经皮前路枢椎齿状突螺钉内固定术的并发症分析

The complications of percutaneous anterior odontoid screw fixation

中文关键词:  齿状突骨折  内固定  经皮  微创  并发症

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

中文摘要:

  【摘要】 目的：分析经皮前路齿状突螺钉内固定术治疗枢椎齿状突骨折的并发症及相关防治措施。方法：2006年6月~2013年12月共收治新鲜枢椎齿状突骨折患者122例，其中男79例，女43例，年龄28~73岁（45.6±14.8岁）。根据Anderson-D′Alonzo分型，Ⅱ型88例，浅Ⅲ型34例。均采用经皮颈椎前路枢椎齿状突螺钉内固定术。记录手术时间，术中出血量，螺钉松动及断裂，医源性血管、神经及食管损伤和切口感染等情况。术后及随访时行颈椎正侧位、开口位X线片及CT检查评估螺钉位置和骨折愈合情况，并记录并发症处理措施。结果：皮肤切口长约0.8~1cm，手术时间40.7±12.2min，术中出血量<20ml。术中未发生咽后壁、食管、血管和重要神经等邻近组织损伤。共21例患者出现相关并发症，其中3例在置入螺钉过程中产生枢椎前方骨折，1例术中再置入1枚螺钉行双螺钉固定，另2例术后予Halo-Vest架固定治疗后齿状突骨折骨性愈合；1例术后骨折端分离过大，再次行内窥镜下骨折端植骨术而愈合；1例骨折端轻度移位，术后予以支具固定后骨性愈合；9例螺钉钉尾留置过长，但未出现临床症状；1例术后2d出现喉上神经麻痹，经营养神经治疗后恢复正常；1例切口感染，经抗感染治疗后痊愈；2例分别在术后2个月、3个月出现螺钉脱出，均予翻修，1例行前路寰枢关节融合内固定术，另1例行后路寰枢关节融合内固定术；3例纤维连接，齿状突骨折处无移位，内固定无松动，无需佩戴颈围和二次手术。结论：经皮前路齿状突螺钉内固定术是一种方便、安全、微创的手术方式，术后并发症多数经处理后预后良好，整体翻修率低。

英文摘要:

  【Abstract】 Objectives: To analyze the complications and prevention of percutaneous anterior odontoid screw fixation. Methods: 122 patients with fresh odontoid fractures from June 2006 to December 2013 were included in this study, with 79 males and 43 female, the averaged age of 45.6 years. 88 cases were type Ⅱ and 34 cases were shallow type Ⅲ odontoid fractures according to Anderson-D′Alonzo classification. All of the patients underwent the percutaneous anterior odontoid screw fixation. The operation time, blood loss, screw loose or cut off, surround soft tissue(vessels, nerve and esophageal) injury, and wound infection were recorded. Anteroposterior/lateral films and CT scans were obtained at post-operation and follow-up to assess the position of screw and whether achieve bony union. Results: The length of skin wound was about 0.8-1cm, the operation time was 40.7±12.2 minutes, the blood loss was less than 20ml. None of intraoperative posterior pharyngeal wall, esophagus, blood vessels and important nerve and other surround tissue injury were observed. Total of 21 patients with complications were recorded. Three cases had anterior axis fracture when introduce the odontoid screw, for one case, another odontoid screw was added and two other cases were treated with Halo-Vest fixation after operation. One case with enlarged gap of fracture line, additional endoscopic bone graft was performed and achieved fusion. For one case with mild displacement of the fracture line, bony union was achieved with post-operative orthosis. Nine cases had the over long screws but without clinical symptoms, bony fusion was achieved after post-operative cervical orthosis. One case of paralysis of superior laryngeal nerve was recorded two days after surgery and recovered after drug treatment. One case of wound infection was treated by antibiotics. Two cases had screw loose and cut out at 2 and 3 months postoperatively, respectively, secondary surgery of anterior atlantoaxial transarticular screw fixation and posterior atlantoaxial transarticular screw fixation was performed. After followed-up of 36-92 months(average, 57.6±14.9 months), 119/122(97.5%) had bony fusion, three cases of fiber connection, no further prolonged cervical orthosis was used and secondary surgery was performed, and the fracture did not displace and without screw loose. Conclusions: Percutaneous anterior odontoid screw fixation is a feasible, safe and minimally invasive technique. The most complications are mild and with good prognosis after treatment. The rate of complications that needs secondary surgical revision is low.