson-D'Alonzo分型)齿状突骨折患者进行不同手术治疗:其中10例行前路齿状突空心螺钉固定术,6例行后路寰枢椎钉棒固定术+二期内固定取出术。通过收集两组患者临床、影像学及随访资料,分析手术时间、术中出血量、颈椎活动度、JOA评分、颈部疼痛VAS评分、术后并发症、骨折愈合率等方面的差异,分析对比两种手术方式的临床疗效。结果:随访6~36个月,平均9个月,骨折均获愈合,术中齿状突骨折复位满意,未发生椎动脉、脊髓损伤。其中后路一期术后随访12~24个月,平均16个月,末次随访CT复查显示6例患者齿状突骨折均获得骨性愈合,旋转功能,后入路组一期65.35°±10.17°,后入路组二期83.16°±6.12°;屈伸功能,后入路组一期63.02°±9.12°,后入路组二期手69.13°±6.28°。结论:新鲜ⅡA、B型齿状突骨折首选前路齿状突螺钉固定治疗方案;对于不适合前路齿状突螺钉固定及手术禁忌症的患者,采用一期后路寰枢椎钉棒固定(融合或非融合)+二期取出的方法可保留寰枢椎的旋转功能。Objective To evaluate the therapies and clinical outcome for different types of odontoid fracture.Method Retrospective analysis of16TypeⅡ(Anderson type)fresh odontoid fractures underwent different surgery.We can divide them into two groups according to their surgical approaches-anterior and posterior group.Among them,10cases were treated with inner hollow anterior odontoid screw fixation,and the other6cases were with posterior atlantoaxial(C1-C2)pedicle screw fixation with implant removal surgery.By collecting clinical and imageology follow-up data of the two groups,we decided to compare the clinical efficacy of the two surgical methods,to analyze operative time,blood loss,cervical activity,JOA score,neck pain VAS scores,complications,fracture healing rate and other differences.Results They were all followed up for success,and its follow-up time was about6-36months,with mean follow-up time9months.All10cases got an odontoid fracture reduction and a successful posterior C1-C2screw fixation and no neurovascular injury was noted.All6posterior cases were followed up from12-24months(average16months)after the first stage,thar all patients had a solid bony fusion on radiographs and CT scans.The cervical rotaton ROM was65.35°±10.17°and the flexion ROM was63.02°±9.12°at the first stage,after the second stage operation the cervical rotaton ROM was83.16°±6.12°and the flexion ROM was69.13°±6.28°.Conclusion Anterior odontoid screw fixation is the best treatment options for typeⅡA,ⅡB fresh odontoid fractures.Posterior surgery can apply to typeⅡC,and fresh odontoid fracture patients who had AOSF contraindications.For patient with fress typeⅡodontoid fracture and unsuitable anterior odontoid screw fixation,posterior screw-rod fixation follow by second stage instruments remobing can preserveC1-C2rotation function.

关 键 词：齿状突骨折 单枚中空钉内固定 寰枢椎椎弓根螺钉固定 前后入路 非融合 

分 类 号：R687.3[医药卫生—骨科学]