后路寰枢椎钉棒固定非融合治疗新鲜Ⅱ型齿状突骨折保留寰枢椎旋转功能的临床初探

The primary outcome of posterior nonfusion screw-rod fixation for preserving the atlantoaxial rotary function due to fresh type Ⅱ odontoid fracture

中文关键词:  枢椎  齿状突骨折  新鲜骨折  钉棒固定  非融合

英文关键词:Axis  Odontoid fracture  Fresh fracture  Screw-rod fixation  Nonfusion

中文摘要:

  【摘要】 目的：介绍寰枢椎后路钉棒固定非融合治疗新鲜Ⅱ型齿状突骨折保留寰枢椎旋转功能的临床初步疗效。方法：2010年1月~2011年7月收治8例不适合前路齿状突螺钉固定的新鲜Ⅱ型齿状突骨折患者，其中骨折线呈前下后上型者5例，牵引后齿状突骨折复位不佳者3例；男6例，女2例；年龄21~56岁，平均38岁。在气管插管全麻下行一期后路寰枢椎钉棒固定，不进行后路植骨；待术后随访CT复查显示齿状突骨折骨性愈合后，二期后路手术取出内固定，观察寰枢椎旋转功能的恢复情况。结果：8例患者均成功进行寰枢椎后路钉棒固定，共置入直径3.5mm的寰椎、枢椎螺钉各16枚，其中寰椎采用椎弓根螺钉固定13枚、部分经椎弓根螺钉固定3枚，枢椎采用椎弓根螺钉固定11枚、椎板螺钉固定5枚；术中齿状突骨折复位满意，未发生椎动脉、脊髓损伤。一期术后随访12～24个月，平均16个月，末次随访CT复查显示8例患者齿状突骨折均获得骨性愈合，颈椎左、右旋转均约35°～55°，平均约45°。二期后路钉棒内固定取出术后颈椎旋转功能即刻得到部分恢复，颈椎左、右旋转均约50°～70°，平均约60°；随访6～12个月后颈椎旋转功能基本恢复正常，颈椎左、右旋转均约80°～90°，平均约85°。结论：对不适合前路齿状突螺钉固定的新鲜Ⅱ型齿状突骨折患者，采用一期后路寰枢椎钉棒固定非融合、二期取出内固定的方法可保留寰枢椎的旋转功能。

英文摘要:

  【Abstract】 Objectives: To introduce the primary outcome of posterior nonfusion screw-rod fixation for preserving the atlantoaxial rotary function due to fresh type Ⅱ odontoid fracture. Methods: From January 2010 to July 2011, 8 cases suffering from fresh type Ⅱ odontoid fracture and unsuitable for anterior odontoid screw fixation were included in this study, of them, anterior-inferior to posterior-superior incline fracture line was noted in 5 cases, poor fracture reduction after traction in 3 cases. There were 6 males and 2 females, with an average age of 38 years(range, 21-56 years). Under the general anesthesia, all 8 cases underwent C1-C2 screw-rod fixation without bony graft. When a solid bony union of the dens was confirmed by CT scan, instruments were removed, and the recovery of atlantoaxial rotation function was observed. Results: All 8 cases got an odontoid fracture reduction and a successful posterior C1-C2 screw-rods fixation, and no neurovascular injury was noted. A total of 16 3.5mm diameter screws including 13 pedicle screws and 3 partial trans-pedicle screws was placed in C1; and 16 3.5mm diameter screws including 11 pedicle screws and 5 translaminar screws were placed in C2. All cases were followed up from 12 to 24 months(average, 16 months) after the first stage operation, that all patients had a solid bony fusion on radiographs and CT scans, and the cervical rotation ROM was from 35° to 55°(average, 45°). After the second stage operation, the atlantoaxial rotation ROM partially recovered instantly, with the cervical rotation ROM from 50° to 70°(average 60°), and almost recovered to normal 6 to 12 months later, with the cervical ROM from 80° to 90°(average 85°) finally. Conclusions: For patients with fresh type Ⅱ odontoid fracture and unsuitable for anterior odontoid screw fixation, posterior screw-rod fixation followed by second-stage instruments removing can preserve the C1-2 rotation function.