陈旧性Ⅱ型齿状突骨折的术式选择及治疗效果

Clinical treatment options and results of the old type Ⅱ odontoid fracture

中文关键词:  Ⅱ型齿状突骨折  陈旧性骨折  术式选择  治疗效果

英文关键词:Type Ⅱ odontoid fracture  Old fracture  Treatment options  Clinical results

中文摘要:

  【摘要】 目的：探讨陈旧性Ⅱ型齿状突骨折的临床术式选择及其治疗效果。方法：2010年6月~2015年6月收治77例骨折时间超过3周的陈旧性Ⅱ型齿状突骨折患者，其中男52例，女25例，年龄16~65岁（37.0±14.5岁），根据骨折后时间长短和复位的难易程度，5例患者采用前路单枚中空拉力螺钉固定，6例采用寰枢椎后路钉棒固定非融合，40例采用后路寰枢椎钉棒固定融合，26例采用经口咽前路寰枢椎复位钢板（transoral atlantoaxial reduction plate，TARP）固定融合。采用美国脊髓损伤学会（ASIA）分级及日本骨科学会（JOA）评分对神经功能进行评价，术前ASIA分级D级32例，E级45例；术前JOA评分12.9±2.4分。术后定期复查X线片、CT，评价齿状突骨折愈合、寰枢椎复位、植骨融合情况。结果：77例患者均成功完成手术，术中未发生椎动脉、脊髓损伤。术后颈项部疼痛、四肢麻木及肌力下降等症状均不同程度改善，术前32例ASIA分级为D级的患者中20例术后改善为E级，其余患者分级无变化；术后JOA评分改善至15.2±1.2分，与术前比较差异有统计学意义（t=-12.211，P=0.000）。所有患者均获随访，随访时间3～36个月（27.0±9.6个月），1例前路单枚中空螺钉固定者齿状突骨折呈纤维/瘢痕愈合，4例前路单枚中空螺钉固定及6例寰枢椎后路钉棒临时固定者的齿状突骨折均获复位及骨折端的骨性愈合，40例后路及26例前路固定植骨融合者的寰枢椎脱位均获复位及寰枢椎间的骨性融合。结论：陈旧性Ⅱ型齿状突骨折根据骨折时间及骨折复位情况选择恰当的手术方式，可获得满意的临床治疗效果。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical results and treatment options of the old type Ⅱ odontoid fracture. Methods: From June 2010 to June 2015, 77 patients(mean age, 37.0±14.5 years; range, 16 to 65 years) with old type Ⅱ odontoid fracture, with the time of injury exceeding 3 weeks, including 52 males and 25 females, were treated by cannulated odontoid screw fixation(5 cases), C1-C2 screw-rod fixation(6 nonfusion cases and 40 fusion cases) or transoral atlantoaxial reduction plate(TARP) fixation(26 cases) under general anesthesia according the fracture time period and individual conditions. American Spinal Injury Association(ASIA) and Japanese Orthopaedic Association(JOA) score system were used to evaluate the surgical outcomes. Before operation, 32 patients were in grade D, and 45 cases were in grade E. Preoperative JOA score was 12.9±2.4. Patients were followed up and performed X-ray and CT to investigate the union, reduction and fusion. Results: All operations were successfully performed without neurovascular injury. The incidence of neck pain and extremity anesthesia or asthenia of all cases decreased in different degrees. According to ASIA grading system, 20 cases improved from D to E after surgery, and the other cases remained no change postoperatively. JOA score improved from preoperative 12.9±2.4 to 15.2±1.2 after surgery, the difference had statistical significance(t=-12.211, P=0.000). All cases were followed up with an average time of 27.0±9.6 months (range, 3-36 months). Odontoid fracture of 4 cases with cannulated odontoid screw fixation and 6 cases with screw-rod nonfusion fixation had a reduction and bone union on radiographs, except that 1 case of anterior odontoid screw fixation got a fibrous union. Atlantoaxial dislocation in 66 cases with anterior or posterior fusion fixation attained a reduction and solid bone fusion. Conclusions: The treatment methods of the old type Ⅱ odontoid fracture should be selected according to the fracture time period and individual conditions to acquire satisfying clinical results.