齿状突骨折的经皮微创治疗策略

Strategies of percutaneous minimally invasive surgical techniques for patients with odontoid fractures

中文关键词:  齿状突骨折  经皮  微创  策略

英文关键词:Odontoid fracture  Percutaneous  Minimally invasive  Strategies

中文摘要:

  【摘要】 目的：探讨齿状突骨折经皮微创手术方法的选择。方法：回顾性分析2003年7月～2010年5月因齿状突骨折在我院行微创手术治疗随访1年以上患者113例，按患者骨折的不同特点和接受手术方式的不同分成5组，组1为可复位、非ⅡC型骨折及部分骨折面整齐的陈旧性齿状突骨折患者采用经皮前路齿状突螺钉内固定术，共65例；组2为移位重、陈旧性、ⅡC型骨折或伴有寰椎前弓、后弓骨折者患者采用经皮前路颈1/2关节突螺钉内固定术，共29例；组3为联合寰椎前后弓多发骨折患者采用经皮前路齿状突螺钉联合颈1/2侧方关节螺钉内固定术，共6例；组4为移位重、ⅡC型骨折者患者，均无椎动脉高拱畸形采用经皮后路颈1/2侧方关节螺钉内固定术，共4例；组5为陈旧性骨折伴寰枢椎难复性脱位患者采用经皮显微内窥镜下松解复位植骨内固定术，共9例。记录和分析不同组别患者的骨折愈合情况、疗效和并发症。结果：113例患者术后得到12～67个月的随访，未发现弯钉及断钉现象。组1患者中末次随访7例仍见骨折线，其余患者均骨性愈合；组2中1例术后2个月发现螺钉切割，予以取出螺钉+后路开放手术，6例无植骨患者末次随访影像显示颈椎稳定，其余患者均得到骨性愈合；组3患者均骨性愈合；组4患者1例术后发现轻度前移，予以二期开放后路C1/2植骨钛缆内固定，另1例术后CT示螺钉可疑损伤椎动脉；组5患者均骨性愈合，5例症状基本缓解，3例中度缓解，1例轻度缓解。结论：不同类型齿状突骨折可以选择不同方式的经皮微创上颈椎技术治疗，只要正确选择手术方式，掌握手术适应证，可以取得安全、有效的结果。

英文摘要:

  【Abstract】 Objectives: To investigate the strategies of percutaneous minimally invasive surgical techniques for odontoid fractures. Methods: Retrospective analysis of 113 patients with odontoid fractures treated by minimally invasive percutaneous techniques in our department between July 2003 and May 2010. They were divided into 5 groups according to the type of fracture and the operative manner. Group 1: reducible, non-ⅡC type or part of chronic fracture with neat fractured surface treated by percutaneous anterior odontoid screw fixation, 65 cases. Group 2: considerable displacement, chronic or ⅡC fracture, or associated with one arch fracture of atlas treated by percutaneous anterior transarticular screw fixation, 29 cases. Group 3: combinated atlas-axis multiple fractures treated by percutaneous anterior odontoid screw fixation and anterior transarticular screw fixation, 6 cases. Group 4: considerable displacement, or ⅡC fracture without high-riding vertebral artery treated by percutaneous posterior transarticular screw fixation, 4 cases. Group 5: chronic fracture with irreducible atlantoaxial dislocation treated by percutaneous anterior microendoscopic release and transarticular screw fixation, 9 cases. The efficacy of different surgical manners was analyzed and complications were recorded. Results: 113 patients were followed up at least for 12 months(12-67 months), none of bend or breakage of screw. Group 1: the fracture line could be still observed in 7 patients at the last follow-up, the others had bone healing. Group 2: one patient had postoperative screw cutting, and underwent screw removal surgery and posterior fusion, the dynamic radiography showed cervical stability on 6 patients without bone graft, the others achieved bone healing. Group 3: all patients achieved bone healing. Group 4: one patient underwent second surgery of titanium cable fixation, and one patient had suspicious damage of the vertebral artery. Group 5: all patients achieved bone healing, the symptoms of 5 patients had complete relief, 3 patients had moderate relief, and 1 patient had mild relief. Conclusions: The majority of patients with odontoid fractures can be treated by minimally invasive surgical technique, the efficacy and safety can be obtained only by choosing the proper surgical indications for different surgical manners.