成人新鲜Ⅱ型、浅Ⅲ型齿状突骨折手术治疗效果分析

Effect of surgical treatment for adult fresh type Ⅱ and shallow type Ⅲ dens fractures

中文关键词:  齿状突骨折  齿状突螺钉  椎弓根螺钉  内固定

英文关键词:Dens fracture  Dens screw  Pedicle screw  Internal fixation

中文摘要:

  【摘要】 目的：探讨颈前路齿状突螺钉内固定术和颈后路寰枢椎椎弓根螺钉内固定植骨融合术治疗成人新鲜Ⅱ型、浅Ⅲ型齿状突骨折的临床疗效。方法：回顾分析我院2010年3月~2016年3月手术治疗的成人新鲜齿状突骨折23例，根据Anderson-D′Alonzo分型，Ⅱ型17例，浅Ⅲ型6例，男15例，女8例，年龄15~68岁（41.2±15.1岁）。患者入院时均有颈部疼痛、颈部活动受限；其中5例有不同程度脊髓神经损伤表现，术前JOA评分10~14分（12.8±1.6分）。13例齿状突骨折无移位或牵引后复位良好的Ⅱa型、Ⅱb型、浅Ⅲ型患者行颈前路齿状突螺钉内固定术，8例牵引后复位不理想及2例Ⅱc型齿状突骨折患者行颈后路寰枢椎椎弓根螺钉内固定植骨融合术。结果：术后23例患者均未出现血管、食道损伤及脊髓神经损伤加重等并发症。术后23例患者随访8~30个月（18.0±6.4个月）。5例合并脊髓损伤患者术后半年JOA评分14~17分（16.3±1.3分），平均改善率为83.3%。术后影像学复查寰枢椎对应关系良好，内固定无松动、断裂。术后1例前路齿状突螺钉内固定患者随访至8个月时骨折端尚未愈合，其余12例齿状突螺钉内固定均骨性愈合。10例寰枢椎椎弓根螺钉内固定植骨患者植骨均获得骨性融合。结论：颈前路齿状突螺钉内固定和颈后路寰枢椎椎弓根螺钉内固定植骨融合术治疗成人新鲜Ⅱ型、浅Ⅲ型齿状突骨折，固定牢固，愈合率高，具有良好的临床疗效。

英文摘要:

  【Abstract】 Objectives: To explore the clinical effect of anterior odontoid screw fixation and posterior C1-C2 screw fixation for adult type Ⅱ and shallow type Ⅲ dens fractures. Methods: Between March 2010 and March 2016, 23 consecutive patients(15 males and 8 females; mean age 41.2±15.1 years old, range 15-68) with dens fracture were evaluated retrospectively. There were 17 type Ⅱ dens fracture patients and 6 shallow type Ⅲ dens fracture patients according to Anderson and D′Alonzo classification of odontoid fractures. All patients presented with neck pain and limited neck motion. Neurological deficits were found in 5 patients. Preoperative JOA scores were 10-14 points(mean, 12.8±1.6). 13 patients received anterior odontoid screw fixation while 10 cases received posterior C1-C2 screw fixation and fusion(Harms and Melcher Fixation). Results: None of the 23 patients suffered from any complication such as injury of vessel, nerve or esophagus. All of the 23 patients were followed up for 8 to 30 months with an average follow-up of 18.0±6.4 months. At 6 months after operation, the JOA scores of 5 patients suffering from neurological deficits preoperatively were 14-17 points(mean, 16.3±1.3). The average improvement rate was 83.3%. Postoperative imaging findings revealed that the relative positions of atlantoaxial vertebrae were satisfactory. There was no loosening or fracture of the internal fixation. One patient who received anterior odontoid screw fixation was found nonunion at 8-month follow-up. All the other 12 patients who received anterior odontoid screw fixation achieved solid bony healing. 10 patients who received posterior C1-C2 screw fixation achieved bony healing. Conclusions: Anterior odontoid screw fixation and posterior C1-C2 screw fixation are effective, reliable and safe, which are options for the treatment of adult type Ⅱ and shallow Ⅲ dens fractures.