双孔导管在经皮颈椎前路枢椎齿状突螺钉内固定术中的应用

A novel device of two-hole guide tube for percutaneous anterior odontoid screw fixation

中文关键词:  齿状突骨折  经皮  内固定  微创

英文关键词:Odontoid fracture  Percutaneous  Internal fixation  Minimally invasive

中文摘要:

  【摘要】 目的：探讨双孔导管在经皮颈椎前路枢椎齿状突螺钉内固定术中的应用价值。方法：22例新鲜齿状突骨折患者，男性18例，女性4例，平均年龄40.5±14.7岁，按照Anderson-D′Alonzo分型，17例为Ⅱ型，5例为浅Ⅲ型。骨折端无移位6例，移位小于5mm 10例，移位大于5mm 6例。所有患者均采用经皮颈椎前路枢椎齿状突螺钉内固定，且因术中初始置入的导针位置不满意而采用双孔导管调整。分析该技术的手术时间、出血量、骨折复位、骨折愈合和并发症情况。结果：所有患者的枢椎齿状突导针经过采用双孔导管后均调整成功并置入螺钉，手术时间35±12min，出血<20ml。20例骨折获得基本解剖复位，2例仍有小于3mm移位。术中和术后无明显技术有关的并发症发生，螺钉位置正确。平均随访16.7个月，无寰枢关节不稳或脱位，21例获得骨融合，1例纤维连接，无需佩戴颈围和二次手术，随访中无螺钉松动、脱出或断裂发生。结论：采用双孔导管调整并置入导针，具有操作容易、快速和准确的优点，减少了术者和患者的放射线暴露，保证了齿状突螺钉处于正确位置。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical results of a novel device of two-hole guide tube for percutaneous anterior odontoid screw fixation. Methods: Twenty-two patients(18 males and 4 females) with odontoid fractures were treated by percutaneous anterior odontoid screw fixation with two-hole guide tube under fluoroscopic guidance. Their mean age at presentation was 40.5 years. Seventeen cases were Type Ⅱ and five were shallow Type Ⅲ fracture according to Anderson and D′Alonzo system. No displacement of fracture ending was noted in 6 cases, displacement of less than 5mm in 10 cases, over 5mm in 6 cases. The operation time, blood loss, fracture reduction, bone healing and complications were investigated. Results: The K-wire was confirmed to have a satisfactory angle and position after adjusting the K-wire at an ideal angle and position referring to the first one with the two-hole guide tube. The operation time was 35±12min and the blood loss was less than 20ml. Anatomical reduction of odontoid fractures occurred in 20 patients, and partial reduction in 2 patients. No complications associated with this technique occurred. Satisfactory results were achieved in all patients and all of the screws were in good position. Radiographic osseous union was documented in 21 of 22 patients after a follow-up of 16.7 months, and atlantoaxial stability was found in all patients. Neither clinical symptoms nor screw loosening or breakage occurred. Conclusions: The two-hole guide tube provides percutaneous anterior odontoid screw fixation procedure more feasible, quick and accurate placement of guide K-wire, thus ensures the accurate trajectory of odontoid screw.