悬臂梁支撑线缆牵拉复位固定融合术治疗陈旧性齿状突骨折伴寰枢椎脱位

Cable-dragged reduction/cantilever beam internal fixation and fusion for the treatment of old odontoid fracture combined with atlantoaxial dislocation

中文关键词:  陈旧性齿状突骨折  寰枢椎脱位  牵拉复位  线缆  悬臂梁  固定融合术

英文关键词:Old odontoid fracture  Atlantoaxial dislocation  Dragged reduction  Cable  Cantilever beam  Internal fixation and fusion

中文摘要:

  【摘要】 目的：总结应用悬臂梁支撑线缆牵拉复位固定融合术治疗陈旧性齿状突骨折伴寰枢椎脱位的临床效果。方法：2011年9月～2015年12月共收治42例陈旧性齿状突骨折伴寰枢椎脱位的患者，其中男29例，女13例；年龄16～67岁，平均43.8±12.2岁。根据Anderson-D′Alonzo分型，Ⅱ型骨折31例，Ⅲ型骨折11例。42例患者均有明确外伤史及枕颈部疼痛，35例有颈椎活动受限，30例有不同程度颈髓受压的症状和体征。患者均为寰椎前脱位，术前行颅骨牵引术，27例有不同程度的复位，15例无复位。所有病例均接受经后路悬臂梁支撑线缆牵拉复位固定融合术，记录手术时间、术中失血量和并发症发生情况，随访观察患者神经功能改善情况，用X线片及CT三维重建观察内置物稳定性和植骨融合情况，并采用脊髓有效空间（space available for the cord, SAC）评估寰枢椎复位情况。结果：本组患者均顺利完成手术，手术时间115～220min，平均123±18min，术中失血量30～350ml，平均110±80ml。所有患者均获得随访，随访时间6～54个月，平均34.1±14.8个月。42例患者的枕颈部疼痛均较术前明显减轻，末次随访时NDI及JOA评分较术前明显改善（P<0.001）。术后各随访点影像学检查均提示35例复位满意，另外7例为部分复位，SAC由术前的8.5±3.3mm增加到末次随访时的14.9±3.0mm（P<0.001）。1例患者植骨颗粒部分吸收，并于术后12个月出现线缆断裂，刺入脊髓导致了相应的症状体征，取出内固定后神经症状明显改善；其余患者均在术后6个月获得骨性融合，融合率为97.6%。1例患者术后出现脂肪液化，导致了切口延迟2周愈合。另有2例出现脑脊液漏，经延长引流管安置时间、预防感染等处理，切口愈合良好无感染。未出现椎动脉损伤、螺钉钛棒松动、移位、断裂以及寰枢椎再脱位、失稳等并发症。结论：悬臂梁支撑线缆牵拉复位固定融合术具有操作简单、手术风险低、术中复位、固定可靠等优势，采用该术式治疗陈旧性齿突骨折等导致的寰枢椎脱位可获得优良的疗效。

英文摘要:

  【Abstract】 Objectives: To report the clinical outcomes of cable-dragged reduction/cantilever beam internal fixation and fusion for the treatment of old odontoid fracture complicated with atlantoaxial dislocation. Methods: From September 2011 to December 2015, 42 cases with old odontoid fracture complicated with atlantoaxial dislocation were surgically treated in our hospital, including 29 males and 13 females with an average age of 43.8±12.2(range, 16-67 years) years old. According to Anderson-D′Alonzo classification, 31 cases were type Ⅱ and 11 cases were type Ⅲ. Each patient had a trauma history, clinical features included neck pain in all patients, restricted cervical movement in 35 cases, varying degrees of neural function impairment in 30 cases. All patients had anterior atlantoaxial dislocation and underwent skull traction before surgery. 27 cases were partially reduced, however, the other 15 were not reduced at all. Therefore, the cable-dragged reduction/cantilever beam internal fixation and fusion was performed on all the patients. The operation time, intraoperative blood loss and complications were recorded. The clinical JOA score and NDI score and radiographic implant stability, atlantoaxial reduction and bone graft fusion at follow-up were performed. Results: The surgeries lasted for an average of 123±18min(range, 115-220min) and mean blood loss was 110±80ml(range, 30-350ml). All patients were followed up for 34.1±14.8 months on an average(range, 6-54 months). The neck pain was relieved significantly for all patients after surgery. The JOA score and NDI score at final follow-up were significantly improved compared with the preoperative scores(P<0.001). The postoperative imaging showed complete reduction in 35 patients and partial reduction in the other 7 cases. The SAC was 8.5±3.3mm preoperatively and 14.9±3.0mm at final follow-up(P<0.001). Partial absorption of bone graft occurred in one patient, the cable was found broken and penetrated into spinal cord at 12-month follow-up. Bony fusion was achieved in 41 patients at 6 months after surgery with the fusion rate of 97.6%. Fat liquefaction and delayed wound healing occurred in 1 patient. Cerebrospinal fluid leakage occurred in 2 patients, and was treated by effective drainage and antibiotics, no case presented with wound infection. There was no vertebral artery injury or instrument failure noted. Conclusions: Cable-dragged reduction/cantilever beam internal fixation and fusion has the advantages of easier manipulation, lower risk and satisfactory reduction. It is reliable and effective for old odontoid fracture complicated with atlantoaxial dislocation.