寰枢椎内固定对陈旧齿状突骨折的作用

The healing of old odontoidum fractures after rigid internal fixation for atlanto-axial fusion

中文关键词:  齿状突骨折  寰枢关节不稳定  脱位  陈旧性

英文关键词:Odontoid fracture  Atlanto-axial instability  Dislocation  Old

中文摘要:

  【摘要】 目的：观察陈旧齿状突骨折患者在后路寰枢椎坚强内固定融合术后骨折端的变化，探索采用寰枢椎非融合内固定治疗齿状突骨折、尤其是新鲜骨折的可行性。方法：对我院2001年2月~2012年8月采取后路寰枢椎固定融合术治疗的82例陈旧性齿状突骨折患者手术前后的影像资料进行回顾性分析。其中2005年1月~2012年8月42例有完整的术前、术后CT资料可供分析骨折端变化的患者作为研究对象，伤后手术时间3~8周5例、8周以上~36周30例、36周以上7例，40例选择经寰椎侧块-枢椎椎弓根内固定、寰椎后弓枢椎椎板间植骨融合术，2例选择经寰枢侧块关节螺钉固定融合术，术后随访时间截至寰枢间植骨融合为止。结果：所有患者寰枢椎间后方植骨发生融合，其中30例齿状突骨折也发生愈合，4例疑似愈合，8例未愈合。齿状突骨折端愈合时间：28例发生于术后4个月，1例发生于术后6个月，1例发生于术后9个月。结论：对陈旧齿状突骨折患者经后路寰枢椎间内固定可为齿状突骨折愈合提供可靠的稳定性，为采用非融合寰枢椎内固定治疗齿状突骨折尤其是新鲜骨折提供了可靠的临床依据。

英文摘要:

  【Abstract】 Objectives: To investgate the healing result of old odontoid fractures treated with rigid internal fixation and posterior atlanto-axial fusion. Methods: Clinical history, radiographic films, CT and MRI images of 82 consecutive cases with old odontoid fractures were studied retrospectively. 42 patients who had CT scan reconstruction images both before and after operation were taken to confirm the pathological changes in the fracture sites. The cases were operated with posterior internal fixation and fusion respectively in 5 cases at 3-8 weeks, in 30 cases at 8-36 weeks, in 7 cases beyond 36 weeks after injuries. The fixation of C1 lateral mass screw and C2 pedical screw was performed in 40 cases and C1-2 transarticular screw in 2 cases. The following-up was done until the atlanto-axial fusion was completed. Results: The atlanto-axial fusion was completed in all cases. Concurrently the healing of odontoid fractures appeared in 30 among 42 cases. There were 4 suspected healing cases and 8 non-healing cases. The healing time was 4 months for 28 cases, 6 months for 1 case and 9 months for 1 case, respectively. Conclusions: Rigid atlanto-axial fixation is effective and satisfactory for the healing of old odontoid fractures and maybe also indicated to fresh odontoid fractures.